Liabilities and Responsibilities of the Construction Manager for Implementation and Management of the Safety Program.

DTIC Science & Technology

1987-12-01

acting as an agent of the owner, and the owner contracts directly with several prime or trade contractors. There are four different agreements associated...safety precautions and programs in connection with the project or for the construction manager’s obligations as the agent of the owner. AIA A201/CM...require the general contractor to exercise reasonable care for safety of the subcontractor’s employees. Owners and their agents must be careful that

Contingency management adapted for African-American adolescents with obesity enhances youth weight loss with caregiver participation: a multiple baseline pilot study.

PubMed

Hartlieb, Kathryn Brogan; Naar, Sylvie; Ledgerwood, David M; Templin, Thomas N; Ellis, Deborah A; Donohue, Bradley; Cunningham, Phillippe B

2015-12-07

Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents. To examine the effects of CM in improving adolescent weight loss when added to BST. The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health. Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA. Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss. Youth weight. Linear mixed effects modeling was used in the analysis. CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (p<0.001, [95% CI; -1.96, -0.97]) relative to the baseline trajectory. This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.

Clinician-delivered contingency management increases engagement and attendance in drug and alcohol treatment.

PubMed

Fitzsimons, Heather; Tuten, Michelle; Borsuk, Courtney; Lookatch, Samantha; Hanks, Lisa

2015-07-01

This study examined the impact of a low-cost contingency management (CM) delivered by program clinicians on treatment attendance and utilization for patients enrolled in outpatient psychosocial substance abuse treatment. The study used a pre-posttest design to compare substance abuse patients who received Reinforcement-Based Treatment (RBT) plus low cost CM (n=130; RBT+CM) to patients who received RBT only (n=132, RBT). RBT+CM participants received a $10 incentive for returning to treatment the day following intake assessment (day one), and a $15 incentive for attending treatment on day five following admission. RBT clients received standard care intervention without the addition of the CM procedures. Groups were compared on proportion of participants who returned to treatment on day one, mean days of treatment attendance, individual sessions attended, and treatment utilization during the first week and the first month following treatment admission. Both the RBT+CM and RBT group participants returned to the clinic on day one at high rates (95% versus 89%, respectively). However, the RBT group participants were more likely to attend the intake assessment only (i.e., never return to treatment) compared to the RBT+CM participants. Additionally, the RBT+CM participants attended significantly more treatment days, attended more individual counseling sessions, and had higher rates of overall treatment utilization compared to the RBT participants during the one week and one month following treatment admission. Findings support the feasibility and effectiveness of a CM intervention delivered by clinicians for increasing treatment attendance and utilization in a community substance abuse program. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Introducing a High-Risk HPV DNA Test Into a Public Sector Screening Program in El Salvador.

PubMed

Cremer, Miriam L; Maza, Mauricio; Alfaro, Karla M; Kim, Jane J; Ditzian, Lauren R; Villalta, Sofia; Alonzo, Todd A; Felix, Juan C; Castle, Philip E; Gage, Julia C

2016-04-01

In a primary human papillomavirus (HPV) screening program, we compared the 6-month follow-up among colposcopy and noncolposcopy-based management strategies for screen-positive women. Women aged 30 to 49 years were screened with HPV DNA tests using both self-collection and provider collection of samples. Women testing positive received either (1) colposcopy management (CM) consisting of colposcopy and management per local guidelines or (2) screen-and-treat (ST) management using visual inspection with acetic acid to determine cryotherapy eligibility, with eligible women undergoing immediate cryotherapy. One thousand women were recruited in each cohort. Of these, 368 (18.4%) of 2000 women were recruited using a more intensive outreach strategy. Demographics, HPV positivity, and treatment compliance were compared across recruitment and management strategies. More women in the ST cohort received treatment within 6 months compared with those in the CM cohort (117/119 [98.3%] vs 64/93 [68.8%]; p < .001). Women recruited through more intensive outreach were more likely to be HPV positive, lived in urban areas, were more educated, and had higher numbers of lifetime sexual partners and fewer children. Women in the CM arm were less likely to complete care than women in the ST arm. Targeted outreach to underscreened women successfully identified women with higher prevalence of HPV and possibly higher disease burden.

Acceptability of contingency management among clinicians and clients within a co-occurring mental health and substance use treatment program.

PubMed

Srebnik, Debra; Sugar, Andrea; Coblentz, Patrick; McDonell, Michael G; Angelo, Frank; Lowe, Jessica M; Ries, Richard K; Roll, John

2013-01-01

Emerging evidence supports the effectiveness of contingency management (CM) for addictions treatment among individuals with co-occurring serious mental illness (SMI). Addiction treatment for people with SMI generally occurs within community mental health centers (CMHCs) and it is not known whether CM is acceptable within this context. Client views regarding CM are also unknown. This study is the first to describe CM acceptability among CMHC clinicians, and the first to explore client views. Clinician-level predictors of CM acceptability are also examined. This study examined views about CM among 80 clinicians and 29 clients within a CMHC within the context of a concurrent CM study. Three-quarters of clinicians reported they would use CM if funding were available. Clinicians and clients affirmed that incentives enhance abstinence motivation. Clinician CM acceptability was related to greater years of experience, and identifying as an addictions or co-occurring disorders counselor, more than a mental health clinician. The findings provide preliminary evidence that CMHC clinicians, serving clients with addictions and complicating SMI, and client participants in CM, view CM as motivating and a positive tool to facilitate recovery. As an evidence-based intervention, CM warrants further efforts toward funding and dissemination in CMHCs. Copyright © American Academy of Addiction Psychiatry.

The cost and management of different types of clinical mastitis in dairy cows estimated by dynamic programming.

PubMed

Cha, E; Bar, D; Hertl, J A; Tauer, L W; Bennett, G; González, R N; Schukken, Y H; Welcome, F L; Gröhn, Y T

2011-09-01

The objective of this study was to estimate the cost of 3 different types of clinical mastitis (CM) (caused by gram-positive bacteria, gram-negative bacteria, and other organisms) at the individual cow level and thereby identify the economically optimal management decision for each type of mastitis. We made modifications to an existing dynamic optimization and simulation model, studying the effects of various factors (incidence of CM, milk loss, pregnancy rate, and treatment cost) on the cost of different types of CM. The average costs per case (US$) of gram-positive, gram-negative, and other CM were $133.73, $211.03, and $95.31, respectively. This model provided a more informed decision-making process in CM management for optimal economic profitability and determined that 93.1% of gram-positive CM cases, 93.1% of gram-negative CM cases, and 94.6% of other CM cases should be treated. The main contributor to the total cost per case was treatment cost for gram-positive CM (51.5% of the total cost per case), milk loss for gram-negative CM (72.4%), and treatment cost for other CM (49.2%). The model affords versatility as it allows for parameters such as production costs, economic values, and disease frequencies to be altered. Therefore, cost estimates are the direct outcome of the farm-specific parameters entered into the model. Thus, this model can provide farmers economically optimal guidelines specific to their individual cows suffering from different types of CM. Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Configuration and Data Management Process and the System Safety Professional

NASA Technical Reports Server (NTRS)

Shivers, Charles Herbert; Parker, Nelson C. (Technical Monitor)

2001-01-01

This article presents a discussion of the configuration management (CM) and the Data Management (DM) functions and provides a perspective of the importance of configuration and data management processes to the success of system safety activities. The article addresses the basic requirements of configuration and data management generally based on NASA configuration and data management policies and practices, although the concepts are likely to represent processes of any public or private organization's well-designed configuration and data management program.

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

Edema index-guided disease management improves 6-month outcomes of patients with acute heart failure.

PubMed

Liu, Min-Hui; Wang, Chao-Hung; Huang, Yu-Yen; Tung, Tao-Hsin; Lee, Chii-Ming; Yang, Ning-I; Wang, Jong-Shyan; Kuo, Li-Tang; Cherng, Wen-Jin

2012-01-01

The efficacy of heart failure (HF) management programs is compromised by the challenge of early identification of patients at imminent risk. Segmental multifrequency bioelectrical impedance analysis can generate an "edema index" (EI) as a surrogate for the body fluid status. In this study, we tested whether integration of EI-guided management improved the 6-month outcomes of HF patients under multidisciplinary care. In total, 159 patients with acute HF were randomized into control, case management (CM), and EI-guided CM (EI) groups (n = 53 in each group). In the EI group, a management algorithm was designed based on the measured EI. The analyzed endpoints included HF-related and all cause-related events during the 6-month follow-up period. In the 6 months, there were 11 (6.9%) deaths, 19 (11.9%) HF-related rehospitalizations, and 45 (28.3%) all-cause-related rehospitalizations. Compared to the control (26.4%) and CM groups (15.1%), the EI group had a lower rate of HF-related death and rehospitalization (3.8%, P = 0.004). Multivariate analysis revealed that EI-guided management was an independent predictor of a lower HF-related event rate (hazard ratio = 0.15, 95%CI = 0.03~0.66, P = 0.012). Patients with a higher pre-discharge EI were older, had lower blood albumin and hemoglobin levels, and had a higher functional class and incidences of diabetes mellitus and chronic kidney disease. An increase in the pre-discharge EI by 0.001 increased the HF-related event rate by 6% (P = 0.002). Use of EI-guided management lowered this risk (P = 0.03). In conclusion, an EI-based HF management program demonstrated an event-lowering effect superior to traditional nurse-led multidisciplinary care in 6 months after an acute HF episode.

Cooking Matters for Adults Improves Food Resource Management Skills and Self-confidence Among Low-Income Participants.

PubMed

Pooler, Jennifer A; Morgan, Ruth E; Wong, Karen; Wilkin, Margaret K; Blitstein, Jonathan L

Determine the impact of Cooking Matters for Adults (CM) on food resource management (FRM) skills and self-confidence 6 months after course completion. Quasi-experimental design with nonequivalent comparison group and 6-month follow-up. Cooking Matters for Adults programs in CA, CO, ME, MA, MI, and OR. Participants in CM attending classes in April to July, 2016 (n = 332); comparison group (n = 336). Cooking Matters for Adults educated low-income adults to shop for and prepare healthy meals economically using hands-on meal preparation, facilitated discussion, and an interactive grocery store tour. Classes met for 2 hours, once a week for 6 weeks. Food resource management practices; FRM self-confidence (ie, in shopping for and preparing healthy foods on a budget); worrying that food might run out. Pearson's chi-square test and t tests identified measures associated with outcomes of interest and between-group differences. Repeated-measures linear mixed models with fixed and random effects were used to examine differences in outcomes between participants in CM and nonequivalent comparison group and to estimate the treatment effect of the program at 3 and 6 months after course completion. Six months after course completion, CM participants demonstrated improvements in all outcome measures of interest: Use of FRM practices improved (P = .002) as did FRM confidence (P < .001). Participants also worried less that food would run out before they had money to buy more (P = .03). This study demonstrated a positive impact of including FRM skills and confidence building in a nutrition education program, the effects of which could be seen for 6 months after participation in the program. Equipping low-income families with FRM skills allowed them to access healthier foods even during times of hardship. Copyright © 2017 Society for Nutrition Education and Behavior. All rights reserved.

Quality assurance planning for lunar Mars exploration

NASA Technical Reports Server (NTRS)

Myers, Kay

1991-01-01

A review is presented of the tools and techniques required to meet the challenge of total quality in the goal of traveling to Mars and returning to the moon. One program used by NASA to ensure the integrity of baselined requirements documents is configuration management (CM). CM is defined as an integrated management process that documents and identifies the functional and physical characteristics of a facility's systems, structures, computer software, and components. It also ensures that changes to these characteristics are properly assessed, developed, approved, implemented, verified, recorded, and incorporated into the facility's documentation. Three principal areas are discussed that will realize significant efficiencies and enhanced effectiveness, change assessment, change avoidance, and requirements management.

Adapting the helpful responses questionnaire to assess communication skills involved in delivering contingency management: preliminary psychometrics.

PubMed

Hartzler, Bryan

2015-08-01

A paper/pencil instrument, adapted from Miller and colleagues' (1991) Helpful Responses Questionnaire (HRQ), was developed to assess clinician skill with core communicative aspects involved in delivering contingency management (CM). The instrument presents a single vignette consisting of six points of client dialogue to which respondents write 'what they would say next.' In the context of an implementation/effectiveness hybrid trial, 19 staff clinicians at an opiate treatment program completed serial training outcome assessments before, following, and three months after CM training. Assessments included this adaptation of the HRQ, a multiple-choice CM knowledge test, and a recorded standardized patient encounter scored for CM skillfulness. Study results reveal promising psychometric properties for the instrument, including strong scoring reliability, internal consistency, concurrent and predictive validity, test-retest reliability and sensitivity to training effects. These preliminary findings suggest the instrument is a viable, practical method to assess clinician skill in communicative aspects of CM delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

An Effectiveness Trial of Contingency Management in a Felony Preadjudication Drug Court

ERIC Educational Resources Information Center

Marlowe, Douglas B.; Festinger, David S.; Dugosh, Karen L.; Arabia, Patricia L.; Kirby, Kimberly C.

2008-01-01

This study evaluated a contingency management (CM) program in a drug court. Gift certificates for compliance were delivered at 4- to 6-week intervals (total value = $390.00). Participants in one condition earned gift certificates that escalated by $5.00 increments. Participants in a second condition began earning higher magnitude gift…

Outpatient case management in low-income epilepsy patients.

PubMed

Tatum, William O; Al-Saadi, Sam; Orth, Thomas L

2008-12-01

Case management (CM) has been shown to improve the medical care of patients in several paradigms of general medicine. This study was undertaken to assess the impact of CM on low-income patients with epilepsy. From 2002 to 2003, 737 epilepsy patients had CM provided by a non-profit, state-supported, epilepsy service subserving a four county region in southeastern Florida. Standardized survey forms distributed by the Florida Department of Health were completed by 159 consecutive patients at program admission. Follow-up information regarding seizure frequency, antiepileptic drugs, and quality of life self-rating was performed after 1 year of CM. The patients evaluated were composed of 58.5% men, with a mean age of 41.0 years. After CM, an increase in self-reported seizure control was seen in 40.2% of patients (p<0.0001, Fisher's exact test), in addition to a shift in the principal utilization of the older to the newer antiepileptic drugs. Furthermore, the total number of emergency department (ED) visits was reduced by 90% with a mean reduction of ED visits per patient from 1.83 per patient per year before CM to 0.14 per patient per year after CM (p<0.0001, Wilcoxon matched-pairs test). Following CM, fewer patients reported difficulty with friends, employers, problems socializing, and feelings of anger (p<0.05, Fisher's exact test). CM of low-income patients with epilepsy resulted in self-reported improvement in seizure control, QoL, and significantly reduced ED visitation. CM in epilepsy is feasible and represents a cost-effective improvement in outpatient epilepsy management.

Income Levels and Response to Contingency Management for Smoking Cessation.

PubMed

López-Núñez, Carla; Secades-Villa, Roberto; Peña-Suárez, Elsa; Fernández-Artamendi, Sergio; Weidberg, Sara

2017-06-07

Contingency management (CM) has demonstrated its efficacy in treating many drug addictions, including nicotine. However, one of the most commonly perceived limitations with regard to its dissemination into community settings is whether this protocol could be equally effective for treating patients across different income levels. This study aimed to examine whether individuals' income levels affect treatment success in a cognitive behavioral treatment (CBT) that included a voucher-based CM protocol for smoking cessation. A total of 92 treatment-seeking smokers in a community setting were randomly assigned to a CBT group (N = 49) or to a CBT plus CM group (N = 43). The CM procedure included a voucher program through which smoking abstinence was reinforced on a schedule of escalating magnitude of reinforcement with a reset contingency. We analyzed the impact of self-reported monthly income, alone and in combination with treatment condition, on short-term (treatment retention) and long-term (self-reported number of days of continuous smoking abstinence at 6-month follow-up) results. Income had no effect on treatment retention and continuous abstinence outcomes at 6-month follow-up in either treatment condition. Treatment modality emerged as the only significant predictor of treatment success. Our findings suggest that treatment-seeking smokers from the general population respond equally well to CM regardless of their income levels. The results of this randomized controlled trial support the generalizability of this evidenced-based program into community settings.

[Psychiatric case management. Chronic Disease Management application experience in a public Mental Health Service].

PubMed

Pompili, Enrico; Silvestrini, Cristiana; Nicolò, Giuseppe; Pitino, Annalisa; Bernabei, Laura

2014-01-01

Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient. Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study. Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study. There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

Where do we go from here? Interim analysis to forge ahead in violence prevention.

PubMed

Dicker, Rochelle A; Jaeger, Sebastian; Knudson, Mary M; Mackersie, Robert C; Morabito, Diane J; Antezana, Javier; Texada, Michael

2009-12-01

The severity and disparity of interpersonal violent injury is staggering. Fifty-three per 100,000 African Americans (AA) die of homicide yearly, 20 per 100,000 in Latinos, whereas the rate is 3 per 100,000 in Caucasians. With the ultimate goal of reducing injury recidivism, which now stands at 35% to 50%, we have designed and implemented a hospital-based, case-managed violence prevention program uniquely applicable to trauma centers. The Wraparound Project (WP) seizes the "teachable moment" after injury to implement culturally competent case management (CM) and shepherd clients through risk reduction resources with city and community partners. The purpose of this study was to perform a detailed intermediate evaluation of this multi-modal violence prevention program. We hypothesized that this evaluation would demonstrate feasibility and early programmatic efficacy. We looked to identify areas of programmatic weakness that, if corrected, could strengthen the project and enhance its effectiveness. We performed intermediate evaluation on the 18-month-old program. We selected the Centers for Disease Control and Prevention-recommended instrument used for unintentional injury prevention programs and applied it to the WP. The four sequential stages in this methodology are formative, process, impact, and outcome. To test feasibility of WP, we used process evaluation. To evaluate intermediate goals of risk reduction and early efficacy, we used impact evaluation. Four hundred thirty-five people met screening criteria. The two case managers were able to make contact and screen 73% of gun shot victims, and 57% of stab wound victims. Of those not seen, 48% were in the hospital for 6 h/wk with the client. Forty-one percent of the time, they spent 3 hours to 6 hours. Seventeen of 18 people who required >6 hours had two to three needs. Attrition rate is only 4%. The table demonstrates percent success thus far in providing risk reduction resources. WP case managers served high-risk clients by developing trust, credibility, and a risk reduction plan. Cultural competency has been vital. Six of seven major needs were successfully addressed at least 50% of the time. The value of reporting these results has led WP to gain credibility with municipal stakeholders, who have now agreed to fund a third CM position. Intermediate evaluation provided a framework in our effort to achieve the ultimate goal of reducing recidivism through culturally competent CM and risk factor modification.

Medicaid care management: description of high-cost addictions treatment clients.

PubMed

Neighbors, Charles J; Sun, Yi; Yerneni, Rajeev; Tesiny, Ed; Burke, Constance; Bardsley, Leland; McDonald, Rebecca; Morgenstern, Jon

2013-09-01

High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals <90th percentile of AODTx expenditures (n=41,054); high-cost clients in the top decile of AODTx expenditures (HC; n=5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals. Copyright © 2013 Elsevier Inc. All rights reserved.

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

U.S. Army Research Institute 1983 Annual Report

DTIC Science & Technology

1983-10-01

Olllc») v TYPE OF REPORT a PERIOD COVERED Annual; TY 1983 6 PERFORMING ORG. REPORT NUMBER 6. CONTRACT OR GRANT NUMBERf«) 10. PROGRAM ELEMENT...AtTWACT tCmSm mm nrmam «M» W nmommmr —ä Idomlllr br Mock mnkw; An overview of the FY83 research program la presented in terms of these five research...awards, in-house publication«, professional publications and pres- entations, FY83 program management (mission, the core program , the three component

Obesity Cardiometabolic Comorbidity Prevalence in Children in a Rural Weight-Management Program.

PubMed

O'Hara, Valerie; Browne, Nancy; Fathima, Samreen; Sorondo, Barbara; Bayleran, Janet; Johnston, Starr; Hastey, Kathrin

2017-01-01

This descriptive study examines the prevalence of obesity-related cardiometabolic (CM) risk factors using CM laboratory metrics, in 3 to 19 year olds presenting to a rural American Academy of Pediatrics stage 3 multidisciplinary weight management clinic based on gender, age ranges, and obesity classes. From 2009 to 2016, 382 children (body mass index ≥85th percentile) enrolled. Multiple logistic regression determined the effects of age, gender, or obesity class on CM risk factors. Odds of elevated insulin were more significant in 15 to 19 year olds than in 3 to 5 year olds, or in 6 to 11 year olds. Obesity class III had higher odds than class II, class I, and overweight in having elevated insulin; twice likely than class II for having low high-density lipoprotein; and twice as likely than class I for high triglycerides. Adolescents and obesity class III categories have significant CM risk but the burden in younger and less severe obesity cohorts cannot be underestimated.

A Randomized Trial of Contingency Management for Smoking Cessation During Intensive Outpatient Alcohol Treatment.

PubMed

Cooney, Judith L; Cooper, Sharon; Grant, Christoffer; Sevarino, Kevin; Krishnan-Sarin, Suchitra; Gutierrez, Ian A; Cooney, Ned L

2017-01-01

This randomized clinical trial was designed to evaluate the efficacy of contingency management (CM) for smoking cessation for smokers with alcohol abuse or dependence delivered concurrently with intensive outpatient alcohol treatment. The study also explored the indirect effects of CM smoking treatment and smoking cessation on alcohol and drug use outcomes. Alcohol abuse/dependent smokers were randomized to cognitive behavioral therapy plus nicotine replacement therapy plus contingency management (CBT+NRT+CM) or to cognitive behavior therapy plus nicotine replacement therapy (CBT+NRT) delivered concurrent with a three-week intensive outpatient alcohol treatment program. Participants in the CBT+NRT+CM condition were significantly more likely to be cigarette abstinent at the end of treatment (χ 2 (1)=8.48, p=.004) with approximately double the carbon monoxide confirmed quit rate (60%) compared with the CBT+NRT condition (29%). At the one-month and six-month time-points there were nonsignificant differences in smoking abstinence outcomes by condition. Smoking treatment condition did not directly affect alcohol abstinence outcomes, but we observed an indirect effect of smoking treatment on alcohol and drug abstinence at one-month follow-up that was mediated by smoking cessation at the end of treatment. Adding CM to an evidence-based smoking cessation treatment that included medication and behavioral counseling doubled the quit rate at the end of treatment. This finding provides strong evidence for the efficacy of CM for helping alcohol dependent smokers reach the milestone of initial smoking abstinence. Published by Elsevier Inc.

Cost-effective way to reduce stimulant-abuse among gay/bisexual men and transgender women: a randomized clinical trial with a cost comparison.

PubMed

Zhang, S X; Shoptaw, S; Reback, C J; Yadav, K; Nyamathi, A M

2018-01-01

A randomized controlled study was conducted with 422 homeless, stimulant-using gay/bisexual (G/B) men and 29 transgender women (n = 451) to assess two community-based interventions to reduce substance abuse and improve health: (a) a nurse case-managed program combined with contingency management (NCM + CM) versus (b) standard education plus contingency management (SE + CM). Hypotheses tested included: a) completion of hepatitis A/B vaccination series; b) reduction in stimulant use; and c) reduction in number of sexual partners. A deconstructive cost analysis approach was utilized to capture direct costs associated with the delivery of both interventions. Based on an analysis of activity logs and staff interviews, specific activities and the time required to complete each were analyzed as follows: a) NCM + CM only; b) SE + CM only; c) time to administer/record vaccines; and d) time to receive and record CM visits. Cost comparison of the interventions included only staffing costs and direct cash expenditures. The study outcomes showed significant over time reductions in all measures of drug use and multiple sex partners, compared to baseline, although no significant between-group differences were detected. Cost analysis favored the simpler SE + CM intervention over the more labor-intensive NCM + CM approach. Because of the high levels of staffing required for the NCM relative to SE, costs associated with it were significantly higher. Findings suggest that while both intervention strategies were equally effective in achieving desired health outcomes, the brief SE + CM appeared less expensive to deliver. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Experiment module concepts study. Volume 5 book 1, appendix A: Shuttle only task

NASA Technical Reports Server (NTRS)

1970-01-01

Results of a preliminary investigation of the effect on the candidate experiment program implementation of experiment module operations in the absence of an orbiting space station and with the availability of the space shuttle orbiter vehicle only are presented. The fundamental hardware elements for shuttle-only operation of the program are: (1) integrated common experiment modules CM-1, CM-3, and CM-4, together with the propulsion slice; (2) support modules capable of supplying on-orbit crew life support, power, data management, and other services normally provided by a space station; (3) dormancy kits to enable normally attached modules to remain in orbit while shuttle returns to earth; and (4) shuttle orbiter. Preliminary cost estimates for 30 day on-orbit and 5 day on-orbit capabilities for a four year implementation period are $4.2 billion and $2.1 billion, respectively.

In-home behavioral health case management: an integrated model for high-risk populations.

PubMed

Theis, Gerald A; Kozlowski, Deirdre; Behrens, Jenna

2006-01-01

The escalating health care costs attributed to high-risk populations have fueled a need for a proactive approach to deal with people affected by complex mental health issues that often coexist with chronic medical conditions. Through an in-home behavioral health case management (CM) program, patients with mental illnesses (some with coexisting medical conditions) receive integrated medical and mental health services through a disease-management approach that has proven effective in treating high-risk patients.

The indigenous Somba cattle of the hilly Atacora region in North-West Benin: threats and opportunities for its sustainable use.

PubMed

Dossa, Luc Hippolyte; Vanvanhossou, Fridaïus Ulrich Sèyi

2016-02-01

The objective of this study was to characterize the declining Somba cattle population in its production system context. Two-hundred-twenty-four (224) cattle farm-households were surveyed in the Boukombe district, the natural habitat of the breed in North-West Benin. Information on their socioeconomic characteristics and on their herd management practices were recorded using a semi-structured questionnaire. In addition, 15 body measurements were recorded from 102 adult cattle. Three types of breeders were distinguished: the owners-herders (54.0 %); the absentee owners (40.2 %) and the professional herders (5.8 %). The average cattle herd sizes were 4.7 ± 3.70 and 58.6 ± 22.83 heads for owner-managed and entrusted herds, respectively. Offtakes were more associated with sociocultural purposes (75.5 %) than market. While crop farming was the main occupation and income source of their owners, the Somba cattle were used for ploughing during the rainy season. In contrast to the widely accepted belief that this indigenous genetic resource is mainly threatened by crossbreeding and/or replacement, our findings suggest high mortalities due to diseases, feed and water shortages and poor reproduction management as the main causes of the decline of this cattle population. Somba cattle generally have short horns and a small body size. However, bulls have significantly (P ≤ 0.05) longer horns (21.2 ± 16.44 cm against 13.9 ± 7.21 cm), higher height at withers (99.7 ± 6.97 cm against 95.9 ± 5.76 cm) and body length (149.7 ± 12.87 cm against 146.8 ± 11.01 cm) than cows. All surveyed farmers expressed their willingness and readiness to participate in and contribute materially or financially to any program towards a sustainable use and preservation of this breed which they perceived as hardy and embedded in their culture. We therefore argue that strategies for its sustainable use and conservation should consist of simultaneously improving general herd management practices, organizing farmers and involving them in participatory breed improvement programs.

Primary Care-Mental Health Integration in the Veterans Affairs Health System: Program Characteristics and Performance.

PubMed

Cornwell, Brittany L; Brockmann, Laurie M; Lasky, Elaine C; Mach, Jennifer; McCarthy, John F

2018-06-01

The Veterans Health Administration (VHA) has achieved substantial national implementation of primary care-mental health integration (PC-MHI) services. However, little is known regarding program characteristics, variation in characteristics across settings, or associations between program fidelity and performance. This study identified core elements of PC-MHI services and evaluated their associations with program characteristics and performance. A principal-components analysis (PCA) of reports from 349 sites identified factors associated with PC-MHI fidelity. Analyses assessed the correlation among factors and between each factor and facility type (medical center or community-based outpatient clinic), primary care population size, and performance indicators (receipt of PC-MHI services, same-day access to mental health and primary care services, and extended duration of services). PCA identified seven factors: core implementation, care management (CM) assessments and supervision, CM supervision receipt, colocated collaborative care (CCC) by prescribing providers, CCC by behavioral health providers, participation in patient aligned care teams (PACTs) for special populations, and treatment of complex mental health conditions. Sites serving larger populations had greater core implementation scores. Medical centers and sites serving larger populations had greater scores for CCC by prescribing providers, CM assessments and supervision, and participation in PACTs. Greater core implementation scores were associated with greater same-day access. Sites with greater scores for CM assessments and supervision had lower scores for treatment of complex conditions. Outpatient clinics and sites serving smaller populations experienced challenges in integrated care implementation. To enhance same-day access, VHA should continue to prioritize PC-MHI implementation. Providing brief, problem-focused care may enhance CM implementation.

Optimizing national immunization program supply chain management in Thailand: an economic analysis.

PubMed

Riewpaiboon, A; Sooksriwong, C; Chaiyakunapruk, N; Tharmaphornpilas, P; Techathawat, S; Rookkapan, K; Rasdjarmrearnsook, A; Suraratdecha, C

2015-07-01

This study aimed to conduct an economic analysis of the transition of the conventional vaccine supply and logistics systems to the vendor managed inventory (VMI) system in Thailand. Cost analysis of health care program. An ingredients based approach was used to design the survey and collect data for an economic analysis of the immunization supply and logistics systems covering procurement, storage and distribution of vaccines from the central level to the lowest level of vaccine administration facility. Costs were presented in 2010 US dollar. The total cost of the vaccination program including cost of vaccine procured and logistics under the conventional system was US$0.60 per packed volume procured (cm(3)) and US$1.35 per dose procured compared to US$0.66 per packed volume procured (cm(3)) and US$1.43 per dose procured under the VMI system. However, the findings revealed that the transition to the VMI system and outsourcing of the supply chain system reduced the cost of immunization program at US$6.6 million per year because of reduction of un-opened vaccine wastage. The findings demonstrated that the new supply chain system would result in efficiency improvement and potential savings to the immunization program compared to the conventional system. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Closing the Knowledge Gap: Effects of Land Use Conversion on Belowground Carbon near the 100th Meridian

NASA Astrophysics Data System (ADS)

Waldron, S. E.; Phillips, R. L.; Dell, R.; Suddick, E. C.

2012-12-01

Native prairie of the northern Great Plains near the 100th meridian is currently under land use conversion pressure due to high commodity prices. From 2002 to 2007, approximately 303,515 hectares of prairie were converted to crop production in the Prairie Pothole Region (PPR) from Montana to the Dakotas. The spatiotemporal effects of land-use conversion on soil organic matter are still unclear for the PPR. Effects will vary with management, soil properties and time, making regional experiments and simulation modeling necessary. Grassland conservationists are interested in soil carbon data and soil carbon simulation models to inform potential voluntary carbon credit programs. These programs require quantification of changes in soil carbon associated with land-use conversion and management. We addressed this issue by 1) designing a regional-scale experiment, 2) collecting and analyzing soil data, and 3) interviewing producers about land management practices, as required for regional, process-based biogeochemical models. We selected farms at random within a 29,000 km2 area of interest and measured soil properties at multiple depths for native prairie and adjacent annual crop fields. The cores were processed at six different depths (between 0 and 100 cm) for bulk density, pH, texture, total carbon, inorganic carbon, and total nitrogen. We found that the largest difference in soil organic carbon occurred at the 0-10 cm depth, but the magnitude of the effect of land use varied with soil properties and land management. Results from this project, coupled with regional model simulations (Denitrification-Decomposition, DNDC) represent the baseline data needed for future voluntary carbon credit programs and long-term carbon monitoring networks. Enrollment in such programs could help ranchers and farmers realize a new income stream from maintaining their native prairie and the carbon stored beneath it.

Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador.

PubMed

Cremer, Miriam; Maza, Mauricio; Alfaro, Karla; Morales Velado, Mario; Felix, Juan; Castle, Philip E; Kim, Jane; Gage, Julia C

2017-01-01

The Cervical Cancer Prevention in El Salvador is a demonstration project to introduce a lower-cost human papillomavirus (HPV)-DNA test into a public sector project. Started in October 2012, The Cervical Cancer Prevention in El Salvador consists of 3 phases and will ultimately screen 30,000 women. Results of phase 2 of the project are presented. The objective of this project was to compare colposcopy and noncolposcopy-based management for HPV-positive women. In phase 2, a total of 8,050 women, aged 30 to 49 years, were screened; 6,761 provided both self- and provider-collected specimens and 1,289 provided only provider-testing specimens. HPV results from self-collected specimens were not used in clinical management decisions. Women with provider-collected HPV-positive results were treated based on the strategy assigned to their community; the strategy was colposcopy management (CM) or screen-and-treat (ST) management if they were cryotherapy eligible or colposcopy if not eligible. Outcomes were assessed 6 months after screening. Overall, 489 (12.3%) of 3,963 women receiving CM and 465 (11.4%) of 4,087 women receiving ST tested HPV positive. In the CM cohort, 216 (44.2%) of 489 completed their intervention (203 treated, 11 diagnosed negative, 2 pregnant). In the ST cohort, 411 (88.4%) of 465 completed their intervention (407 treated, 2 diagnosed negative, 1 pregnant). Overall agreement between HPV test results from self-collected and provider-collected specimens was 93.7%, with a κ value of 0.70 (95% CI = 0.68-0.73). Human papillomavirus testing with ST management resulted in an approximately twice completion rate compared with CM management. Agreement between self- and provider-based sampling was good and might be used to extend screening to women in areas that are more difficult to reach.

A Markov decision process for managing habitat for Florida scrub-jays

USGS Publications Warehouse

Johnson, Fred A.; Breininger, David R.; Duncan, Brean W.; Nichols, James D.; Runge, Michael C.; Williams, B. Ken

2011-01-01

Florida scrub-jays Aphelocoma coerulescens are listed as threatened under the Endangered Species Act due to loss and degradation of scrub habitat. This study concerned the development of an optimal strategy for the restoration and management of scrub habitat at Merritt Island National Wildlife Refuge, which contains one of the few remaining large populations of scrub-jays in Florida. There are documented differences in the reproductive and survival rates of scrubjays among discrete classes of scrub height (<120 cm or "short"; 120-170 cm or "optimal"; .170 cm or "tall"; and a combination of tall and optimal or "mixed"), and our objective was to calculate a state-dependent management strategy that would maximize the long-term growth rate of the resident scrub-jay population. We used aerial imagery with multistate Markov models to estimate annual transition probabilities among the four scrub-height classes under three possible management actions: scrub restoration (mechanical cutting followed by burning), a prescribed burn, or no intervention. A strategy prescribing the optimal management action for management units exhibiting different proportions of scrub-height classes was derived using dynamic programming. Scrub restoration was the optimal management action only in units dominated by mixed and tall scrub, and burning tended to be the optimal action for intermediate levels of short scrub. The optimal action was to do nothing when the amount of short scrub was greater than 30%, because short scrub mostly transitions to optimal height scrub (i.e., that state with the highest demographic success of scrub-jays) in the absence of intervention. Monte Carlo simulation of the optimal policy suggested that some form of management would be required every year. We note, however, that estimates of scrub-height transition probabilities were subject to several sources of uncertainty, and so we explored the management implications of alternative sets of transition probabilities. Generally, our analysis demonstrated the difficulty of managing for a species that requires midsuccessional habitat, and suggests that innovative management tools may be needed to help ensure the persistence of scrub-jays at Merritt Island National Wildlife Refuge. The development of a tailored monitoring program as a component of adaptive management could help reduce uncertainty about controlled and uncontrolled variation in transition probabilities of scrub-height and thus lead to improved decision making.

Impacts of Center of Mass Shifts on Messenger Spacecraft Operations

NASA Technical Reports Server (NTRS)

O'Shaughnessy, D. J.; Vaughan, R. M.; Chouinard, T. L., III; Jaekle, D. E.

2007-01-01

The MESSENGER (MErcury Surface, Space ENvironment, GEochemistry, and Ranging) has successfully completed its first three years of flight operations following launch on August 3, 2004. As part of NASA s Discovery Program, MESSENGER will observe Mercury during flybys in 2008 and 2009, as well as from orbit beginning in March 2011. This paper discusses the impact that center of mass (CM) location changes have had on many mission activities, particularly angular momentum management and maneuver execution. Momentum trends were altered significantly following the first deep-space maneuver, and these changes were related to a change in the CM. The CM location also impacts maneuver execution, and uncertainties in its location led to the significant direction errors experienced at trajectory correction maneuver 11. Because of the spacecraft sensitivity to CM location, efforts to estimate its position are important to momentum and maneuver prediction. This paper summarizes efforts to estimate the CM from flight data, as well as the operational strategy to handle CM uncertainties and their impact on momentum trends and maneuver execution accuracy.

From decentralization to commonization of HIV healthcare resources: keys to reduction in health disparity and equitable distribution of health services in Nigeria.

PubMed

Oleribe, Obinna Ositadimma; Oladipo, Olabisi Abiodun; Ezieme, Iheaka Paul; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

2016-01-01

Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities. This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes.

Parent training plus contingency management for substance abusing families: A Complier Average Causal Effects (CACE) analysis*

PubMed Central

Stanger, Catherine; Ryan, Stacy R.; Fu, Hongyun; Budney, Alan J.

2011-01-01

Background Children of substance abusers are at risk for behavioral/emotional problems. To improve outcomes for these children, we developed and tested an intervention that integrated a novel contingency management (CM) program designed to enhance compliance with an empirically-validated parent training curriculum. CM provided incentives for daily monitoring of parenting and child behavior, completion of home practice assignments, and session attendance. Methods Forty-seven mothers with substance abuse or dependence were randomly assigned to parent training + incentives (PTI) or parent training without incentives (PT). Children were 55% male, ages 2-7 years. Results Homework completion and session attendance did not differ between PTI and PT mothers, but PTI mothers had higher rates of daily monitoring. PTI children had larger reductions in child externalizing problems in all models. Complier Average Causal Effects (CACE) analyses showed additional significant effects of PTI on child internalizing problems, parent problems and parenting. These effects were not significant in standard Intent-to-Treat analyses. Conclusion Results suggest our incentive program may offer a method for boosting outcomes. PMID:21466925

Coding for effective denial management.

PubMed

Miller, Jackie; Lineberry, Joe

2004-01-01

Nearly everyone will agree that accurate and consistent coding of diagnoses and procedures is the cornerstone for operating a compliant practice. The CPT or HCPCS procedure code tells the payor what service was performed and also (in most cases) determines the amount of payment. The ICD-9-CM diagnosis code, on the other hand, tells the payor why the service was performed. If the diagnosis code does not meet the payor's criteria for medical necessity, all payment for the service will be denied. Implementation of an effective denial management program can help "stop the bleeding." Denial management is a comprehensive process that works in two ways. First, it evaluates the cause of denials and takes steps to prevent them. Second, denial management creates specific procedures for refiling or appealing claims that are initially denied. Accurate, consistent and compliant coding is key to both of these functions. The process of proactively managing claim denials also reveals a practice's administrative strengths and weaknesses, enabling radiology business managers to streamline processes, eliminate duplicated efforts and shift a larger proportion of the staff's focus from paperwork to servicing patients--all of which are sure to enhance operations and improve practice management and office morale. Accurate coding requires a program of ongoing training and education in both CPT and ICD-9-CM coding. Radiology business managers must make education a top priority for their coding staff. Front office staff, technologists and radiologists should also be familiar with the types of information needed for accurate coding. A good staff training program will also cover the proper use of Advance Beneficiary Notices (ABNs). Registration and coding staff should understand how to determine whether the patient's clinical history meets criteria for Medicare coverage, and how to administer an ABN if the exam is likely to be denied. Staff should also understand the restrictions on use of ABNs and the compliance risks associated with improper use. Finally, training programs should include routine audits to monitor coders for competence and precision. Constantly changing codes and guidelines mean that a coder's skills can quickly become obsolete if not reinforced by ongoing training and monitoring. Comprehensive reporting and routine analysis of claim denials is without a doubt one of the greatest assets to a practice that is suffering from excessive claim denials and should be considered an investment capable of providing both short and long term ROIs. Some radiologists may lack the funding or human resources needed to implement truly effective coding programs for their staff members. In these circumstances, radiology business managers should consider outsourcing their coding.

Project Management Meets Change Management - A Success Story. Focus Area: Tech Perspectives TI012SN

NASA Technical Reports Server (NTRS)

Hall, Wayne

2011-01-01

Utilizing the concepts and terminology from Project Management, the process of planning and executing a Change Management (CM) Infrastructure improvement project is described. The primary audience for this presentation includes both experienced and relatively new CM administrators and their managers. It also includes anyone with an interest in the application of project management knowledge to CM administration. There are several benefits: the complexity of the CM tool technology is more manageable, CM administrators get to use project management knowledge to complete a project (not "firefighting"), improve relations with your customers (that means developers and managers), and get the opportunity to do it again.

Utilization of Local Law Enforcement Aerial Resources in Consequence Management (CM) Response

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

Wasiolek, Piotr T.; Malchow, Russell L.

2013-03-12

During the past decade the U.S. Department of Homeland Security (DHS) was instrumental in enhancing the nation’s ability to detect and prevent a radiological or nuclear attack in the highest risk cities. Under the DHS Securing the Cities initiative, nearly 13,000 personnel in the New York City region have been trained in preventive radiological and nuclear detection operations, and nearly 8,500 pieces of radiological detection equipment have been funded. As part of the preventive radiological/nuclear detection (PRND) mission, several cities have received funding to purchase commercial aerial radiation detection systems. In 2008, the U.S. Department of Energy, National Nuclear Securitymore » Administration Aerial Measuring System (AMS) program started providing Mobile Aerial Radiological Surveillance (MARS) training to such assets, resulting in over 150 HAZMAT teams’ officers and pilots from 10 law enforcement organizations and fire departments being trained in the aerial radiation detection. From the beginning, the MARS training course covered both the PRND and consequence management (CM) missions. Even if the law enforcement main focus is PRND, their aerial assets can be utilized in the collection of initial radiation data for post-event radiological CM response. Based on over 50 years of AMS operational experience and information collected during MARS training, this presentation will focus on the concepts of CM response using aerial assets as well as utilizing law enforcement/fire department aerial assets in CM. Also discussed will be the need for establishing closer relationships between local jurisdictions’ aerial radiation detection capabilities and state and local radiation control program directors, radiological health department managers, etc. During radiological events these individuals may become primary experts/advisers to Incident Commanders for radiological emergency response, especially in the early stages of a response. The knowledge of the existence, specific capabilities, and use of local aerial radiation detection systems would be critical in planning the response, even before federal assets arrive on the scene. The relationship between local and federal aerial assets and the potential role for the further use of the MARS training and expanded AMS Reachback capabilities in facilitating such interactions will be discussed.« less

Balancing Materiel Readiness Risks and Concurrency in Weapon System Acquisition: A Handbook for Program Managers

DTIC Science & Technology

1984-07-15

ftViCCii UWNC COMMAND MIX CM AFT DCP OUTUNC moo ffEOUCST FOR PROGRAM DECISION DRAFT DCP AFSC REVIEW RECOWMEM CATIONS OHI*OC Arse wioc...CS.P3 F16. El*. P» MCA Exhibit 4-6b. EMBEDDED COMPUTER HARDWARE vs. SOFTWARE Exhibit 4-6c. DoD EMBEDDED COMPUTER MARKET 31.J1...the mix of stores carried by that vehicle 6. Anticipated combat tactics employed by the carrying or launching vehicle and its maneuvering

Finding harmony so the music plays on: pragmatic trial design considerations to promote organizational sustainment of an empirically-supported behavior therapy.

PubMed

Hartzler, Bryan; Peavy, K Michelle; Jackson, T Ron; Carney, Molly

2016-01-22

Pragmatic trials of empirically-supported behavior therapies may inform clinical and policy decisions concerning therapy sustainment. This retrospective trial design paper describes and discusses pragmatic features of a hybrid type III implementation/effectiveness trial of a contingency management (CM) intervention at an opioid treatment program. Prior reporting (Hartzler et al., J Subst Abuse Treat 46:429-438, 2014; Hartzler, Subst Abuse Treat Prev Policy 10:30, 2015) notes success in recruiting program staff for voluntary participation, durable impacts of CM training on staff-level outcomes, provisional setting implementation of the intervention, documentation of clinical effectiveness, and post-trial sustainment of CM. Six pragmatic design features, and both scientific and practical bases for their inclusion in the trial, are presented: (1) a collaborative intervention design process, (2) voluntary recruitment of program staff for therapy training and implementation, (3) serial training outcome assessments, with quasi-experimental staff randomization to either single or multiple baseline assessment conditions, (4) designation of a 90-day period immediately after training in which the setting implemented the intervention on a provisional basis, (5) inclusive patient eligibility for receipt of the CM intervention, and (6) designation of two staff as local implementation leaders to oversee clinical/administrative issues in provisional implementation. Each pragmatic trial design feature is argued to have contributed to sustainment of CM. Contributions implicate the building of setting proprietorship for the CM intervention, culling of internal staff expertise in its delivery, iterative use of assessment methods that limited setting burden, documentation of setting-specific clinical effectiveness, expanded penetration of CM among staff during provisional implementation, and promotion of setting self-reliance in the oversight of sustainable implementation procedures. It is hoped this discussion offers ideas for how to impact local clinical and policy decisions via effective behavior therapy dissemination.

Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador

PubMed Central

Cremer, Miriam; Maza, Mauricio; Alfaro, Karla; Morales Velado, Mario; Felix, Juan; Castle, Philip E.; Kim, Jane; Gage, Julia C.

2017-01-01

Objective The Cervical Cancer Prevention in El Salvador is a demonstration project to introduce a lower-cost human papillomavirus (HPV)-DNA test into a public sector project. Started in October 2012, The Cervical Cancer Prevention in El Salvador consists of 3 phases and will ultimately screen 30,000 women. Results of phase 2 of the project are presented. The objective of this project was to compare colposcopy and noncolposcopy-based management for HPV-positive women. Material and Methods In phase 2, a total of 8,050 women, aged 30 to 49 years, were screened; 6,761 provided both self- and provider-collected specimens and 1,289 provided only provider-testing specimens. HPV results from self-collected specimens were not used in clinical management decisions. Women with provider-collected HPV-positive results were treated based on the strategy assigned to their community; the strategy was colposcopy management (CM) or screen-and-treat (ST) management if they were cryotherapy eligible or colposcopy if not eligible. Outcomes were assessed 6 months after screening. Results Overall, 489 (12.3%) of 3,963 women receiving CM and 465 (11.4%) of 4,087 women receiving ST tested HPV positive. In the CM cohort, 216 (44.2%) of 489 completed their intervention (203 treated, 11 diagnosed negative, 2 pregnant). In the ST cohort, 411 (88.4%) of 465 completed their intervention (407 treated, 2 diagnosed negative, 1 pregnant). Overall agreement between HPV test results from self-collected and provider-collected specimens was 93.7%, with a κ value of 0.70 (95% CI = 0.68–0.73). Conclusions Human papillomavirus testing with ST management resulted in an approximately twice completion rate compared with CM management. Agreement between self- and provider-based sampling was good and might be used to extend screening to women in areas that are more difficult to reach. PMID:27922905

Error Analysis of CM Data Products Sources of Uncertainty

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

Hunt, Brian D.; Eckert-Gallup, Aubrey Celia; Cochran, Lainy Dromgoole

This goal of this project is to address the current inability to assess the overall error and uncertainty of data products developed and distributed by DOE’s Consequence Management (CM) Program. This is a widely recognized shortfall, the resolution of which would provide a great deal of value and defensibility to the analysis results, data products, and the decision making process that follows this work. A global approach to this problem is necessary because multiple sources of error and uncertainty contribute to the ultimate production of CM data products. Therefore, this project will require collaboration with subject matter experts across amore » wide range of FRMAC skill sets in order to quantify the types of uncertainty that each area of the CM process might contain and to understand how variations in these uncertainty sources contribute to the aggregated uncertainty present in CM data products. The ultimate goal of this project is to quantify the confidence level of CM products to ensure that appropriate public and worker protections decisions are supported by defensible analysis.« less

Satellite Estimation of Fractional Cover in Several California Specialty Crops

NASA Technical Reports Server (NTRS)

Johnson, Lee; Cahn, Michael; Rosevelt, Carolyn; Guzman, Alberto; Farrara, Barry; Melton, Forrest S.

2016-01-01

Past research in California and elsewhere has revealed strong relationships between satellite NDVI, photosynthetically active vegetation fraction (Fc), and crop evapotranspiration (ETc). Estimation of ETc can support efficiency of irrigation practice, which enhances water security and may mitigate nitrate leaching. The U.C. Cooperative Extension previously developed the CropManage (CM) web application for evaluation of crop water requirement and irrigation scheduling for several high-value specialty crops. CM currently uses empirical equations to predict daily Fc as a function of crop type, planting date and expected harvest date. The Fc prediction is transformed to fraction of reference ET and combined with reference data from the California Irrigation Management Information System to estimate daily ETc. In the current study, atmospherically-corrected Landsat NDVI data were compared with in-situ Fc estimates on several crops in the Salinas Valley during 2011-2014. The satellite data were observed on day of ground collection or were linearly interpolated across no more than an 8-day revisit period. Results will be presented for lettuce, spinach, celery, broccoli, cauliflower, cabbage, peppers, and strawberry. An application programming interface (API) allows CM and other clients to automatically retrieve NDVI and associated data from NASA's Satellite Irrigation Management Support (SIMS) web service. The SIMS API allows for queries both by individual points or user-defined polygons, and provides data for individual days or annual timeseries. Updates to the CM web app will convert these NDVI data to Fc on a crop-specific basis. The satellite observations are expected to play a support role in Salinas Valley, and may eventually serve as a primary data source as CM is extended to crop systems or regions where Fc is less predictable.

Satellite Estimation of Fractional Cover in Several California Specialty Crops

NASA Astrophysics Data System (ADS)

Johnson, L.; Cahn, M.; Rosevelt, C.; Guzman, A.; Lockhart, T.; Farrara, B.; Melton, F. S.

2016-12-01

Past research in California and elsewhere has revealed strong relationships between satellite NDVI, photosynthetically active vegetation fraction (Fc), and crop evapotranspiration (ETc). Estimation of ETc can support efficiency of irrigation practice, which enhances water security and may mitigate nitrate leaching. The U.C. Cooperative Extension previously developed the CropManage (CM) web application for evaluation of crop water requirement and irrigation scheduling for several high-value specialty crops. CM currently uses empirical equations to predict daily Fc as a function of crop type, planting date and expected harvest date. The Fc prediction is transformed to fraction of reference ET and combined with reference data from the California Irrigation Management Information System to estimate daily ETc. In the current study, atmospherically-corrected Landsat NDVI data were compared with in-situ Fc estimates on several crops in the Salinas Valley during 2011-2014. The satellite data were observed on day of ground collection or were linearly interpolated across no more than an 8-day revisit period. Results will be presented for lettuce, spinach, celery, broccoli, cauliflower, cabbage, peppers, and strawberry. An application programming interface (API) allows CM and other clients to automatically retrieve NDVI and associated data from NASA's Satellite Irrigation Management Support (SIMS) web service. The SIMS API allows for queries both by individual points or user-defined polygons, and provides data for individual days or annual timeseries. Updates to the CM web app will convert these NDVI data to Fc on a crop-specific basis. The satellite observations are expected to play a support role in Salinas Valley, and may eventually serve as a primary data source as CM is extended to crop systems or regions where Fc is less predictable.

Factors associated with contingency management adoption among opioid treatment providers receiving a comprehensive implementation strategy.

PubMed

Becker, Sara J; Kelly, Lourah M; Kang, Augustine W; Escobar, Katherine I; Squires, Daniel D

2018-03-29

Contingency management (CM) is an evidence-based behavioral intervention for opioid use disorders (OUDs); however, CM adoption in OUD treatment centers remains low due to barriers at patient, provider, and organizational levels. In a recent trial, OUD treatment providers who received the Science to Service Laboratory (SSL), a multilevel implementation strategy developed by a federally funded addiction training center, had significantly greater odds of CM adoption than providers who received training as usual. This study examined whether CM adoption frequency varied as a function of provider sociodemographic characteristics (i.e., age, race/ethnicity, licensure) and perceived barriers to adoption (i.e., patient-, provider-, organization-level) among providers receiving the SSL in an opioid treatment program. Thirty-nine providers (67% female, 77% non-Hispanic white, 72% with specialty licensure, M age = 42 [SD = 11.46]) received the SSL, which consisted of didactic training, performance feedback, specialized training of internal change champions, and external coaching. Providers completed a comprehensive baseline assessment and reported on their adoption of CM biweekly for 52 weeks. Providers reported using CM an average of nine 2-week intervals (SD = 6.35). Hierarchical multiple regression found that providers identifying as younger, non-Hispanic white, and without addiction-related licensure all had higher levels of CM adoption frequency. Higher perceived patient-level barriers predicted lower levels of CM adoption frequency, whereas provider- and organization-level barriers were not significant predictors. The significant effect of age on CM adoption frequency was consistent with prior research on predictors of evidence-based practice adoption, whereas the effect of licensure was counter to prior research. The finding that CM adoption frequency was lower among racially/ethnically diverse providers was not expected and suggests that the SSL may require adaptation to meet the needs of diverse opioid treatment providers. Entities using the SSL may also wish to incorporate a more explicit focus on patient-level barriers.

AFCOMS (Air Force Commissary Service): Does this SOA Need an Executive Development Program?

DTIC Science & Technology

1985-03-01

ll)NALHuKAU U STADARS 19,l liii I0 󈧽 AAfR WAR COLLG RESEARCH REPORT LZ? e lNo. AU-AWC-35-011 - N4 AFCOMS: DOES THIS SQA NEED AN EXECUTIVE cm...high incidence of safety and physical security violations. Serious deficiencies existed in the financial management area. Accounting errors were not

Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer Over a Decade: How Many Surgeries and Complications Can Be Avoided?

PubMed

Griffin, Andrew; Brito, Juan P; Bahl, Manisha; Hoang, Jenny K

2017-04-01

The 2015 American Thyroid Association guidelines acknowledged that "an active surveillance management approach can be considered as an alternative to immediate surgery" in patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to determine the proportion of PTC that would meet the criteria for active surveillance and the surgeries and complications that could have been avoided. A total of 681 patients with thyroid cancer who underwent thyroid surgery from 2003 to 2012 were retrospectively reviewed. A decision-making framework for active surveillance was applied to patients with PTC in nodules measuring ≤1.5 cm on ultrasound. Patients were identified as suitable for active surveillance based on imaging and patient characteristics. These patients were reviewed for management and outcomes. PTC was diagnosed based on fine-needle aspiration histology of Bethesda V or VI in thyroid nodules in 243 patients. Of these, 77 patients had nodules measuring ≤1.5 cm on ultrasound, and 56/77 (23%) patients met the criteria for surveillance: 15/243 (6%) patients met the criteria with a ≤1 cm size threshold, and 41/243 (17%) met the criteria with a 1.1-1.5 cm threshold. Of the 56 patients who met the criteria for active surveillance, 52 underwent total thyroidectomy, and four had a lobectomy. Forty-five (80%) patients had elective central nodal dissection, and 14 had nodal metastases on pathology (all <4 mm). Three patients had permanent complications from surgery, including vocal cord paralysis, hypoparathyroidism, and a chipped tooth from intubation. No patients died or had recurrent disease. Future programs in the United States should consider increasing the size threshold for active surveillance of PTC to 1.5 cm, since this will allow up to one quarter of patients to be eligible instead of only 6% with a 1 cm size threshold. Without an active surveillance program, the majority of patients with low-risk cancers have thyroidectomy and carry a small risk of permanent complications.

Assessment of Ocean Wave Model used to Analyze the Constellation Program (CxP) Orion Project Crew Module Water Landing Conditions

NASA Technical Reports Server (NTRS)

Smith, Bryan K.; Bouchard, Richard; Teng, Chung-Chu; Dyson, Rodger; Jenson, Robert; OReilly, William; Rogers, Erick; Wang, David; Volovoi, Vitali

2009-01-01

Mr. Christopher Johnson, NASA's Systems Manager for the Orion Project Crew Module (CM) Landing and Recovery at the Johnson Space Center (JSC), and Mr. James Corliss, Project Engineer for the Orion CM Landing System Advanced Development Project at the Langley Research Center (LaRC) requested an independent assessment of the wave model that was developed to analyze the CM water landing conditions. A NASA Engineering and Safety Center (NESC) initial evaluation was approved November 20, 2008. Mr. Bryan Smith, NESC Chief Engineer at the NASA Glenn Research Center (GRC), was selected to lead this assessment. The Assessment Plan was presented and approved by the NESC Review Board (NRB) on December 18, 2008. The Assessment Report was presented to the NRB on March 12, 2009. This document is the final Assessment Report.

Soil and Crop management: Lessons from the laboratory biosphere 2002-2004

NASA Astrophysics Data System (ADS)

Silverstone, S.; Nelson, M.; Alling, A.; Allen, J.

During the years 2002 and 2003, three closed system experiments were carried out in the "Laboratory Biosphere" facility located in Santa Fe, New Mexico. The program involved experimentation with "Hoyt" Soy Beans, USU Apogee Wheat and TU-82-155 sweet potato using a 5.37 m2 soil planting bed which was 30 cm deep. The soil texture, 40% clay, 31% sand and 28% silt (a clay loam), was collected from an organic farm in New Mexico to avoid chemical residues. Soil management practices involved minimal tillage, mulching and returning crop residues to the soil after each experiment. Between experiment #2 and #3, the top 15 cm of the soil was amended using a mix of peat moss, green sand, humates and pumice to improve soil texture, lower soil pH and increase nutrient availability. Soil analyses for all three experiments are presented to show how the soils have changed with time and how the changes relate to crop selection and rotation, soil selection and management, water management and pest control. The experience and information gained from these experiments are being applied to the future design of the Mars On Earth facility.

Tank waste remediation system configuration management plan

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

Vann, J.M.

The configuration management program for the Tank Waste Remediation System (TWRS) Project Mission supports management of the project baseline by providing the mechanisms to identify, document, and control the functional and physical characteristics of the products. This document is one of the tools used to develop and control the mission and work. It is an integrated approach for control of technical, cost, schedule, and administrative information necessary to manage the configurations for the TWRS Project Mission. Configuration management focuses on five principal activities: configuration management system management, configuration identification, configuration status accounting, change control, and configuration management assessments. TWRS Projectmore » personnel must execute work in a controlled fashion. Work must be performed by verbatim use of authorized and released technical information and documentation. Application of configuration management will be consistently applied across all TWRS Project activities and assessed accordingly. The Project Hanford Management Contract (PHMC) configuration management requirements are prescribed in HNF-MP-013, Configuration Management Plan (FDH 1997a). This TWRS Configuration Management Plan (CMP) implements those requirements and supersedes the Tank Waste Remediation System Configuration Management Program Plan described in Vann, 1996. HNF-SD-WM-CM-014, Tank Waste Remediation System Configuration Management Implementation Plan (Vann, 1997) will be revised to implement the requirements of this plan. This plan provides the responsibilities, actions and tools necessary to implement the requirements as defined in the above referenced documents.« less

Reducing the Risk of Cardiovascular Diseases in Non-selected Outpatients With Schizophrenia: A 30-Month Program Conducted in a Real-life Setting.

PubMed

Hjorth, Peter; Juel, Anette; Hansen, Mette Vinther; Madsen, Nikolaj Juul; Viuff, Anne Grethe; Munk-Jørgensen, Povl

2017-12-01

The most common cause of premature death in people with schizophrenia is cardiovascular disease, partially explained by an unhealthy lifestyle, smoking, poor diet and sedentary behavior. We aimed to reduce cardiovascular risk factors. Naturalistic follow-up study with 54 long-term-treated non-selected outpatients with schizophrenia. The 30-month program consisted of individual guidance, group sessions and normal treatment and care offered in our clinic. On average, the participating women reduced their waist circumference by 11.4cm (P=0.037), whereas the participating men increased their waist circumference by 3.3cm (P=0.590). Patients' consumption of fast food was reduced from 1.2 to 0.8 times/week (P=0.016), just as their consumption of soft drinks was reduced from 0.7 to 0.1l/day (P=0.006). Their consumption of coffee increased from 1.6 to 2.5 cups/day (P=0.086). The time women spent on light physical activity increased from 134 to 469min/week (P=0.055). The number of daily cigarettes smoked was reduced by 25.7% for all smokers. Our program showed that it is possible for women but not for men to reduce their risk factors for developing cardiovascular disease. The program is manageable in most outpatient clinics and can be performed by nursing staff interested in physical health with support from and in cooperation with medical doctors, psychiatrist and leaders/managers. Copyright © 2017 Elsevier Inc. All rights reserved.

Spend today, clean tomorrow: Predicting methamphetamine abstinence in a randomized controlled trial

PubMed Central

Murtaugh, Kimberly Ling; Krishnamurti, Tamar; Davis, Alexander L.; Reback, Cathy J.; Shoptaw, Steven

2013-01-01

Objective This secondary analysis of data from a randomized controlled trial tested two behavioral economics mechanisms (substitutability and delay discounting) to explain outcomes using contingency management (CM) for methamphetamine dependence. Frequency and purchase type (hedonic/utilitarian and consumable/durable) of CM payments were also examined. Methods 82 methamphetamine-dependent gay/bisexual men randomly assigned to conditions delivering CM received monetary vouchers in exchange for stimulant-negative urine samples in a 16-week trial requiring thrice weekly visits (Shoptaw et al., 2005). At any visit participants could redeem vouchers for goods. A time-lagged counting process Cox Proportional Hazards model for recurrent event survival analysis examined aspects of the frequency and type of these CM purchases. Results After controlling for severity of baseline methamphetamine use and accumulated CM wealth, as measured by cumulative successful earning days, participants who redeemed CM earnings at any visit (“spenders”) were significantly more likely to produce stimulant-negative urine samples in the subsequent visit, compared to those who did not redeem (“savers”) 1.011* [1.005, 1.017], Z=3.43, p<0.001. Conclusions Findings support the economic concept of substitutability of CM purchases and explain trial outcomes as a function of frequency of CM purchases rather than frequency or accumulated total CM earnings. Promotion of frequent purchases in incentive-based programs should facilitate substitution for the perceived value of methamphetamine and improve abstinence outcomes. PMID:24001246

'Work it out': evaluation of a chronic condition self-management program for urban Aboriginal and Torres Strait Islander people, with or at risk of cardiovascular disease.

PubMed

Mills, Kyly; Gatton, Michelle L; Mahoney, Ray; Nelson, Alison

2017-09-26

Chronic diseases disproportionately burden Aboriginal and Torres Strait Islander people in Australia, with cardiovascular (CV) diseases being the greatest contributor. To improve quality of life and life expectancy for people living with CV disease, secondary prevention strategies such as rehabilitation and self-management programs are critical. However, there is no published evidence examining the effect of chronic condition self-management (CCSM) group programs for Aboriginal and Torres Strait Islander people who have, or are at risk of, CV disease specifically. This study evaluates the Work It Out program for its effect on clinical outcome measures in urban Aboriginal and Torres Strait Islander participants with or at risk of CV disease. This study was underpinned by a conceptual framework based on Aboriginal and Torres Strait Islander community control. Participants had at least one diagnosed CV disease, or at least one CV disease risk factor. Short-term changes in clinical outcome measures over (approximately) 12 weeks were evaluated with a quasi-experimental, pre-post test design, using paired t-tests. Factors contributing to positive changes were tested using general linear models. The outcome measures included blood pressure (mmHg), weight (kg), body mass index (kg/m 2 ), waist and hip circumference (cm), waist to hip ratio (waist cm/hip cm) and six minute walk test (6MWT). Changes in several clinical outcome measures were detected, either within the entire group (n = 85) or within specific participant sub-groups. Participant's 6MWT distance improved by an average 0.053 km (95% CI: 0.01-0.07 km). The change in distance travelled was influenced by number of social and emotional wellbeing conditions participants presented with. The weight of participants classified with extreme obesity decreased on average by 1.6 kg (95% CI: 0.1-3.0 kg). Participants with high baseline systolic blood pressure demonstrated a mean decrease of 11 mmHg (95% CI: 3.2-18.8 mmHg). Change in blood pressure was influenced by the number of cardiovascular conditions participants experienced. Short-term improvements seen in some measures could indicate a trend for improvement in other indicators over the longer term. These results suggest the Work It Out program could be a useful model for cardiovascular rehabilitation and prevention for other urban Aboriginal and Torres Strait Islander populations.

Sojourner Rover View of Shark and Half Dome

NASA Technical Reports Server (NTRS)

1997-01-01

The rounded knobs (arrows) up to 3 or 4 cm wide on Shark (left; approximately 70 cm wide)) and Half Dome (upper right) and in the foreground could be pebbles in a cemented matrix of clays, silts, and sands; such rocks are called conglomerates. Well-rounded objects like these were not seen at the Viking sites.

NOTE: original caption as published in Science Magazine.

Mars Pathfinder is the second in NASA's Discovery program of low-cost spacecraft with highly focused science goals. The Jet Propulsion Laboratory, Pasadena, CA, developed and manages the Mars Pathfinder mission for NASA's Office of Space Science, Washington, D.C. JPL is a division of the California Institute of Technology (Caltech).

Rationale, design and pilot feasibility results of a smartphone-assisted, mindfulness-based intervention for smokers with mood disorders: Project mSMART MIND.

PubMed

Minami, Haruka; Brinkman, Hannah R; Nahvi, Shadi; Arnsten, Julia H; Rivera-Mindt, Monica; Wetter, David W; Bloom, Erika Litvin; Price, Lawrence H; Vieira, Carlos; Donnelly, Remington; McClain, Lauren M; Kennedy, Katherine A; D'Aquila, Erica; Fine, Micki; McCarthy, Danielle E; Graham Thomas, J; Hecht, Jacki; Brown, Richard A

2018-03-01

Although individuals with psychiatric disorders are disproportionately affected by cigarette smoking, few outpatient mental health treatment facilities offer smoking cessation services. In this paper, we describe the development of a smartphone-assisted mindfulness smoking cessation intervention with contingency management (SMI-CM), as well as the design and methods of an ongoing pilot randomized controlled trial (RCT) targeting smokers receiving outpatient psychiatric treatment. We also report the results of an open-label pilot feasibility study. In phase 1, we developed and pilot-tested SMI-CM, which includes a smartphone intervention app that prompts participants to practice mindfulness, complete ecological momentary assessment (EMA) reports 5 times per day, and submit carbon monoxide (CO) videos twice per day. Participants earned incentives if submitted videos showed CO≤6ppm. In phase 2, smokers receiving outpatient treatment for mood disorders are randomized to receive SMI-CM or enhanced standard treatment plus non-contingent CM (EST). The results from the pilot feasibility study (N=8) showed that participants practiced mindfulness an average of 3.4times/day (≥3min), completed 72.3% of prompted EMA reports, and submitted 68.0% of requested CO videos. Participants reported that the program was helpful overall (M=4.85/5) and that daily mindfulness practice was helpful for both managing mood and quitting smoking (Ms=4.50/5). The results from the feasibility study indicated high levels of acceptability and satisfaction with SMI-CM. The ongoing RCT will allow evaluation of the efficacy and mechanisms of action underlying SMI-CM for improving cessation rates among smokers with mood disorders. Copyright © 2017 Elsevier Inc. All rights reserved.

Farm-by-farm analysis of microsatellite, mtDNA and SNP genotype data reveals inbreeding and crossbreeding as threats to the survival of a native Spanish pig breed.

PubMed

Herrero-Medrano, J M; Megens, H J; Crooijmans, R P; Abellaneda, J M; Ramis, G

2013-06-01

The Chato Murciano (CM), a pig breed from the Murcia region in the southeastern region of Spain, is a good model for endangered livestock populations. The remaining populations are bred on approximately 15 small farms, and no herdbook exists. To assess the genetic threats to the integrity and survival of the CM breed, and to aid in designing a conservation program, three genetic marker systems - microsatellites, SNPs and mtDNA - were applied across the majority of the total breeding stock. In addition, mtDNA and SNPs were genotyped in breeds that likely contributed genetically to the current CM gene pool. The analyses revealed the levels of genetic diversity within the range of other European local breeds (H(e) = 0.53). However, when the eight farms that rear at least 10 CM pigs were independently analyzed, high levels of inbreeding were found in some. Despite the evidence for recent crossbreeding with commercial breeds on a few farms, the entire breeding stock remains readily identifiable as CM, facilitating the design of traceability assays. The genetic management of the breed is consistent with farm size, farm owner and presence of other pig breeds on the farm, demonstrating the highly ad hoc nature of current CM breeding. The results of genetic diversity and substructure of the entire breed, as well as admixture and crossbreeding obtained in the present study, provide a benchmark to develop future conservation strategies. Furthermore, this study demonstrates that identifying farm-based practices and farm-based breeding stocks can aid in the design of a sustainable breeding program for minority breeds. © 2012 The Authors, Animal Genetics © 2012 Stichting International Foundation for Animal Genetics.

The acceptability and feasibility of the Positive Reinforcement Opportunity Project, a community-based contingency management methamphetamine treatment program for gay and bisexual men in San Francisco.

PubMed

Strona, Frank V; McCright, Jacque; Hjord, Hanna; Ahrens, Katherine; Tierney, Steven; Shoptaw, Steven; Klausner, Jeffrey D

2006-11-01

The Positive Reinforcement Opportunity Project (PROP) was a pilot program developed to build on the efficacy of contingency management (CM) using positive reinforcement to address the treatment needs of gay and bisexual men currently using crystal methamphetamines (meth). It was hypothesized that a version of CM could be implemented in San Francisco that was less costly than traditional treatment methods and reached gay and other MSM using meth who also engaged in high-risk sexual activity. Of the 178 men who participated in PROPfrom December 2003 to December 2005, many self-reported behaviors for acquiring and spreading sexually transmitted diseases including HIV infection. During the initial intake, 73% reported high-risk sexual behavior in the prior three months, with 60% reporting anal receptive and/or insertive sex without condoms. This report describes the implementation of PROP and suggest both its limitations and potential strengths. Initial findings suggest that PROP was a useful and low cost substance use treatment option that resulted in a 35% 90-day completion rate, which is similar to graduation rates from traditional, more costly treatment options. Further evaluation of the limited data from three- and six-month follow-up of those who completed PROP is currently ongoing.

Risk Management Implementation Tool

NASA Technical Reports Server (NTRS)

Wright, Shayla L.

2004-01-01

Continuous Risk Management (CM) is a software engineering practice with processes, methods, and tools for managing risk in a project. It provides a controlled environment for practical decision making, in order to assess continually what could go wrong, determine which risk are important to deal with, implement strategies to deal with those risk and assure the measure effectiveness of the implemented strategies. Continuous Risk Management provides many training workshops and courses to teach the staff how to implement risk management to their various experiments and projects. The steps of the CRM process are identification, analysis, planning, tracking, and control. These steps and the various methods and tools that go along with them, identification, and dealing with risk is clear-cut. The office that I worked in was the Risk Management Office (RMO). The RMO at NASA works hard to uphold NASA s mission of exploration and advancement of scientific knowledge and technology by defining and reducing program risk. The RMO is one of the divisions that fall under the Safety and Assurance Directorate (SAAD). I worked under Cynthia Calhoun, Flight Software Systems Engineer. My task was to develop a help screen for the Continuous Risk Management Implementation Tool (RMIT). The Risk Management Implementation Tool will be used by many NASA managers to identify, analyze, track, control, and communicate risks in their programs and projects. The RMIT will provide a means for NASA to continuously assess risks. The goals and purposes for this tool is to provide a simple means to manage risks, be used by program and project managers throughout NASA for managing risk, and to take an aggressive approach to advertise and advocate the use of RMIT at each NASA center.

Developing and testing evidence-based weight management in Australian pharmacies: A Healthier Life Program.

PubMed

Um, Irene S; Krass, Ines; Armour, Carol; Gill, Timothy; Chaar, Betty B

2015-10-01

Pharmacies represent a valuable opportunity to deliver weight management services, rather than just the routine supply of weight-loss products. In order to provide optimal services and translation of evidence-based weight management in community pharmacy, a best practice model program was designed and pilot tested to facilitate implementation of such services in pharmacies in Australia. To develop and pilot a pharmacist-delivered, evidence-based, non-product-centred weight management service for community pharmacy in Australia. Setting Sydney, New South Wales, Australia. A pharmacy-based weight management service called the A Healthier Life Program (AHLP), for overweight and obese individuals, was developed based on current Australian weight management guidelines and recommendations made by key stakeholders. The pharmacist undertook training to acquire specific competencies to deliver the program. The AHLP involved six individual face-to-face sessions with the pharmacist over 3 months. The intervention targeted three areas: diet, physical activity and behavioural change. Weight, BMI, waist circumference, blood pressure, dietary intake, and physical activity levels at 3 months were compared with values at baseline. Qualitative feedback on participants' satisfaction and willingness to pay were also analysed. Eight pharmacies provided the AHLP between February and December 2013. Thirty-four participants were enrolled in the AHLP; mean age 50.7 years (SD 15.7) and mean BMI 34.3 kg/m(2) (SD 5.3). Of the 22 (65%) participants who completed the program, six had achieved the target weight loss of ≥5%. The mean change in weight was -3.5 kg (95% CI -4.8, -2.2) and waist circumference -2.0 cm (95% CI -2.8, -1.3) for program completers at 3 months. Furthermore, participants reported overall positive experiences of the program, and identified accessibility of the pharmacy and high comfort level with the pharmacist, as the major advantages. The AHLP was well received and participants achieved targeted weight loss. This study demonstrated that an evidence-based patient-centred weight management program can be implemented in Australian pharmacies.

Effects of Including Misidentified Sharks in Life History Analyses: A Case Study on the Grey Reef Shark Carcharhinus amblyrhynchos from Papua New Guinea

PubMed Central

Smart, Jonathan J.; Chin, Andrew; Baje, Leontine; Green, Madeline E.; Appleyard, Sharon A.; Tobin, Andrew J.; Simpfendorfer, Colin A.; White, William T.

2016-01-01

Fisheries observer programs are used around the world to collect crucial information and samples that inform fisheries management. However, observer error may misidentify similar-looking shark species. This raises questions about the level of error that species misidentifications could introduce to estimates of species’ life history parameters. This study addressed these questions using the Grey Reef Shark Carcharhinus amblyrhynchos as a case study. Observer misidentification rates were quantified by validating species identifications using diagnostic photographs taken on board supplemented with DNA barcoding. Length-at-age and maturity ogive analyses were then estimated and compared with and without the misidentified individuals. Vertebrae were retained from a total of 155 sharks identified by observers as C. amblyrhynchos. However, 22 (14%) of these were sharks were misidentified by the observers and were subsequently re-identified based on photographs and/or DNA barcoding. Of the 22 individuals misidentified as C. amblyrhynchos, 16 (73%) were detected using photographs and a further 6 via genetic validation. If misidentified individuals had been included, substantial error would have been introduced to both the length-at-age and the maturity estimates. Thus validating the species identification, increased the accuracy of estimated life history parameters for C. amblyrhynchos. From the corrected sample a multi-model inference approach was used to estimate growth for C. amblyrhynchos using three candidate models. The model averaged length-at-age parameters for C. amblyrhynchos with the sexes combined were  L¯∞ = 159 cm TL and  L¯0 = 72 cm TL. Females mature at a greater length (l50 = 136 cm TL) and older age (A50 = 9.1 years) than males (l50 = 123 cm TL; A50 = 5.9 years). The inclusion of techniques to reduce misidentification in observer programs will improve the results of life history studies and ultimately improve management through the use of more accurate data for assessments. PMID:27058734

Effects of Including Misidentified Sharks in Life History Analyses: A Case Study on the Grey Reef Shark Carcharhinus amblyrhynchos from Papua New Guinea.

PubMed

Smart, Jonathan J; Chin, Andrew; Baje, Leontine; Green, Madeline E; Appleyard, Sharon A; Tobin, Andrew J; Simpfendorfer, Colin A; White, William T

2016-01-01

Fisheries observer programs are used around the world to collect crucial information and samples that inform fisheries management. However, observer error may misidentify similar-looking shark species. This raises questions about the level of error that species misidentifications could introduce to estimates of species' life history parameters. This study addressed these questions using the Grey Reef Shark Carcharhinus amblyrhynchos as a case study. Observer misidentification rates were quantified by validating species identifications using diagnostic photographs taken on board supplemented with DNA barcoding. Length-at-age and maturity ogive analyses were then estimated and compared with and without the misidentified individuals. Vertebrae were retained from a total of 155 sharks identified by observers as C. amblyrhynchos. However, 22 (14%) of these were sharks were misidentified by the observers and were subsequently re-identified based on photographs and/or DNA barcoding. Of the 22 individuals misidentified as C. amblyrhynchos, 16 (73%) were detected using photographs and a further 6 via genetic validation. If misidentified individuals had been included, substantial error would have been introduced to both the length-at-age and the maturity estimates. Thus validating the species identification, increased the accuracy of estimated life history parameters for C. amblyrhynchos. From the corrected sample a multi-model inference approach was used to estimate growth for C. amblyrhynchos using three candidate models. The model averaged length-at-age parameters for C. amblyrhynchos with the sexes combined were L∞ = 159 cm TL and L0 = 72 cm TL. Females mature at a greater length (l50 = 136 cm TL) and older age (A50 = 9.1 years) than males (l50 = 123 cm TL; A50 = 5.9 years). The inclusion of techniques to reduce misidentification in observer programs will improve the results of life history studies and ultimately improve management through the use of more accurate data for assessments.

Community opioid treatment perspectives on contingency management: Perceived feasibility, effectiveness, and transportability of social and financial incentives

PubMed Central

Hartzler, Bryan; Rabun, Carl

2013-01-01

Treatment community reluctance toward contingency management (CM) may be better understood by eliciting views of its feasibility, effectiveness, and transportability when social vs. financial incentives are utilized. This mixed method study involved individual staff interviews representing three personnel tiers (an executive, clinical supervisor, and two front-line clinicians) at 16 opiate treatment programs. Interviews included Likert ratings of feasibility, effectiveness, and transportability of each incentive type, and content analysis of corresponding interviewee narrative. Multi-level modeling analyses indicated that social incentives were perceived more feasible, more effective, and more transportable than financial incentives, with results pervading personnel tier. Content analysis suggested the more positive perception of social incentives was most often due to expected logistical advantages, positive impacts on patient quality-of-life, and philosophical congruence among staff. Weaker perception of financial incentives was most often influenced by concerns about costs, patient dissatisfaction, and staff philosophical incongruence. Implications for CM dissemination are discussed. PMID:23506780

Testing an Irrigation Decision Support Tool for California Specialty Crops

NASA Astrophysics Data System (ADS)

Johnson, L.; Cahn, M.; Benzen, S.; Zaragoza, I.; Murphy, L.; Melton, F. S.; Martin, F.; Quackenbush, A.; Lockhart, T.

2015-12-01

Estimation of crop evapotranspiration supports efficiency of irrigation water management, which in turn can mitigate nitrate leaching, groundwater depletion, and provide energy savings. Past research in California and elsewhere has revealed strong relationships between photosynthetically active vegetation fraction (Fc) and crop evapotranspiration (ETc). Additional research has shown the potential of monitoring Fc by satellite remote sensing. The U.C. Cooperative Extension developed and operates CropManage (CM) as on-line database irrigation (and nitrogen) scheduling tool. CM accounts for the rapid growth and typically brief cycle of cool-season vegetables, where Fc and fraction of reference ET can change daily during canopy development. The model automates crop water requirement calculations based on reference ET data collected by California Dept. Water Resources. Empirically-derived equations are used to estimate daily Fc time-series for a given crop type primarily as a function of planting date and expected harvest date. An application programming interface (API) is under development to provide a check on modeled Fc of current crops and facilitate CM expansion to new crops. The API will enable CM to extract field scale Fc observations from NASA's Satellite Irrigation Management Support (SIMS). SIMS is mainly Landsat based and currently monitors Fc over about 8 million irrigation acres statewide, with potential for adding data from ESA/Sentinel for improved temporal resolution. In the current study, a replicated irrigation trial was performed on romaine lettuce at the USDA Agricultural Research Station in Salinas, CA. CropManage recommendations were used to guide water treatments by drip irrigation at 50%, 75%, 100% ETc replacement levels, with an added treatment at 150% ET representing grower standard practice. Experimental results indicate that yields from the 100% and 150% treatments were not significantly different and were in-line with industry average, while yields from the 75% and 50% treatments were significantly lower. Additional results will be presented with respect to a subsequent cabbage trial harvested October 2015.

A Stock Assessment of the Blue Swimming Crab Portunus pelagicus (Linnaeus, 1758) for Sustainable Management in Kung Krabaen Bay, Gulf of Thailand.

PubMed

Kunsook, Chutapa; Gajaseni, Nantana; Paphavasit, Nittharatana

2014-08-01

A stock assessment of blue swimming crabs, Portunus pelagicus was conducted with crab gill nets and collapsible crab traps at Kung Krabaen Bay, in the eastern Gulf of Thailand, from 2008 to 2009. Several key indicators show that P. pelagicus population is in crisis. Fishing mortality shows an increase to 4.14. The exploitation rate is 0.71, higher than the optimal value of 0.38. The size of the mature females has also decreased from 8.10±0.39 cm to 7.52±1.14 cm. The average fecundity is 0.572×10(6)±0.261×10(6) eggs per batch, and the sex ratio (male:female) is 1:0.92. Based on these results, a sustainable management program for P. pelagicus was proposed as follows: (i) closing the bay during the spawning season, (ii) restoration of the Enhalus acoroides seagrass beds, (iii) restocking crab larvae in the bay and (iv) educating and networking all stakeholders to develop a better understanding of the ecology of the crab to support sustainable fishery management in Kung Krabaen Bay.

Predicting available water of soil from particle-size distribution and bulk density in an oasis-desert transect in northwestern China

NASA Astrophysics Data System (ADS)

Li, Danfeng; Gao, Guangyao; Shao, Ming'an; Fu, Bojie

2016-07-01

A detailed understanding of soil hydraulic properties, particularly the available water content of soil, (AW, cm3 cm-3), is required for optimal water management. Direct measurement of soil hydraulic properties is impractical for large scale application, but routinely available soil particle-size distribution (PSD) and bulk density can be used as proxies to develop various prediction functions. In this study, we compared the performance of the Arya and Paris (AP) model, Mohammadi and Vanclooster (MV) model, Arya and Heitman (AH) model, and Rosetta program in predicting the soil water characteristic curve (SWCC) at 34 points with experimental SWCC data in an oasis-desert transect (20 × 5 km) in the middle reaches of the Heihe River basin, northwestern China. The idea of the three models emerges from the similarity of the shapes of the PSD and SWCC. The AP model, MV model, and Rosetta program performed better in predicting the SWCC than the AH model. The AW determined from the SWCCs predicted by the MV model agreed better with the experimental values than those derived from the AP model and Rosetta program. The fine-textured soils were characterized by higher AW values, while the sandy soils had lower AW values. The MV model has the advantages of having robust physical basis, being independent of database-related parameters, and involving subclasses of texture data. These features make it promising in predicting soil water retention at regional scales, serving for the application of hydrological models and the optimization of soil water management.

Case management to reduce risk of cardiovascular disease in a county health care system.

PubMed

Ma, Jun; Berra, Kathy; Haskell, William L; Klieman, Linda; Hyde, Shauna; Smith, Mark W; Xiao, Lan; Stafford, Randall S

2009-11-23

Case management (CM) is a systematic approach to supplement physician-centered efforts to prevent cardiovascular disease (CVD). Research is limited on its implementation and efficacy in low-income, ethnic minority populations. We conducted a randomized clinical trial to evaluate a nurse- and dietitian-led CM program for reducing major CVD risk factors in low-income, primarily ethnic minority patients in a county health care system, 63.0% of whom had type 2 diabetes mellitus. The primary outcome was the Framingham risk score (FRS). A total of 419 patients at elevated risk of CVD events were randomized and followed up for a mean of 16 months (81.4% retention). The mean FRS was significantly lower for the CM vs usual care group at follow-up (7.80 [95% confidence interval, 7.21-8.38] vs 8.93 [8.36-9.49]; P = .001) after adjusting for baseline FRS. This is equivalent to 5 fewer heart disease events per 1000 individuals per year attributable to the intervention or to 200 individuals receiving the intervention to prevent 1 event per year. The pattern of group differences in the FRS was similar in subgroups defined a priori by sex and ethnicity. The main driver of these differences was lowering the mean (SD) systolic (-4.2 [18.5] vs 2.6 [22.7] mm Hg; P = .003) and diastolic (-6.0 [11.6] vs -3.0 [11.7] mm Hg; P = .02) blood pressures for the CM vs usual care group. Nurse and dietitian CM targeting multifactor risk reduction can lead to modest improvements in CVD risk factors among high-risk patients in low-income, ethnic minority populations receiving care in county health clinics. clinicaltrials.gov Identifier: NCT00128687.

NCCDS configuration management process improvement

NASA Technical Reports Server (NTRS)

Shay, Kathy

1993-01-01

By concentrating on defining and improving specific Configuration Management (CM) functions, processes, procedures, personnel selection/development, and tools, internal and external customers received improved CM services. Job performance within the section increased in both satisfaction and output. Participation in achieving major improvements has led to the delivery of consistent quality CM products as well as significant decreases in every measured CM metrics category.

How Configuration Management (CM) Can Help Project Teams To Innovate and Communicate

NASA Technical Reports Server (NTRS)

Cioletti, Louis

2009-01-01

Traditionally, CM is relegated to a support role in project management activities. CM s traditional functions of identification, change control, status accounting, and audits/verification are still necessary and play a vital role. However, this presentation proposes CM s role in a new and innovative manner that will significantly improve communication throughout the organization and, in turn, augment the project s success. CM s new role is elevated to the project management level, above the engineering or sub-project level in the Work Breakdown Structure (WBS), where it can more effectively accommodate changes, reduce corrective actions, and ensure that requirements are clear, concise, and valid, and that results conform to the requirements. By elevating CM s role in project management and orchestrating new measures, a new communication will emerge that will improve information integrity, structured baselines, interchangeability/traceability, metrics, conformance to standards, and standardize the best practices in the organization. Overall project performance (schedule, quality, and cost) can be no better than the ability to communicate requirements which, in turn, is no better than the CM process to communicate project decisions and the correct requirements.

The effects of combining Web-based eHealth with telephone nurse case management for pediatric asthma control: a randomized controlled trial.

PubMed

Gustafson, David; Wise, Meg; Bhattacharya, Abhik; Pulvermacher, Alice; Shanovich, Kathleen; Phillips, Brenda; Lehman, Erik; Chinchilli, Vernon; Hawkins, Robert; Kim, Jee-Seon

2012-07-26

Asthma is the most common pediatric illness in the United States, burdening low-income and minority families disproportionately and contributing to high health care costs. Clinic-based asthma education and telephone case management have had mixed results on asthma control, as have eHealth programs and online games. To test the effects of (1) CHESS+CM, a system for parents and children ages 4-12 years with poorly controlled asthma, on asthma control and medication adherence, and (2) competence, self-efficacy, and social support as mediators. CHESS+CM included a fully automated eHealth component (Comprehensive Health Enhancement Support System [CHESS]) plus monthly nurse case management (CM) via phone. CHESS, based on self-determination theory, was designed to improve competence, social support, and intrinsic motivation of parents and children. We identified eligible parent-child dyads from files of managed care organizations in Madison and Milwaukee, Wisconsin, USA, sent them recruitment letters, and randomly assigned them (unblinded) to a control group of treatment as usual plus asthma information or to CHESS+CM. Asthma control was measured by the Asthma Control Questionnaire (ACQ) and self-reported symptom-free days. Medication adherence was a composite of pharmacy refill data and medication taking. Social support, information competence, and self-efficacy were self-assessed in questionnaires. All data were collected at 0, 3, 6, 9, and 12 months. Asthma diaries kept during a 3-week run-in period before randomization provided baseline data. Of 305 parent-child dyads enrolled, 301 were randomly assigned, 153 to the control group and 148 to CHESS+CM. Most parents were female (283/301, 94%), African American (150/301, 49.8%), and had a low income as indicated by child's Medicaid status (154/301, 51.2%); 146 (48.5%) were single and 96 of 301 (31.9%) had a high school education or less. Completion rates were 127 of 153 control group dyads (83.0%) and 132 of 148 CHESS+CM group dyads (89.2%). CHESS+CM group children had significantly better asthma control on the ACQ (d = -0.31, 95% confidence limits [CL] -0.56, -0.06, P = .011), but not as measured by symptom-free days (d = 0.18, 95% CL -0.88, 1.60, P = 1.00). The composite adherence scores did not differ significantly between groups (d = 1.48%, 95% CL -8.15, 11.11, P = .76). Social support was a significant mediator for CHESS+CM's effect on asthma control (alpha = .200, P = .01; beta = .210, P = .03). Self-efficacy was not significant (alpha = .080, P = .14; beta = .476, P = .01); neither was information competence (alpha = .079, P = .09; beta = .063, P = .64). Integrating telephone case management with eHealth benefited pediatric asthma control, though not medication adherence. Improved methods of measuring medication adherence are needed. Social support appears to be more effective than information in improving pediatric asthma control. Clinicaltrials.gov NCT00214383; http://clinicaltrials.gov/ct2/show/NCT00214383 (Archived by WebCite at http://www.webcitation.org/68OVwqMPz).

Using aerial photography to estimate wood suitable for charcoal in managed oak forests

NASA Astrophysics Data System (ADS)

Ramírez-Mejía, D.; Gómez-Tagle, A.; Ghilardi, A.

2018-02-01

Mexican oak forests (genus Quercus) are frequently used for traditional charcoal production. Appropriate management programs are needed to ensure their long-term use, while conserving the biodiversity and ecosystem services, and associated benefits. A key variable needed to design these programs is the spatial distribution of standing woody biomass. A state-of-the-art methodology using small format aerial photographs was developed to estimate the total aboveground biomass (AGB) and aboveground woody biomass suitable for charcoal making (WSC) in intensively managed oak forests. We used tree crown area (CAap) measurements from very high-resolution (30 cm) orthorectified small format digital aerial photographs as the predictive variable. The CAap accuracy was validated using field measurements of the crown area (CAf). Allometric relationships between: (a) CAap versus AGB, and (b) CAap versus WSC had a high significance level (R 2 > 0.91, p < 0.0001). This approach shows that it is possible to obtain sound biomass estimates as a function of the crown area derived from digital small format aerial photographs.

A Randomized Trial of Contingency Management Delivered by Community Therapists

ERIC Educational Resources Information Center

Petry, Nancy M.; Alessi, Sheila M.; Ledgerwood, David M.

2012-01-01

Objective: Contingency management (CM) is an evidence-based treatment, but few clinicians deliver this intervention in community-based settings. Method: Twenty-three clinicians from 3 methadone maintenance clinics received training in CM. Following a didactics seminar and a training and supervision period in which clinicians delivered CM to pilot…

Motivation and Contingency Management Treatments for Substance Use Disorders.

PubMed

Walter, Kimberly N; Petry, Nancy M

2016-01-01

Contingency management (CM) is a highly efficacious psychosocial treatment for substance use disorders based on the principles of behavioral analysis. CM involves delivering a tangible positive reinforcer following objective evidence of submission of a drug-negative urine sample. Although CM interventions primarily involve applying extrinsic rewards, a patient's intrinsic motivation to change substance use behavior may also be impacted by CM. This chapter provides an introduction to CM interventions for substance use disorders and examines the impact of CM on intrinsic motivation . It also addresses applications of this intervention to other conditions and patient populations.

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

PubMed

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

2007-03-05

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

[A strategy of constructing the technological system for quality control of Chinese medicine based on process control and management].

PubMed

Cheng, Yi-Yu; Qian, Zhong-Zhi; Zhang, Bo-Li

2017-01-01

The current situation, bottleneck problems and severe challenges in quality control technology of Chinese Medicine (CM) are briefly described. It is presented to change the phenomenon related to the post-test as the main means and contempt for process control in drug regulation, reverse the situation of neglecting the development of process control and management technology for pharmaceutical manufacture and reconstruct the technological system for quality control of CM products. The regulation and technology system based on process control and management for controlling CM quality should be established to solve weighty realistic problems of CM industry from the root causes, including backwardness of quality control technology, weakness of quality risk control measures, poor reputation of product quality and so on. By this way, the obstacles from poor controllability of CM product quality could be broken. Concentrating on those difficult problems and weak links in the technical field of CM quality control, it is proposed to build CMC (Chemistry, Manufacturing and Controls) regulation for CM products with Chinese characteristics and promote the regulation international recognition as soon as possible. The CMC technical framework, which is clinical efficacy-oriented, manufacturing manner-centered and process control-focused, was designed. To address the clinical characteristics of traditional Chinese medicine (TCM) and the production feature of CM manufacture, it is suggested to establish quality control engineering for CM manufacturing by integrating pharmaceutical analysis, TCM chemistry, TCM pharmacology, pharmaceutical engineering, control engineering, management engineering and other disciplines. Further, a theoretical model of quality control engineering for CM manufacturing and the methodology of digital pharmaceutical engineering are proposed. A technology pathway for promoting CM standard and realizing the strategic goal of CM internationalization is elaborated. Copyright© by the Chinese Pharmaceutical Association.

Psychosocial interventions for pregnant women in outpatient illicit drug treatment programs compared to other interventions.

PubMed

Terplan, M; Lui, S

2007-10-17

Illicit drug use in pregnancy is a complex social and public health problem. It is important to develop and evaluate effective treatments. There is evidence for the effectiveness of psychosocial in this population; however, to our knowledge, no systematic review on the subject has been undertaken. To evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in illicit drug treatment programs on birth and neonatal outcomes, on attendance and retention in treatment, as well as on maternal and neonatal drug abstinence. In short, do psychosocial interventions translate into less illicit drug use, greater abstinence, better birth outcomes, or greater clinic attendance.? We searched the Cochrane Drugs and Alcohol Group's trial register (May 2006), the Cochrane Central Register of Trials (Central- The Cochrane Library, Issue 3, 2005); MEDLINE (1.1996-8.2006); EMBASE (1.1996-8.2006); CINAHL (1.1982-8.2006), and reference lists of articles. Randomised studies comparing any psychosocial intervention versus pharmacological interventions or placebo or non-intervention or another psychosocial intervention for treating illicit drug use in pregnancy. Two reviewers independently assessed trial quality and extracted data. Nine trials involving 546 pregnant women were included. Five studies considered contingency management (CM), and four studies considered manual based interventions such as motivational interviewing (MI). The main finding was that contingency management led to better study retention. There was only minimal effect of CM on illicit drug abstinence. In contrast, motivational interviewing led towards poorer study retention, although this did not approach statistical significance. For both, no difference in birth or neonatal outcomes was found, but this was an outcome rarely captured in the studies. The present evidence suggests that CM strategies are effective in improving retention of pregnant women in illicit drug treatment programs as well as in transiently reducing illicit drug use. There is insufficient evidence to support the use of MI. Overall the available evidence has low numbers and, therefore, it is impossible to accurately assess the effect of psychosocial interventions on obstetrical and neonatal outcomes. It is important to develop a better evidence base to evaluate psychosocial modalities of treatment in this important population.

The GReat-Child™ Trial: A Quasi-Experimental Intervention on Whole Grains with Healthy Balanced Diet to Manage Childhood Obesity in Kuala Lumpur, Malaysia.

PubMed

Koo, Hui Chin; Poh, Bee Koon; Abd Talib, Ruzita

2018-01-30

Background: The GReat-Child Trial was a quasi-experimental intervention that has emphasized whole grain as a strategy to manage childhood obesity. Methods: Two schools in Kuala Lumpur with similar demographic characteristics were assigned as intervention (IG) and control (CG). Eligibility criteria were overweight/obese children aged 9 to 11 years who had no serious co-morbidity. Children who reported consuming wholegrain foods in their 3-day diet-recall during screening were excluded. A total of 63 children (31 IG; 32 CG) completed the entire intervention program. The IG children underwent six 30-min nutrition education lessons and had school delivery of wholegrain food on a daily basis over a 12-week period. Parents of IG children attended 1-h individual diet counseling. Anthropometric outcomes including BMI-for-age z-score (BAZ), body fat percentage and waist circumference were measured at baseline [T0], post-intervention [T1] (3rd month) and follow-up [T2] (9th month). Results: IG showed significantly lower BAZ (weighted difference: -0.12; 95% CI: -0.21, -0.03; p = 0.009), body fat percentage (weighted difference: -2.6%; 95% CI: -3.7, -1.5; p < 0.001) and waist circumference (weighted difference: -2.4 cm; 95% CI: -3.8, -1.0; p = 0.001) compared to CG. IG reported significantly lower body fat percentage (weighted difference: -3.4%; 95% CI: 1.8, 5.0; p < 0.001) and waist circumference (weighted difference: -2.1 cm; 95% CI: -3.7, -0.5; p = 0.014) at T1 compared to T0. Conclusions: The GReat-Child Trial made a positive impact in managing childhood obesity. It can be incorporated into childhood obesity intervention programs that are being implemented by the policy makers.

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

PubMed Central

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-01-01

Objective The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Design Thematic analysis review of CM studies. Methods We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Results Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. Conclusions CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. PMID:29061623

Case managers for older persons with multi-morbidity and their everyday work – a focused ethnography

PubMed Central

2013-01-01

Background Modern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences. Methods The study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis. Results An overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy. Conclusions Findings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs. PMID:24279695

Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial

PubMed Central

Alexopoulos, George S.; Raue, Patrick J.; McCulloch, Charles; Kanellopoulos, Dora; Seirup, Joanna K.; Sirey, Jo Anne; Banerjee, Samprit; Kiosses, Dimitris N.; Areán, Patricia A.

2015-01-01

Objective To test the hypotheses that (1) clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in reducing depressive symptoms of depressed, disabled, impoverished patients and that (2) development of problem-solving skills mediates improvement of depression. Methods This randomized clinical trial with a parallel design allocated participants to CM or CM-PST at 1:1 ratio. Raters were blind to patients’ assignments. Two hundred seventy-one individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST. Participants were at least 60 years old with major depression measured with the 24-item Hamilton Depression Rating Scale (HAM-D), had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties’ median. Results CM and CM-PST led to similar declines in HAM-D over 12 weeks (t = 0.37, df = 547, p = 0.71); CM was noninferior to CM-PST. The entire study group (CM plus CM-PST) had a 9.6-point decline in HAM-D (t = 18.7, df = 547, p <0.0001). The response (42.5% versus 33.3%) and remission (37.9% versus 31.0%) rates were similar (χ2 = 1.5, df = 1, p = 0.22 and χ2 = 0.9, df = 1, p = 0.34, respectively). Development of problem-solving skills did not mediate treatment outcomes. There was no significant increase in depression between the end of interventions and 12 weeks later (0.7 HAM-D point increase) (t = 1.36, df = 719, p = 0.17). Conclusion Organizations offering CM are available across the nation. With training in CM, their social workers can serve the many depressed, disabled, low-income patients, most of whom have poor response to antidepressants even when combined with psychotherapy. PMID:25794636

Selectivity lists of pesticides to beneficial arthropods for IPM programs in carrot--first results.

PubMed

Hautier, L; Jansen, J-P; Mabon, N; Schiffers, B

2005-01-01

In order to improve IPM programs in carrot, 7 fungicides, 12 herbicides and 9 insecticides commonly used in Belgium were tested for their toxicity towards five beneficial arthropods representative of most important natural enemies encountered in carrot: parasitic wasps - Aphidius rhopalosiphi (De Stefani-Perez) (Hym., Aphidiidae), ladybirds - Adalia bipunctata (L.) (Col., Coccinellidae), hoverfly - Episyrphus balteatus (Dipt.. Syrphidae), rove beetle - Aleochara bilineata (Col., Staphylinidae) and carabid beetle - Bembidion lampros (Col., Carabidae). Initialy, all plant protection products were tested on inert substrate glass plates or sand according to the insect. Products with a corrected mortality (CM) or a parasitism reduction (PR) lower than 30% were kept for the constitution of positive list (green list). The other compounds were further tested on plant for A. rhopalosiphi, A. bipunctata, E. balteatus and soil for B. lampros and A. bilineata. With these extended laboratory tests results, products were listed in toxicity class: green category [CM or PR < or = 30%], yellow category [30% < CM or PR < or = 60%] and orange category [60% < CM or PR < or = 80%]. Products with toxicity higher than 80% on plants or that reduce parasitism more than 80% on soil were put in red category and are not recommended to Integrated Pest Management programs in carrot. Results showed that all fungicides tested were harmless to beneficials except Tebuconazole, which was slightly harmful for A. bipunctata. Herbicides were also harmless for soil beneficials, except Chlorpropham. This product was very toxic on sand towards A. bilineata and must be tested on soil. All soil insecticides tested were very toxic for ground beneficials and considered as non-selective. Their use in IPM is subject to questioning in view of negative impacts on beneficials. Among foliar insecticides, Dimethoate and Deltamethrin are not recommended for IPM because their high toxicity for all beneficials. The other foliar insecticides were more selective; any of them were harmless for all species tested.

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

ERIC Educational Resources Information Center

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

2012-01-01

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

Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients.

PubMed

Polak, Rani; Phillips, Edward M; Nordgren, Julia; La Puma, John; La Barba, Julie; Cucuzzella, Mark; Graham, Robert; Harlan, Timothy S; Burg, Tracey; Eisenberg, David

2016-01-01

Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation. The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature. During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their program's structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection. All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) provider's self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients' curricula, educating 4225 individuals per year. These programs' content varies and focuses on either specific diets or various culinary behaviors. All the programs' directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data. There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges.

Effects of caloric restriction with varying energy density and aerobic exercise on weight change and satiety in young female adults.

PubMed

Song, Sae Won; Bae, Yoon Jung; Lee, Dae Taek

2010-10-01

This study examines the combined effects of caloric restriction on body composition, blood lipid, and satiety in slightly overweight women by varying food density and aerobic exercise. Twenty-three women were randomly assigned to one of two groups for a four-week weight management program: the high-energy density diet plus exercise (HDE: n = 12, 22 ± 2 yrs, 65 ± 7 kg, 164 ± 5 cm, 35 ± 4 % fat) and low-energy density diet plus exercise (LDE: n = 11, 22 ± 1 yrs, 67 ± 7 kg, 161 ± 2 cm, 35 ± 4 % fat) groups. Subjects maintained a low-calorie diet (1,500 kcal/day) during the program. Isocaloric (483 ± 26 for HDE, 487 ± 27 kcal for LDE) but different weight (365 ± 68 for HDE, 814 ± 202 g for LDE) of lunch was provided. After lunch, they biked at 60% of maximum capacity for 40 minutes, five times per week. The hunger level was scaled (1: extremely hungry; 9: extremely full) at 17:30 each day. Before and after the program, the subjects' physical characteristics were measured, and fasting blood samples were drawn. The daily energy intake was 1,551 ± 259 for HDE and 1,404 ± 150 kcal for LDE (P > 0.05). After four weeks, the subjects' weights and % fat decreased for both LDE (-1.9 kg and -1.5%, P < 0.05) and HDE (-1.6 kg and -1.4%, respectively, P < 0.05). The hunger level was significantly higher for HDE (2.46 ± 0.28) than for LDE (3.10 ± 0.26) (P < 0.05). The results suggest that a low-energy density diet is more likely to be tolerated than a high-energy density diet for a weight management program combining a low-calorie diet and exercise, mainly because of a reduced hunger sensation.

How Configuration Management Helps Projects Innovate and Communicate

NASA Technical Reports Server (NTRS)

Cioletti, Louis A.; Guidry, Carla F.

2009-01-01

This slide presentation reviews the concept of Configuration Management (CM) and compares it to the standard view of Project management (PM). It presents two PM models: (1) Kepner-Tregoe,, and the Deming models, describes why projects fail, and presents methods of how CM helps projects innovate and communicate.

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review.

PubMed

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-10-22

The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Thematic analysis review of CM studies. We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004-December 2015 period, then updated to July 2017, with the keywords 'CM' and 'frequent use'. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir's implementation of health innovations framework was used to organise results into four broad levels of factors: (1) ,environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Contingency Management Approaches for Adolescent Substance Use Disorders

PubMed Central

Stanger, Catherine; Budney, Alan J.

2010-01-01

The addition of contingency management (CM) to the menu of effective treatments for adolescent substance abuse has generated excitement in the research and treatment communities. CM interventions are based on extensive basic science and clinical research evidence demonstrating that drug use is sensitive to systematically applied consequences. This article provides (a) a review of basic CM principles, (b) implementation guidelines, (c) a review of the clinical CM research targeting adolescent substance abuse, and (d) a discussion of implementation successes and challenges. Although the research base for CM with adolescents is in its infancy, there are multiple reasons for high expectations. PMID:20682220

Parent-focused child maltreatment prevention: improving assessment, intervention, and dissemination with technology.

PubMed

Self-Brown, Shannon; Whitaker, Daniel J

2008-11-01

The goal of this article is to examine how technology has been and can be utilized to enhance parent-focused child maltreatment (CM) prevention efforts. The authors begin with a brief discussion of the current state of the CM prevention field. In the sections that follow, they review studies that have examined the use of technology across three facets of prevention: identification of CM, administration/augmentation of CM prevention programs, and broad dissemination and implementation of evidenced-based CM prevention programs. They conclude with a discussion of limitations and problems related to the use of technology as a tool to enhance CM prevention and future directions.

Characterization and Monitoring of Natural Attenuation of Chlorinated Solvents in Ground Water: A Systems Approach

NASA Astrophysics Data System (ADS)

Cutshall, N. H.; Gilmore, T.; Looney, B. B.; Vangelas, K. M.; Adams, K. M.; Sink, C. H.

2006-05-01

Like many US industries and businesses, the Department of Energy (DOE) is responsible for remediation and restoration of soils and ground water contaminated with chlorinated ethenes. Monitored Natural Attenuation (MNA) is an attractive remediation approach and is probably the universal end-stage technology for removing such contamination. Since 2003 we have carried out a multifaceted program at the Savannah River Site designed to advance the state of the art for MNA of chlorinated ethenes in soils and groundwater. Three lines of effort were originally planned: 1) Improving the fundamental science for MNA, 2) Promoting better characterization and monitoring (CM) techniques, and 3) Advancing the regulatory aspects of MNA management. A fourth line, developing enhanced attenuation methods based on sustainable natural processes, was added in order to deal with sites where the initial natural attenuation capacity cannot offset contaminant loading rates. These four lines have been pursued in an integrated and mutually supportive fashion. Many DOE site-cleanup program managers view CM as major expenses, especially for natural attenuation where measuring attenuation is complex and the most critical attenuation mechanisms cannot be determined directly. We have reviewed new and developing approaches to CM for potential application in support of natural attenuation of chlorinated hydrocarbons in ground water at DOE sites (Gilmore, Tyler, et al., 2006 WSRC-TR- 2005-00199). Although our project is focused on chlorinated ethenes, many of the concepts and strategies are also applicable to a wider range of contaminants including radionuclides and metals. The greatest savings in CM are likely to come from new management approaches. New approaches can be based, for example, on conceptual models of attenuation capacity, the ability of a formation to reduce risks caused by contaminants. Using the mass balance concept as a guide, the integrated mass flux of contaminant is compared to the attenuation capacity. The mass balance approach is controlled by a combination of boundary conditions (e.g., water inputs and outputs), flow dynamics, and contaminant concentrations. As a result, long term monitoring might be improved while reducing costs by measuring fewer point concentrations and simultaneously adding large-scale measurements of boundary conditions, using weather data, remote sensing of evapotranspiration, stream-flow monitoring, etc. Because there are no specific regulatory drivers for performance-monitoring, regulators are not accustomed to participating in monitoring system design. A partnership with the Interstate Technology Regulatory Council (ITRC) has been formed to promote communication and develop advanced guidance for MNA. Early and continued communication among technology developers, end users, regulators and the public has been essential to this progress.

Contingency Management for Attendance to Group Substance Abuse Treatment Administered by Clinicians in Community Clinics

ERIC Educational Resources Information Center

Ledgerwood, David M.; Alessi, Sheila M.; Hanson, Tressa; Godley, Mark D.; Petry, Nancy M.

2008-01-01

Contingency management (CM) is effective in enhancing retention in therapy. After an 8-week baseline, four community-based substance abuse treatment clinics were exposed in random order to 16 weeks of standard care with CM followed by 16 weeks of standard care without CM or vice versa. In total, 75 outpatients participated. Patients who were…

Integration and baseline management training and transition plan

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

Jech, J.B.

The purpose of the Integration and Baseline Management Training and Transition Plan is to provide a training outline for the Integration and Baseline Management (I and BM) organization and a transition strategy for the Master Equipment List (MEL) Phase 1 application. The training outline includes the following courses: MEL Phase 1 Application Course 1 Master Equipment List General Overview. Course 2 Master Equipment List Editing. Tank Waste Remediation System (TWRS) Labeling Related Course 3 TWRS Equipment Labeling Program (Course Number 350545). As part of courses 1, 2, and 3, it is recommended that a lesson plan be developed and integratedmore » into each of the three courses on the subject of Configuration Management (CM) to include: CM concepts, terminology, definitions, fundamentals and its application with respect to the course. The strategy for the MEL Phase 1 application is to train internal organizations (I and BM) on the MEL-General Overview for read only users and train MEL-Editing for edit users (only on an as needed basis). For external organizations, the strategy is to train selected personnel on the MEL-General Overview and transition them from read only privileges to editing privileges when the appropriate administrative procedures that outline the external organization`s responsibilities (to support MEL) are established. The purpose of this training is to ensure support of the I and BM organization objectives within the TV,IRS Division. These training courses will be added to the existing required training for I and BM personnel only. Other organizations implementing the training will be directed by their management on which training is required.« less

A dementia care management intervention: which components improve quality?

PubMed

Chodosh, Joshua; Pearson, Marjorie L; Connor, Karen I; Vassar, Stefanie D; Kaisey, Marwa; Lee, Martin L; Vickrey, Barbara G

2012-02-01

To analyze whether types of providers and frequency of encounters are associated with higher quality of care within a coordinated dementia care management (CM) program for patients and caregivers. Secondary analysis of intervention-arm data from a dementia CM cluster-randomized trial, where intervention participants interacted with healthcare organization care managers (HOCMs), community agency care managers (CACMs), and/ or healthcare organization primary care providers (HOPCPs) over 18 months. Encounters of 238 patient/caregivers (dyads) with HOCMs, CACMs, and HOPCPs were abstracted from care management electronic records. The quality domains of assessment, treatment, education/support, and safety were measured from medical record abstractions and caregiver surveys. Mean percentages of met quality indicators associated with exposures to each provider type and frequency were analyzed using multivariable regression, adjusting for participant characteristics and baseline quality. As anticipated, for all 4 domains, the mean percentage of met dementia quality indicators was 15.5 to 47.2 percentage points higher for dyads with HOCM--only exposure than for dyads with none (all P < .008); not anticipated were higher mean percentages with increasing combinations of provider-type exposure-up to 73.7 percentage points higher for safety (95% confidence interval 65.2%-82.1%) with exposure to all 3 provider types compared with no exposure. While greater frequency of HOCM-dyad encounters was associated with higher quality (P < .04), this was not so for other provider types. HOCMs' interactions with dyads was essential for dementia care quality improvement. Additional coordinated interactions with primary care and community agency staff yielded even higher quality.

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

PubMed Central

Khanassov, Vladimir; Vedel, Isabelle

2016-01-01

PURPOSE Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patient-caregiver dyad and the effects of CM. METHODS We searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified. RESULTS Fifty-four studies were included. We identified needs of the patient-caregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care. CONCLUSIONS There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patient-caregiver dyad. PMID:26951593

Family Physician-Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review.

PubMed

Khanassov, Vladimir; Vedel, Isabelle

2016-03-01

Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patient-caregiver dyad and the effects of CM. We searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified. Fifty-four studies were included. We identified needs of the patient-caregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care. There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patient-caregiver dyad. © 2016 Annals of Family Medicine, Inc.

Case Report: A Case of Severe Cerebral Malaria Managed with Therapeutic Hypothermia and Other Modalities for Brain Edema.

PubMed

Gad, AbdAllah; Ali, Sajjad; Zahoor, Talal; Azarov, Nick

2018-04-01

Malarial infections are uncommon in the United States and almost all reported cases stem from recent travelers coming from endemic countries. Cerebral malaria (CM) is a severe form of the disease usually affecting children and individuals with limited immunity. Despite proper management, mortality from CM can reach up to 25%, especially when it is associated with brain edema. Inefficient management of the edema may result in brain herniation and death. Uniform guidelines for management of CM-associated brain edema are lacking. In this report, we present a case of CM with associated severe brain edema that was successfully managed using a unique combination of therapeutic hypothermia, hypertonic saline, mannitol, and hyperventilation along with the antimalarial drugs quinidine and doxycycline. Our use of hypothermia was based on its proven benefit for improving neurological outcomes in post-cardiac arrest patients and previous in vitro research, suggesting its potential inhibitory role on malaria growth.

Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients

PubMed Central

Phillips, Edward M.; Nordgren, Julia; La Puma, John; La Barba, Julie; Cucuzzella, Mark; Graham, Robert; Harlan, Timothy S.; Burg, Tracey; Eisenberg, David

2016-01-01

Background: Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation. Objective: The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature. Methods: During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their program's structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection. Results: All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) provider's self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients' curricula, educating 4225 individuals per year. These programs' content varies and focuses on either specific diets or various culinary behaviors. All the programs' directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data. Conclusions: There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges. PMID:26937315

Effectiveness of differing trap types for the detection of emerald ash borer (Coleoptera: Buprestidae).

PubMed

Marshall, Jordan M; Storer, Andrew J; Fraser, Ivich; Beachy, Jessica A; Mastro, Victor C

2009-08-01

The early detection of populations of a forest pest is important to begin initial control efforts, minimizing the risk of further spread and impact. Emerald ash borer (Agrilus planipennis Fairmaire) is an introduced pestiferous insect of ash (Fraxinus spp. L.) in North America. The effectiveness of trapping techniques, including girdled trap trees with sticky bands and purple prism traps, was tested in areas with low- and high-density populations of emerald ash borer. At both densities, large girdled trap trees (>30 cm diameter at breast height [dbh], 1.37 m in height) captured a higher rate of adult beetles per day than smaller trees. However, the odds of detecting emerald ash borer increased as the dbh of the tree increased by 1 cm for trap trees 15-25 cm dbh. Ash species used for the traps differed in the number of larvae per cubic centimeter of phloem. Emerald ash borer larvae were more likely to be detected below, compared with above, the crown base of the trap tree. While larval densities within a trap tree were related to the species of ash, adult capture rates were not. These results provide support for focusing state and regional detection programs on the detection of emerald ash borer adults. If bark peeling for larvae is incorporated into these programs, peeling efforts focused below the crown base may increase likelihood of identifying new infestations while reducing labor costs. Associating traps with larger trees ( approximately 25 cm dbh) may increase the odds of detecting low-density populations of emerald ash borer, possibly reducing the time between infestation establishment and implementing management strategies.

Unified-planning, graded-administration, and centralized-controlling: a management modality for treating acquired immune deficiency syndrome with Chinese medicine in Henan Province of China.

PubMed

Xu, Li-Ran; Guo, Hui-jun; Liu, Zhi-bin; Li, Qiang; Yang, Ji-ping; He, Ying

2015-04-01

Henan Province in China has a major epidemic of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Chinese medicine (CM) has been used throughout the last decade, and a management modality was developed, which can be described by unified-planning, graded-administration, and centralized-controlling (UGC). The UGC modality has one primary concept (patient-centered medicine from CM theory), four basic foundations (classifying administrative region, characteristics of CM on disease treatment, health resource conditions, and distribution of patients living with HIV), six important relationships (the "three uniformities and three combinations," and the six relationships therein guide the treatment of AIDS with CM), and four key sections (management, operation, records, and evaluation). In this article, the authors introduce the UGC modality, which could be beneficial to developing countries or resource-limited areas for the management of chronic infectious disease.

Experimental, Numerical and Analytical Characterization of Slosh Dynamics Applied to In-Space Propellant Storage, Management and Transfer

NASA Technical Reports Server (NTRS)

Storey, Jedediah M.; Kirk, Daniel; Gutierrez, Hector; Marsell, Brandon; Schallhorn, Paul; Lapilli, Gabriel D.

2015-01-01

Experimental and numerical results are presented from a new cryogenic fluid slosh program at the Florida Institute of Technology (FIT). Water and cryogenic liquid nitrogen are used in various ground-based tests with an approximately 30 cm diameter spherical tank to characterize damping, slosh mode frequencies, and slosh forces. The experimental results are compared to a computational fluid dynamics (CFD) model for validation. An analytical model is constructed from prior work for comparison. Good agreement is seen between experimental, numerical, and analytical results.

Lifetime substance use and HIV sexual risk behaviors predict treatment response to contingency management among homeless, substance-dependent MSM.

PubMed

Reback, Cathy J; Peck, James A; Fletcher, Jesse B; Nuno, Miriam; Dierst-Davies, Rhodri

2012-01-01

Homeless, substance-dependent men who have sex with men (MSM) continue to suffer health disparities, including high rates of HIV. One-hundred and thirty one homeless, substance-dependent MSM were randomized into a contingency management (CM) intervention to increase substance abstinence and health-promoting behaviors. Participants were recruited from a community-based, health education/risk reduction HIV prevention program and the research activities were also conducted at the community site. Secondary analyses were conducted to identify and characterize treatment responders (defined as participants in a contingency management intervention who scored at or above the median on three primary outcomes). Treatment responders were more likely to be Caucasian/White (p < .05), report fewer years of lifetime methamphetamine, cocaine, and polysubstance use (p < or = .05), and report more recent sexual partners and high-risk sexual behaviors than nonresponders (p < .05). The application of evidence-based interventions continues to be a public health priority, especially in the effort to implement effective interventions for use in community settings. The identification of both treatment responders and nonresponders is important for intervention development tailored to specific populations, both in service programs and research studies, to optimize outcomes among highly impacted populations.

The melon fruit fly, Bactrocera cucurbitae: A review of its biology and management

PubMed Central

Dhillon, M.K.; Singh, Ram; Naresh, J.S.; Sharma, H.C.

2005-01-01

The melon fruit fly, Bactrocera cucurbitae (Coquillett) (Diptera: Tephritidae) is distributed widely in temperate, tropical, and sub-tropical regions of the world. It has been reported to damage 81 host plants and is a major pest of cucurbitaceous vegetables, particularly the bitter gourd (Momordica charantia), muskmelon (Cucumis melo), snap melon (C. melo var. momordica), and snake gourd (Trichosanthes anguina). The extent of losses vary between 30 to 100%, depending on the cucurbit species and the season. Its abundance increases when the temperatures fall below 32° C, and the relative humidity ranges between 60 to 70%. It prefers to infest young, green, soft-skinned fruits. It inserts the eggs 2 to 4 mm deep in the fruit tissues, and the maggots feed inside the fruit. Pupation occurs in the soil at 0.5 to 15 cm below the soil surface. Keeping in view the importance of the pest and crop, melon fruit fly management could be done using local area management and wide area management. The melon fruit fly can successfully be managed over a local area by bagging fruits, field sanitation, protein baits, cue-lure traps, growing fruit fly-resistant genotypes, augmentation of biocontrol agents, and soft insecticides. The wide area management program involves the coordination of different characteristics of an insect eradication program (including local area options) over an entire area within a defensible perimeter, and subsequently protected against reinvasion by quarantine controls. Although, the sterile insect technique has been successfully used in wide area approaches, this approach needs to use more sophisticated and powerful technologies in eradication programs such as insect transgenesis and geographical information systems, which could be deployed over a wide area. Various other options for the management of fruit fly are also discussed in relation to their bio-efficacy and economics for effective management of this pest. PMID:17119622

A mechanical, thermal and electrical packaging design for a prototype power management and control system for the 30 cm mercury ion thruster

NASA Technical Reports Server (NTRS)

Sharp, G. R.; Gedeon, L.; Oglebay, J. C.; Shaker, F. S.; Siegert, C. E.

1978-01-01

A prototype electric power management and thruster control system for a 30 cm ion thruster is described. The system meets all of the requirements necessary to operate a thruster in a fully automatic mode. Power input to the system can vary over a full two to one dynamic range (200 to 400 V) for the solar array or other power source. The power management and control system is designed to protect the thruster, the flight system and itself from arcs and is fully compatible with standard spacecraft electronics. The system is easily integrated into flight systems which can operate over a thermal environment ranging from 0.3 to 5 AU. The complete power management and control system measures 45.7 cm (18 in.) x 15.2 cm (6 in.) x 114.8 cm (45.2 in.) and weighs 36.2 kg (79.7 lb). At full power the overall efficiency of the system is estimated to be 87.4 percent. Three systems are currently being built and a full schedule of environmental and electrical testing is planned.

Facilitating the Adoption of Contingency Management for the Treatment of Substance Use Disorders

PubMed Central

Roll, John M; Madden, Gregory J; Rawson, Richard; Petry, Nancy M

2009-01-01

Contingency management (CM) is an effective treatment strategy for addressing many types of substance abuse disorders and associated problems. Nonetheless, CM protocols have not been widely embraced by community-based treatment providers. Exploration of the viability of CM outside of a research context remains largely an academic pursuit. In this paper, we outline several areas that may hinder the transfer of CM technology into community-based practice settings, review the literature that may address these barriers, and offer suggestions to researchers for overcoming them. PMID:22477692

Quantitative Improvements in Hop Test Scores After a 6-Week Neuromuscular Training Program.

PubMed

Meierbachtol, Adam; Rohman, Eric; Paur, Eric; Bottoms, John; Tompkins, Marc

2016-09-12

In patients who have undergone anterior cruciate ligament reconstruction (ACLR), the effect of neuromuscular re-education (NMR) programs on standard hop tests outcomes, including limb symmetry indices (LSIs), is unknown. Both legs will show improvement in hop test-measured units after neuromuscular training, but the involved leg will show relatively greater improvement leading to improved limb symmetry. Patients younger than 18 years will show more improvement than patients who are older. Retrospective cohort study. Level 3. Patients self-selected their participation in this NMR program, which was completed after traditional outpatient physical therapy. Pre- and post-hop test scores were recorded as the primary outcome measure. Seventy-one patients met the inclusion criteria and completed hop testing. Overall, the involved leg showed significant improvements (pretest/posttest) for single-leg hop (138.30 cm/156.89 cm), triple crossover hop (370.05 cm/423.11 cm), and timed hop (2.21 s/1.99 s). Similarly, on the uninvolved leg, improvements were seen for the single-leg hop (159.30 cm/171.87 cm) and triple crossover hop (427.50 cm/471.27 cm). Overall mean limb symmetry improved across all 4 hop tests, but there was significant improvement only on the single-leg hop (87% pretest to 92% posttest). Patients younger than 18 years showed mean significant LSI improvement on the triple crossover hop. Utilizing an intensive 6-week NMR program after ACLR prior to return to sport can improve quantitative hop test measurements. Patients younger than 18 years had greater improvement than those 18 years and older. Advanced NMR programs can be successfully utilized in the postoperative ACLR setting to improve quantitative limb symmetry. © 2016 The Author(s).

Quantitative Improvements in Hop Test Scores After a 6-Week Neuromuscular Training Program

PubMed Central

Meierbachtol, Adam; Rohman, Eric; Paur, Eric; Bottoms, John; Tompkins, Marc

2016-01-01

Background: In patients who have undergone anterior cruciate ligament reconstruction (ACLR), the effect of neuromuscular re-education (NMR) programs on standard hop tests outcomes, including limb symmetry indices (LSIs), is unknown. Hypothesis: Both legs will show improvement in hop test–measured units after neuromuscular training, but the involved leg will show relatively greater improvement leading to improved limb symmetry. Patients younger than 18 years will show more improvement than patients who are older. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Patients self-selected their participation in this NMR program, which was completed after traditional outpatient physical therapy. Pre– and post–hop test scores were recorded as the primary outcome measure. Results: Seventy-one patients met the inclusion criteria and completed hop testing. Overall, the involved leg showed significant improvements (pretest/posttest) for single-leg hop (138.30 cm/156.89 cm), triple crossover hop (370.05 cm/423.11 cm), and timed hop (2.21 s/1.99 s). Similarly, on the uninvolved leg, improvements were seen for the single-leg hop (159.30 cm/171.87 cm) and triple crossover hop (427.50 cm/471.27 cm). Overall mean limb symmetry improved across all 4 hop tests, but there was significant improvement only on the single-leg hop (87% pretest to 92% posttest). Patients younger than 18 years showed mean significant LSI improvement on the triple crossover hop. Conclusion: Utilizing an intensive 6-week NMR program after ACLR prior to return to sport can improve quantitative hop test measurements. Patients younger than 18 years had greater improvement than those 18 years and older. Clinical Relevance: Advanced NMR programs can be successfully utilized in the postoperative ACLR setting to improve quantitative limb symmetry. PMID:27620968

Thermal management of high heat flux electronic components in space and aircraft systems, phase 1

NASA Astrophysics Data System (ADS)

Iversen, Arthur H.

1991-03-01

The objectives of this Phase 1 program were to analyze, design, construct and demonstrate the application of curved surface cooling to power devices with the goal of demonstrating greater than 200 W/sq cm chip dissipation while maintaining junction temperatures within specification. Major components of the experiment comprised the test fixture for mounting the device under test and the cooling loop equipment and instrumentation. The work conducted in this Phase 1 study was to establish the basic parameters for the design of an entire class of efficient, compact, lightweight and cost competitive power conversion/conditioning systems for space, aircraft and general DOD requirements. This has been accomplished. Chip power dissipation of greater than 400 W/sq cm was demonstrated, and a general packaging and the thermal management design has been devised to meet the above requirements. The power limit reached was dictated by the junction temperature and not power dissipation, i.e., critical heat flux. The key to the packaging design is a basic construction concept that provides low junction to fluid thermal resistance. High heat flux dissipation without low thermal resistance is useless because excessive junction temperatures will results.

Saturn Apollo Program

NASA Image and Video Library

1969-07-15

Seriousness exudes from launch official Miles Ross (left) of Kennedy Space Flight Center (KSC) and Major General E.F. O’Conner, director of program management of the Marshall Space Flight Center (MSFC), as they participate in the Apollo 11 countdown demonstration test. The Apollo 11 mission, the first lunar landing mission, launched from the KSC in Florida via the MSFC developed Saturn V launch vehicle on July 16, 1969 and safely returned to Earth on July 24, 1969. Aboard the space craft were astronauts Neil A. Armstrong, commander; Michael Collins, Command Module (CM) pilot; and Edwin E. (Buzz) Aldrin Jr., Lunar Module (LM) pilot. The CM, “Columbia”, piloted by Collins, remained in a parking orbit around the Moon while the LM, “Eagle’’, carrying astronauts Armstrong and Aldrin, landed on the Moon. On July 20, 1969, Armstrong was the first human to ever stand on the lunar surface, followed by Aldrin. During 2½ hours of surface exploration, the crew collected 47 pounds of lunar surface material for analysis back on Earth. With the success of Apollo 11, the national objective to land men on the Moon and return them safely to Earth had been accomplished.

Saturn Apollo Program

NASA Image and Video Library

1969-07-15

Lee B. James (left), manager of the Saturn Program at the Marshall Space flight Center (MSFC), talks with Isom Pigell in the firing room 1 of the Kennedy Space Center (KSC) control center during the countdown demonstration test for the Apollo 11 mission. The Apollo 11 mission, the first lunar landing mission, launched from the KSC in Florida via the MSFC developed Saturn V launch vehicle on July 16, 1969 and safely returned to Earth on July 24, 1969. Aboard the space craft were astronauts Neil A. Armstrong, commander; Michael Collins, Command Module (CM) pilot; and Edwin E. (Buzz) Aldrin Jr., Lunar Module (LM) pilot. The CM, “Columbia”, piloted by Collins, remained in a parking orbit around the Moon while the LM, “Eagle’’, carrying astronauts Armstrong and Aldrin, landed on the Moon. On July 20, 1969, Armstrong was the first human to ever stand on the lunar surface, followed by Aldrin. During 2½ hours of surface exploration, the crew collected 47 pounds of lunar surface material for analysis back on Earth. With the success of Apollo 11, the national objective to land men on the Moon and return them safely to Earth had been accomplished.

Saturn Apollo Program

NASA Image and Video Library

1969-07-15

Lee B. James (left), manager of the Saturn Program at the Marshall Space flight Center (MSFC), talks with Isom Pigell in the firing room 1 of the Kennedy Space Center (KSC) control center during the countdown demonstration test for the Apollo 11 mission. At left is Dr. Hans C. Gruen of KSC. The Apollo 11 mission, the first lunar landing mission, launched from the KSC in Florida via the MSFC developed Saturn V launch vehicle on July 16, 1969 and safely returned to Earth on July 24, 1969. Aboard the space craft were astronauts Neil A. Armstrong, commander; Michael Collins, Command Module (CM) pilot; and Edwin E. (Buzz) Aldrin Jr., Lunar Module (LM) pilot. The CM, “Columbia”, piloted by Collins, remained in a parking orbit around the Moon while the LM, “Eagle’’, carrying astronauts Armstrong and Aldrin, landed on the Moon. On July 20, 1969, Armstrong was the first human to ever stand on the lunar surface, followed by Aldrin. During 2½ hours of surface exploration, the crew collected 47 pounds of lunar surface material for analysis back on Earth. With the success of Apollo 11, the national objective to land men on the Moon and return them safely to Earth had been accomplished.

Mortality of American alligators attributed to cannibalism

USGS Publications Warehouse

Delany, Michael F.; Woodward, Allan R.; Kiltie, Richard A.; Moore, Clinton T.

2011-01-01

Mortality of juvenile (Alligator mississippiensis) attributed to cannibalism on Orange Lake, Florida was examined. Alligator web tags used in mark–recapture studies were found in 12% of 267 stomachs sampled from alligators ≥168 cm TL. Captive alligators retained 76% of force-fed tags during a 588-d tag-retention trial. Models relating the probability of tag recovery to the annual probabilities of juvenile survival, cannibalism, tag retention, adult survival, and adult harvest suggested that cannibalism may on average remove 6–7% of the juvenile alligator population annually. Vulnerability continued to 140 cm TL (age 6–8 yr). Cannibalism of juveniles may serve to regulate the alligator population on Orange Lake. Alligator cannibalism may vary widely among populations, depending on demography and environmental conditions. The role and importance of cannibalism in alligator population dynamics should be more fully assessed and environmental and population factors that influence cannibalism identified to better evaluate management programs.

The Feasibility of Interventions to Reduce HIV Risk and Drug Use among Heterosexual Methamphetamine Users.

PubMed

Corsi, Karen F; Lehman, Wayne E; Min, Sung-Joon; Lance, Shannon P; Speer, Nicole; Booth, Robert E; Shoptaw, Steve

2012-06-04

This paper reports on a feasibility study that examined contingency management among out-of-treatment, heterosexual methamphetamine users and the reduction of drug use and HIV risk. Fifty-eight meth users were recruited through street outreach in Denver from November 2006 through March 2007. The low sample size reflects that this was a pilot study to see if CM is feasible in an out-of-treatment, street-recruited population of meth users. Secondary aims were to examine if reductions and drug use and risk behavior could be found. Subjects were randomly assigned to contingency management (CM) or CM plus strengths-based case management (CM/SBCM), with follow-up at 4 and 8 months. Participants were primarily White (90%), 52% male and averaged 38 years old. Eighty-three percent attended at least one CM session, with 29% attending at least fifteen. All participants reduced meth use significantly at follow-up. Those who attended more sessions submitted more stimulant-free urines than those who attended fewer sessions. Participants assigned to CM/SBCM attended more sessions and earned more vouchers than clients in CM. Similarly, participants reported reduced needle-sharing and sex risk. Findings demonstrate that CM and SBCM may help meth users reduce drug use and HIV risk.

The Feasibility of Interventions to Reduce HIV Risk and Drug Use among Heterosexual Methamphetamine Users

PubMed Central

Corsi, Karen F.; Lehman, Wayne E.; Min, Sung-Joon; Lance, Shannon P.; Speer, Nicole; Booth, Robert E.; Shoptaw, Steve

2013-01-01

This paper reports on a feasibility study that examined contingency management among out-of-treatment, heterosexual methamphetamine users and the reduction of drug use and HIV risk. Fifty-eight meth users were recruited through street outreach in Denver from November 2006 through March 2007. The low sample size reflects that this was a pilot study to see if CM is feasible in an out-of-treatment, street-recruited population of meth users. Secondary aims were to examine if reductions and drug use and risk behavior could be found. Subjects were randomly assigned to contingency management (CM) or CM plus strengths-based case management (CM/SBCM), with follow-up at 4 and 8 months. Participants were primarily White (90%), 52% male and averaged 38 years old. Eighty-three percent attended at least one CM session, with 29% attending at least fifteen. All participants reduced meth use significantly at follow-up. Those who attended more sessions submitted more stimulant-free urines than those who attended fewer sessions. Participants assigned to CM/SBCM attended more sessions and earned more vouchers than clients in CM. Similarly, participants reported reduced needle-sharing and sex risk. Findings demonstrate that CM and SBCM may help meth users reduce drug use and HIV risk. PMID:23493796

Configuration Management (CM) Support for KM Processes at NASA/Johnson Space Center (JSC)

NASA Technical Reports Server (NTRS)

Cioletti, Louis

2010-01-01

Collection and processing of information are critical aspects of every business activity from raw data to information to an executable decision. Configuration Management (CM) supports KM practices through its automated business practices and its integrated operations within the organization. This presentation delivers an overview of JSC/Space Life Sciences Directorate (SLSD) and its methods to encourage innovation through collaboration and participation. Specifically, this presentation will illustrate how SLSD CM creates an embedded KM activity with an established IT platform to control and update baselines, requirements, documents, schedules, budgets, while tracking changes essentially managing critical knowledge elements.

Treatment of impulsive aggression in correctional settings.

PubMed

Shelton, Deborah; Sampl, Susan; Kesten, Karen L; Zhang, Wanli; Trestman, Robert L

2009-01-01

This article reports the implementation of Dialectical Behavioral Therapy-Corrections Modified (DBT-CM) for difficult to manage, impulsive and/or aggressive correctional populations. Participants were English-speaking women (n = 18) and men (n = 45) of diverse cultural backgrounds between the ages of 16 and 59 years old retained in state-run prisons in Connecticut. Following consent, and a psychological assessment battery, twice-weekly DBT-CM groups were held over 16 weeks followed by random assignment to DBT coaching or case management condition, with sessions taking place individually for eight weeks. Data analysis. A mixed effects regression model was used to test the hypotheses: participants will show decreased aggression, impulsivity, and psychopathology, as well as improved coping, after completing the DBT-CM groups; and will show greater reduction in targeted behaviors than those receiving case management at the six month and 12 month follow-up assessment periods. Significant reduction in targeted behavior was found from baseline to following the 16 week DBT-CM skills treatment groups. Both case management and DBT coaching were significant at 12 month follow-up. A significant difference was found for adult men and women. The study supports the value of DBT-CM for management of aggressive behaviors in prison settings. (c) 2009 John Wiley & Sons, Ltd.

Saturn Apollo Program

NASA Image and Video Library

1969-07-25

The Apollo 11 mission, the first manned lunar mission, launched from the Kennedy Space Center, Florida via the Marshall Space Flight Center (MSFC) developed Saturn V launch vehicle on July 16, 1969 and safely returned to Earth on July 24, 1969. Aboard the space craft were astronauts Neil A. Armstrong, commander; Michael Collins, Command Module (CM) pilot; and Edwin E. Aldrin Jr., Lunar Module (LM) pilot. The CM, piloted by Michael Collins remained in a parking orbit around the Moon while the LM, named “Eagle’’, carrying astronauts Neil Armstrong and Edwin Aldrin, landed on the Moon. During 2½ hours of surface exploration, the crew collected 47 pounds of lunar surface material for analysis back on Earth. This photograph was taken as the mission’s first loaded sample return container arrived at Ellington Air Force Base by air from the Pacific recovery area. The rock box was immediately taken to the Lunar Receiving Laboratory at the Manned Spacecraft Center (MSC) in Houston, Texas. Happily posing for the photograph with the rock container are (L-R) Richard S. Johnston (back), special assistant to the MSC Director; George M. Low, MSC Apollo Spacecraft Program manager; George S. Trimble (back), MSC Deputy Director; Lt. General Samuel C. Phillips, Apollo Program Director, Office of Manned Spaceflight at NASA headquarters; Eugene G. Edmonds, MSC Photographic Technology Laboratory; Dr. Thomas O. Paine, NASA Administrator; and Dr. Robert R. Gilruth, MSC Director.

Topographic Change Detection at Select Archeological Sites in Grand Canyon National Park, Arizona, 2006-2007

USGS Publications Warehouse

Collins, Brian D.; Minasian, Diane L.; Kayen, Robert

2009-01-01

Topographic change of archeological sites within the Colorado River corridor of Grand Canyon National Park (GCNP) is a subject of interest to National Park Service managers and other stakeholders in the Glen Canyon Dam Adaptive Management Program. Although long-term topographic change resulting from a variety of natural processes is typical in the Grand Canyon region, a continuing debate exists on whether and how controlled releases from Glen Canyon Dam, located immediately upstream of GCNP, are impacting rates of site erosion, artifact transport, and the preservation of archeological resources. Continued erosion of archeological sites threatens both the archeological resources and our future ability to study evidence of past cultural habitation. Understanding the causes and effects of archaeological site erosion requires a knowledge of several factors including the location and magnitude of the changes occurring in relation to archeological resources, the rate of the changes, and the relative contribution of several potential causes, including sediment depletion associated with managed flows from Glen Canyon Dam, site-specific weather patterns, visitor impacts, and long-term climate change. To obtain this information, highly accurate, spatially specific data are needed from sites undergoing change. Using terrestrial lidar data collection techniques and novel TIN- and GRID-based change-detection post-processing methods, we analyzed topographic data for nine archeological sites. The data were collected using three separate data collection efforts spanning 16 months (May 2006 to September 2007). Our results documented positive evidence of erosion, deposition, or both at six of the nine sites investigated during this time interval. In addition, we observed possible signs of change at two of the other sites. Erosion was concentrated in established gully drainages and averaged 12 cm to 17 cm in depth with maximum depths of 50 cm. Deposition was concentrated at specific locations outside of drainages but generally was spread over larger areas (tens to hundreds of square meters). Maximum depths of deposition averaged 12 cm to 15 cm and reached as much as 35 cm. Overall, we found that the spatial distribution and magnitudes of surface change are specific to each site and that a thorough understanding of the geomorphology, weather, and sand supply is requisite for a complete understanding of the data. Additional work in combining these results with site-specific weather, hydrology, and geomorphology data will assist in the development of working models for determining the causes of the documented topographic changes.

Results from the Veterans Health Administration ICD-10-CM/PCS Coding Pilot Study.

PubMed

Weems, Shelley; Heller, Pamela; Fenton, Susan H

2015-01-01

The Veterans Health Administration (VHA) of the US Department of Veterans Affairs has been preparing for the October 1, 2015, conversion to the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedural Coding System (ICD-10-CM/PCS) for more than four years. The VHA's Office of Informatics and Analytics ICD-10 Program Management Office established an ICD-10 Learning Lab to explore expected operational challenges. This study was conducted to determine the effects of the classification system conversion on coding productivity. ICD codes are integral to VHA business processes and are used for purposes such as clinical studies, performance measurement, workload capture, cost determination, Veterans Equitable Resource Allocation (VERA) determination, morbidity and mortality classification, indexing of hospital records by disease and operations, data storage and retrieval, research purposes, and reimbursement. The data collection for this study occurred in multiple VHA sites across several months using standardized methods. It is commonly accepted that coding productivity will decrease with the implementation of ICD-10-CM/PCS. The findings of this study suggest that the decrease will be more significant for inpatient coding productivity (64.5 percent productivity decrease) than for ambulatory care coding productivity (6.7 percent productivity decrease). This study reveals the following important points regarding ICD-10-CM/PCS coding productivity: 1. Ambulatory care ICD-10-CM coding productivity is not expected to decrease as significantly as inpatient ICD-10-CM/PCS coding productivity. 2. Coder training and type of record (inpatient versus outpatient) affect coding productivity. 3. Inpatient coding productivity is decreased when a procedure requiring ICD-10-PCS coding is present. It is highly recommended that organizations perform their own analyses to determine the effects of ICD-10-CM/PCS implementation on coding productivity.

Results from the Veterans Health Administration ICD-10-CM/PCS Coding Pilot Study

PubMed Central

Weems, Shelley; Heller, Pamela; Fenton, Susan H.

2015-01-01

The Veterans Health Administration (VHA) of the US Department of Veterans Affairs has been preparing for the October 1, 2015, conversion to the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedural Coding System (ICD-10-CM/PCS) for more than four years. The VHA's Office of Informatics and Analytics ICD-10 Program Management Office established an ICD-10 Learning Lab to explore expected operational challenges. This study was conducted to determine the effects of the classification system conversion on coding productivity. ICD codes are integral to VHA business processes and are used for purposes such as clinical studies, performance measurement, workload capture, cost determination, Veterans Equitable Resource Allocation (VERA) determination, morbidity and mortality classification, indexing of hospital records by disease and operations, data storage and retrieval, research purposes, and reimbursement. The data collection for this study occurred in multiple VHA sites across several months using standardized methods. It is commonly accepted that coding productivity will decrease with the implementation of ICD-10-CM/PCS. The findings of this study suggest that the decrease will be more significant for inpatient coding productivity (64.5 percent productivity decrease) than for ambulatory care coding productivity (6.7 percent productivity decrease). This study reveals the following important points regarding ICD-10-CM/PCS coding productivity: Ambulatory care ICD-10-CM coding productivity is not expected to decrease as significantly as inpatient ICD-10-CM/PCS coding productivity.Coder training and type of record (inpatient versus outpatient) affect coding productivity.Inpatient coding productivity is decreased when a procedure requiring ICD-10-PCS coding is present. It is highly recommended that organizations perform their own analyses to determine the effects of ICD-10-CM/PCS implementation on coding productivity. PMID:26396553

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

Beaudry, J.; Bergman, A.; British Columbia Cancer Agency - Vancouver Centre, Vancouver, BC

Lung tumours move due to respiratory motion. This is managed during planning by acquiring a 4DCT and capturing the excursion of the GTV (gross tumour volume) throughout the breathing cycle within an IGTV (Internal Gross Tumour Volume) contour. Patients undergo a verification cone-beam CT (CBCT) scan immediately prior to treatment. 3D reconstructed images do not consider tumour motion, resulting in image artefacts, such as blurring. This may lead to difficulty in identifying the tumour on reconstructed images. It would be valuable to create a 4DCBCT reconstruction of the tumour motion to confirm that does indeed remain within the planned IGTV.more » CBCT projections of a Quasar Respiratory Motion Phantom are acquired in Treatment mode (half-fan scan) on a Varian TrueBeam accelerator. This phantom contains a mobile, low-density lung insert with an embedded 3cm diameter tumour object. It is programmed to create a 15s periodic, 2cm (sup/inf) displacement. A Varian Real-time Position Management (RPM) tracking-box is placed on the phantom breathing platform. Breathing phase information is automatically integrated into the projection image files. Using in-house Matlab programs and RTK (Reconstruction Tool Kit) open-source toolboxes, the projections are re-binned into 10 phases and a 4DCBCT scan reconstructed. The planning IGTV is registered to the 4DCBCT and the tumour excursion is verified to remain within the planned contour. This technique successfully reconstructs 4DCBCT images using clinical modes for a breathing phantom. UBC-BCCA ethics approval has been obtained to perform 4DCBCT reconstructions on lung patients (REB#H12-00192). Clinical images will be accrued starting April 2014.« less

Clinical case management for patients with schizophrenia with high care needs.

PubMed

Mas-Expósito, Laia; Amador-Campos, Juan Antonio; Gómez-Benito, Juana; Mauri-Mas, Lluís; Lalucat-Jo, Lluís

2015-02-01

The aim of this study is to establish the effectiveness of a clinical case management (CM) programme compared to a standard treatment programme (STP) in patients with schizophrenia. Patients for the CM programme were consecutively selected among patients in the STP with schizophrenia who had poor functioning. Seventy-five patients were admitted to the CM programme and were matched to 75 patients in the STP. Patients were evaluated at baseline and at 1 year follow-up. At baseline, patients in the CM programme showed lower levels of clinical and psychosocial functioning and more care needs than patients in the STP. Both treatment programmes were effective in maintaining contact with services but the CM programme did not show advantages over the STP on outcomes. Differences between groups at baseline may be masking the effects of CM at one year follow-up. A longer follow-up may be required to evaluate the real CM practices effects.

SSE software test management STM capability: Using STM in the Ground Systems Development Environment (GSDE)

NASA Technical Reports Server (NTRS)

Church, Victor E.; Long, D.; Hartenstein, Ray; Perez-Davila, Alfredo

1992-01-01

This report is one of a series discussing configuration management (CM) topics for Space Station ground systems software development. It provides a description of the Software Support Environment (SSE)-developed Software Test Management (STM) capability, and discusses the possible use of this capability for management of developed software during testing performed on target platforms. This is intended to supplement the formal documentation of STM provided by the SEE Project. How STM can be used to integrate contractor CM and formal CM for software before delivery to operations is described. STM provides a level of control that is flexible enough to support integration and debugging, but sufficiently rigorous to insure the integrity of the testing process.

Cryptococcal meningitis management in Tanzania with strict schedule of serial lumber punctures using intravenous tubing sets: an operational research study.

PubMed

Meda, John; Kalluvya, Samuel; Downs, Jennifer A; Chofle, Awilly A; Seni, Jeremiah; Kidenya, Benson; Fitzgerald, Daniel W; Peck, Robert N

2014-06-01

Cryptococcal meningitis (CM) has a mortality rate of ∼70% among HIV-infected adults in low-income countries. Controlling intracranial pressure (ICP) is essential in CM, but it is difficult in low-income countries because manometers and practical ICP management protocols are lacking. As part of a continuous quality improvement project, our Tanzanian hospital initiated a new protocol for ICP management for CM. All adult inpatients with CM are included in a prospective patient registry. At the time of analysis, this registry included data from 2 years before the initiation of this new ICP management protocol and for a 9-month period after. ICP was measured at baseline and at days 3, 7, and 14 by both manometer and intravenous (IV) tubing set. All patients were given IV fluconazole according to Tanzanian treatment guidelines and were followed until 30 days after admission. Among adult inpatients with CM, 32 of 35 patients (91%) had elevated ICP on admission. Cerebrospinal fluid pressure measurements using the improvised IV tubing set demonstrated excellent agreement (r = 0.96) with manometer measurements. Compared with historical controls, the new ICP management protocol was associated with a significant reduction in 30-day mortality (16/35 [46%] vs. 48/64 [75%] in historical controls; hazard ratio = 2.1 [95% CI: 1.1 to 3.8]; P = 0.018]. Increased ICP is almost universal among HIV-infected adults admitted with CM in Tanzania. Intensive ICP management with a strict schedule of serial lumbar punctures reduced in-hospital mortality compared with historical controls. ICP measurement with IV tubing sets may be a good alternative in resource-limited health facilities where manometers are not available.

Software Maintenance Exercises for a Software Engineering Project Course

DTIC Science & Technology

1989-02-01

what is program style and how can it be measured? Program style has been defined as a "followed convention with respect to punctuation, capitalization ...convention with respect to punctuation, capitalization , and typographic arrangement and display." *DASC is a software tool that takes a syntactically...Specilleauons: A Frarnewo* * CM-12 Software Metrws CM- 13 Introduction to Softwarell Verification and Validation CM-14 Intelectual Property Protection for

Performance measurement for case management: principles and objectives for developing standard measures.

PubMed

Howe, Rufus

2005-01-01

Developing standardized performance measurements for case management (CM) has become the holy grail of the field. The Council for Case Management Accountability (CCMA), a leadership committee of the Case Management Society of America (CMSA), has been grappling with the concept since early 2003. This article lays out a theoretical framework for performance measurement and then outlines the progress on a specific initiative begun by CCMA to correlate CM practices with improved outcome measures.

Essential activities and knowledge domains of case management: new insights from the CCMC role and functions study.

PubMed

Tahan, Hussein

2006-01-01

The Commission for Case Manager Certification (CCMC) defines case management (CM) as "a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs. [Case management] uses communication and available resources to promote quality, cost-effective outcomes." The practice of CM spans the entire health-care spectrum, including pre-acute, acute, and post-acute settings, and the involvement of varied care providers, such as nurses, social workers, rehabilitation counselors, physicians, and other allied health professionals. So what does it mean to practice as a case manager? What roles and job functions are performed and what knowledge is required of a professional in the field for effective practice? These highly relevant questions reflect the thinking of the CCMC commissioners when the latest Case Manager Role and Functions study was undertaken. The primary purpose of this research, which is conducted every 5 years by the CCMC, is to capture the current state of CM practice. This type of in-depth research is required to support an evidence-based certification examination such as the one offered by CCMC-the certified case manager (CCM) credential. Moreover, as the first and largest nationally accredited organization to certify US case managers, the CCMC recognizes its responsibility to undertake and promote scientifically conducted research in the field of CM.

Electrostatic thrusters.

NASA Technical Reports Server (NTRS)

Kaufman, H. R.; Reader, P. D.

1972-01-01

The current status of research and development programs on electrostatic thrusters is reviewed. Current programs that utilize mercury electron-bombardment thrusters range from 5- to 30-cm in diameter. Recent progress on the 5-cm thruster has emphasized durability, with accelerator time exceeding 6300 hours and total time on the rest of the thruster exceeding 8300 hours. Recent progress on the 30-cm thruster has been outstanding in dished-grid accelerator systems. Ion beams up to 5 amperes have been obtained for short periods with 1000 volts net accelerating potential difference. The cesium electron-bombardment and cesium contact programs are also described.

Impact of a Dialectic Behavior Therapy - Corrections Modified (DBT-CM) Upon Behaviorally Challenged Incarcerated Male Adolescents

PubMed Central

Shelton, Deborah; Kesten, Karen; Zhang, Wanli; Trestman, Robert

2011-01-01

Purpose This article reports the findings of a Dialectical Behavioral Therapy- Corrections Modified (DBT-CM) intervention upon difficult to manage, impulsive and/or aggressive incarcerated male adolescents. Methods A secondary analysis of a sub-sample of 38 male adolescents who participated in the study was conducted. A one-group pretest-posttest design was used; descriptive statistics and t-tests were conducted. Results Significant changes were found in physical aggression, distancing coping methods and number of disciplinary tickets for behavior. Conclusion The study supports the value of DBT-CM for management of incarcerated male adolescents with difficult to manage aggressive behaviors. PMID:21501287

Disease severity is associated with the use of complementary medicine to treat or manage type-2 diabetes: data from the 2002 and 2007 National Health Interview Survey.

PubMed

Nahin, Richard L; Byrd-Clark, Danita; Stussman, Barbara J; Kalyanaraman, Nilesh

2012-10-22

The overall prevalence of complementary medicine (CM) use among adults in the United States with diabetes has been examined both in representative national samples and in more restricted populations. However, none of these earlier studies attempted to identify predictors of CM use to treat diabetes among the populations sampled, nor looked for a relationship between CM use and diabetes severity. Combining data from the 2002 and 2007 National Health Interview Survey (NHIS), we constructed a nationally representative sample of 3,978 U.S. adults aged ≥18 years with self-reported diabetes. Both the 2002 and 2007 NHIS contained extensive questions on the use of CM. We used logistic regression to examine the association between diabetes severity and overall CM use, as well as the use of specific categories of CM. In adults with type-2 diabetes, 30.9% used CM for any reason, but only 3.4% used CM to treat or manage their type-2 diabetes versus 7.1% of those with type-1 diabetes. Among those using CM to treat/manage their type-2 diabetes, 77% used both CM and conventional prescription medicine for their diabetes. The most prevalent types of CM therapies used were diet-based interventions (35.19%, S.E. 5.11) and non-vitamin/non-mineral dietary supplements (33.74%, S.E. 5.07). After controlling for sociodemographic factors, we found that, based on a count of measures of diabetes severity, persons with the most severe diabetes had nearly twice the odds of using CM as those with less severe disease (OR=1.9, 95%CI 1.2-3.01). Persons who had diabetes 10 years or more (OR=1.66, 95%CI 1.04-3.66) and those that had a functional limitation resulting from their diabetes (OR=1.74, 95%CI 1.09-2.8) had greater odds of using CM than those not reporting these measures. No significant associations were observed between overall CM use and other individual measures of diabetes severity: use of diabetic medications, weak or failing kidneys, coronary heart disease, or severe vision problems. Our results demonstrate that individuals with more severe diabetes are more likely to use CM independent of sociodemographic factors. Further studies are essential to determine if CM therapies actually improve clinical outcomes when used to treat/manage diabetes.

Disease severity is associated with the use of complementary medicine to treat or manage type-2 diabetes: data from the 2002 and 2007 National Health Interview Survey

PubMed Central

2012-01-01

Background The overall prevalence of complementary medicine (CM) use among adults in the United States with diabetes has been examined both in representative national samples and in more restricted populations. However, none of these earlier studies attempted to identify predictors of CM use to treat diabetes among the populations sampled, nor looked for a relationship between CM use and diabetes severity. Methods Combining data from the 2002 and 2007 National Health Interview Survey (NHIS), we constructed a nationally representative sample of 3,978 U.S. adults aged ≥18 years with self-reported diabetes. Both the 2002 and 2007 NHIS contained extensive questions on the use of CM. We used logistic regression to examine the association between diabetes severity and overall CM use, as well as the use of specific categories of CM. Results In adults with type-2 diabetes, 30.9% used CM for any reason, but only 3.4% used CM to treat or manage their type-2 diabetes versus 7.1% of those with type-1 diabetes. Among those using CM to treat/manage their type-2 diabetes, 77% used both CM and conventional prescription medicine for their diabetes. The most prevalent types of CM therapies used were diet-based interventions (35.19%, S.E. 5.11) and non-vitamin/non-mineral dietary supplements (33.74%, S.E. 5.07). After controlling for sociodemographic factors, we found that, based on a count of measures of diabetes severity, persons with the most severe diabetes had nearly twice the odds of using CM as those with less severe disease (OR=1.9, 95%CI 1.2-3.01). Persons who had diabetes 10 years or more (OR=1.66, 95%CI 1.04-3.66) and those that had a functional limitation resulting from their diabetes (OR=1.74, 95%CI 1.09-2.8) had greater odds of using CM than those not reporting these measures. No significant associations were observed between overall CM use and other individual measures of diabetes severity: use of diabetic medications, weak or failing kidneys, coronary heart disease, or severe vision problems. Conclusions Our results demonstrate that individuals with more severe diabetes are more likely to use CM independent of sociodemographic factors. Further studies are essential to determine if CM therapies actually improve clinical outcomes when used to treat/manage diabetes. PMID:23088705

Better management of cow's milk allergy using a very low dose food challenge test: a retrospective study.

PubMed

Okada, Yu; Yanagida, Noriyuki; Sato, Sakura; Ebisawa, Motohiro

2015-07-01

Low dose reactive cow's milk (CM) allergic children are at high risk of persistent CM allergy and a positive oral food challenge (OFC). The present study aimed to evaluate if the results of a very low dose (VL) OFC with these children contributes to better management of CM allergy. We retrospectively reviewed subjects with CM allergy who underwent a VL OFC with 3 mL heated CM and had a previous allergic reaction to <25 mL heated CM in the 2 years before the OFC. Subjects who passed the OFC were defined as VL tolerant, and subjects who failed were defined as VL reactive. VL tolerant subjects increased the dose to 25 mL heated CM either during an OFC in our hospital or gradually at home. Of the 83 subjects (median age, 4.3 years; range, 1.0-12.9 years) who were included, 41 (49.4%) were VL tolerant, and 42 (51.6%) were VL reactive. Thirty-nine VL reactive subjects had skin and/or respiratory symptoms during the OFC. Most reactions could be treated with an antihistamine and/or a nebulized β2 agonist. The VL tolerant subjects consumed 3 mL heated CM or 10 g butter. Within the year following the OFC, 18 VL tolerant subjects (45.0%), but none of the VL reactive subjects, were able to consume 25 mL heated CM (p < 0.001). A VL OFC allows the management of some low dose reactive CM allergic children to change from complete avoidance to partial intake of CM. Copyright © 2015 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

Incidence of clinical mastitis and distribution of pathogens on large Chinese dairy farms.

PubMed

Gao, Jian; Barkema, Herman W; Zhang, Limei; Liu, Gang; Deng, Zhaoju; Cai, Lingjie; Shan, Ruixue; Zhang, Shiyao; Zou, Jiaqi; Kastelic, John P; Han, Bo

2017-06-01

Knowledge of the incidence of clinical mastitis (CM) and the distribution of pathogens involved is essential for development of prevention and control programs as well as treatment protocols. No country-wide study on the incidence of CM and the distribution of pathogens involved has been conducted in China. Core objectives of this study were, therefore, to determine the cumulative incidence of CM and the distribution of pathogens causing CM on large Chinese (>500 cows) dairy farms. In addition, associations between the distribution of CM pathogens and bedding materials and seasonal factors were also investigated. Bacterial culture was done on a total of 3,288 CM quarter milk samples from 161 dairy herds (located in 21 provinces) between March 2014 and September 2016. Additional data, including geographical region of herds, herd size, bedding types, and number of CM cases during the last month, were also recorded. Mean cumulative incidence of CM was 3.3 cases per 100 cows per month (range = 1.7 to 8.1). The most frequently isolated pathogens were Escherichia coli (14.4%), Klebsiella spp. (13.0%), coagulase-negative staphylococci (11.3%), Streptococcus dysgalactiae (10.5%), and Staphylococcus aureus (10.2%). Streptococcus agalactiae was isolated from 2.8% of CM samples, whereas Streptococcus uberis were isolated from 2.1% of samples, and 15.8% of 3,288 samples were culture-negative. Coagulase-negative staphylococci, E. coli, and other Enterobacter spp. were more frequently isolated in the northwest than the northeast or south of China. Streptococcus dysgalactiae, other streptococci, and Strep. agalactiae were more frequently isolated in winter (October-March), whereas E. coli and Klebsiella spp. were mostly isolated in summer (April-September). Streptococcus dysgalactiae was more often isolated from CM cases of herds using sand bedding, whereas Klebsiella spp. and other streptococci were more common in herds using organic bedding. The incidence of CM and distribution of pathogens differed among herds and better mastitis management is needed. Furthermore, geography, bedding materials, and season should be included when designing mastitis control and prevention schemes for Chinese dairies. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Weight-Related Goal Setting in a Telephone-Based Preventive Health-Coaching Program: Demonstration of Effectiveness.

PubMed

O'Hara, Blythe J; Gale, Joanne; McGill, Bronwyn; Bauman, Adrian; Hebden, Lana; Allman-Farinelli, Margaret; Maxwell, Michelle; Phongsavan, Philayrath

2017-11-01

This study investigated whether participants in a 6-month telephone-based coaching program, who set physical activity, nutrition, and weight loss goals had better outcomes in these domains. Quasi-experimental design. The Australian Get Healthy Information and Coaching Service (GHS), a free population-wide telephone health-coaching service that includes goal setting as a key component of its coaching program. Consenting GHS coaching participants who had completed coaching between February 2009 and December 2012 (n = 4108). At baseline, participants select a goal for the coaching program, and sociodemographic variables are collected. Self-reported weight, height, waist circumference, physical activity, and nutrition-related behaviors are assessed at baseline and 6 months. Descriptive analysis was performed on key sociodemographic variables, and the relationship between goal type and change in health outcomes was assessed using a series of linear mixed models that modeled change from baseline to 6 months. Participants who set goals in relation to weight management and physical activity achieved better results in these areas than those who set alternate goals, losing more than those who set alternate goals (1.5 kg and 0.9 cm in waist circumference) and increasing walking per week (40 minutes), respectively. There was no difference in food-related outcomes for those that set nutrition-related goals. Goal setting for weight management and increasing physical activity in the overweight and obese population, undertaken in a telephone-based coaching program, can be effective.

The GReat-Child™ Trial: A Quasi-Experimental Intervention on Whole Grains with Healthy Balanced Diet to Manage Childhood Obesity in Kuala Lumpur, Malaysia

PubMed Central

Koo, Hui Chin; Poh, Bee Koon; Abd Talib, Ruzita

2018-01-01

Background: The GReat-Child Trial was a quasi-experimental intervention that has emphasized whole grain as a strategy to manage childhood obesity. Methods: Two schools in Kuala Lumpur with similar demographic characteristics were assigned as intervention (IG) and control (CG). Eligibility criteria were overweight/obese children aged 9 to 11 years who had no serious co-morbidity. Children who reported consuming wholegrain foods in their 3-day diet-recall during screening were excluded. A total of 63 children (31 IG; 32 CG) completed the entire intervention program. The IG children underwent six 30-min nutrition education lessons and had school delivery of wholegrain food on a daily basis over a 12-week period. Parents of IG children attended 1-h individual diet counseling. Anthropometric outcomes including BMI-for-age z-score (BAZ), body fat percentage and waist circumference were measured at baseline [T0], post-intervention [T1] (3rd month) and follow-up [T2] (9th month). Results: IG showed significantly lower BAZ (weighted difference: −0.12; 95% CI: −0.21, −0.03; p = 0.009), body fat percentage (weighted difference: −2.6%; 95% CI: −3.7, −1.5; p < 0.001) and waist circumference (weighted difference: −2.4 cm; 95% CI: −3.8, −1.0; p = 0.001) compared to CG. IG reported significantly lower body fat percentage (weighted difference: −3.4%; 95% CI: 1.8, 5.0; p < 0.001) and waist circumference (weighted difference: −2.1 cm; 95% CI: −3.7, −0.5; p = 0.014) at T1 compared to T0. Conclusions: The GReat-Child Trial made a positive impact in managing childhood obesity. It can be incorporated into childhood obesity intervention programs that are being implemented by the policy makers. PMID:29385769

Outreach program by measurements of frost depth in Japan

NASA Astrophysics Data System (ADS)

Harada, K.; Yoshikawa, K.; Iwahana, G.; Stanilovskaya, J. V.; Sawada, Y.

2015-12-01

In order to emphasis their interest for earth sciences, an outreach program through measurements of frost depth is conducting in Japan since 2011. This program is made at elementary, junior high and high schools in Hokkaido, northern part of Japan where seasonal ground freezing occurs in winter. At schools, a lecture was made and a frost tube was set at schoolyard, as the same tube and protocol as UAF's Permafrost Outreach Program, using clear tube with blue-colored water. Frost depth was measured directly once a week at each school by students during ground freezing under no snow-removal condition. In 2011 season, we started this program at three schools, and the number of participated school is extended to 29 schools in 2014 winter season, 23 elementary schools, 5 junior high schools and one high school. We visited schools summer time and just before frost season to talk about the method of measurement. After the end of measured period, we also visited schools to explain measured results by each school and the other schools in Japan, Alaska, Canada and Russia. The measured values of frost depth in Hokkaido were ranged between 0cm and more than 50cm. We found that the frost depth depends on air temperature and snow depth. We discussed with student why the frost depth ranged widely and explained the effect of snow by using the example of igloo. In order to validate the effect of snow and to compare frost depths, we tried to measure frost depths under snow-removal and no snow-removal conditions at one elementary school. At the end of December, depths had no significant difference between these conditions, 11cm and 10cm, and the difference went to 14cm, 27cm and 13cm after one month, with about 30cm of snow depth. After these measurements and lectures, students noticed snow has a role as insulator and affects the frost depth. The network of this program will be expected to expand, finally more than a hundred schools.

Effects of a long-term lifestyle intervention program with Mediterranean diet and exercise for the management of patients with metabolic syndrome in a primary care setting.

PubMed

Gomez-Huelgas, R; Jansen-Chaparro, S; Baca-Osorio, A J; Mancera-Romero, J; Tinahones, F J; Bernal-López, M R

2015-06-01

The impact of a lifestyle intervention (LSI) program for the long-term management of subjects with metabolic syndrome in a primary care setting is not known. This 3-year prospective controlled trial randomized adult subjects with metabolic syndrome to receive intensive LSI or to usual care in a community health centre in Malaga, Spain. LSI subjects received instruction on Mediterranean diet and a regular aerobic exercise program by their primary care professionals. Primary outcome included changes from baseline on different components of metabolic syndrome (abdominal circumference, blood pressure, HDL-cholesterol, fasting plasma glucose and triglycerides). Among the 2,492 subjects screened, 601 subjects with metabolic syndrome (24.1%) were randomized to LSI (n = 298) or to usual care (n = 303); of them, a 77% and a 58%, respectively, completed the study. At the end of the study period, LSI resulted in significant differences vs. usual care in abdominal circumference (-0.4 ± 6 cm vs. + 2.1 ± 6.7 cm, p < 0.001), systolic blood pressure (-5.5 ± 15 mmHg vs. -0.6 ± 19 mmHg, p = 0.004), diastolic blood pressure (-4.6 ± 10 mmHg vs. -0.2 ± 13 mmHg, p < 0.001) and HDL-cholesterol (+4 ± 12 mg/dL vs. + 2 ± 12 mg/dL, p = 0.05); however, there were no differences in fasting plasma glucose and triglyceride concentration (-4 ± 35 mg/dl vs. -1 ± 32 mg/dl, p = 0.43 and -0.4 ± 83 mg/dl vs. +6 ± 113 mg/dl, p = 0.28). Intensive LSI counseling provided by primary care professionals resulted in significant improvements in abdominal circumference, blood pressure and HDL-cholesterol but had limited effects on glucose and triglyceride levels in patients with metabolic syndrome. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Interdependent Group Contingency Management for Cocaine-Dependent Methadone Maintenance Patients

ERIC Educational Resources Information Center

Kirby, Kimberly C.; Kerwin, MaryLouise E.; Carpenedo, Carolyn M.; Rosenwasser, Beth J.; Gardner, Robert S.

2008-01-01

Contingency management (CM) for drug abstinence has been applied to individuals independently even when delivered in groups. We developed a group CM intervention in which the behavior of a single, randomly selected, anonymous individual determined reinforcement delivery for the entire group. We also compared contingencies placed only on cocaine…

Managing an invasive corallimorph at Palmyra Atoll National Wildlife Refuge, Line Islands, Central Pacific

USGS Publications Warehouse

Work, Thierry M.; Aeby, Greta S.; Neal, Benjamin P.; Price, Nichole N.; Conklin, Eric; Pollock, Amanda

2018-01-01

In 2007, a phase shift from corals to corallimorpharians (CM) centered around a shipwreck was documented at Palmyra Atoll, Line Islands. Subsequent surveys revealed CM to be overgrowing the reef benthos, including corals and coralline algae, potentially placing coral ecosystems in the atoll at risk. This prompted the U.S. Fish and Wildlife Service, the lead management agency of the atoll, to remove the shipwreck. Subsequent surveys showed reductions in CM around the ship impact site. We explain patterns of spread of the CM in terms of both life history and local currents and show with a pilot study that pulverized bleach may be an effective tool to eradicate CM on a local scale. If applied strategically, particularly in heavily infested (> 66% cover) areas, active intervention such as this could be an effective management tool to reduce CM impact on localized areas and decrease colonization rate of remaining reefs. This is the first documentation of the response of an invasive cnidarian to shipwreck removal. While this was a singular event in Palmyra, the spatial and temporal patterns of this invasion and the eradications lessons described herein, are useful for anticipating and controlling similar situations elsewhere.

A laboratory-based evaluation of exercise plus contingency management for reducing cigarette smoking.

PubMed

Kurti, Allison N; Dallery, Jesse

2014-11-01

Both contingency management (CM) and exercise have shown promise as smoking cessation treatments, but their combined effects have not been evaluated. The present study evaluated whether CM (in which motivational incentives are provided for abstinence) plus exercise reduced smoking more than either component alone. In a within-subjects design, 20 smokers were exposed to exercise plus CM, exercise plus CM-control (non-contingent incentives), inactivity plus CM, and inactivity plus CM-control. CM increased latencies to smoke and decreased total puffs (Mdns = 39.6 min and .8 puffs, respectively) relative to CM-control (Mdns = 2.5 min and 12.8 puffs). Exercise decreased craving relative to baseline for craving based on both the pleasurable consequences of smoking (D=-10.7 on a 100-point visual analog scale) and anticipated relief from withdrawal (D=-5.9), whereas inactivity increased both components of craving (Ds=7.6 and 3.5). Exercise had no effect on smoking or a measure of temporal discounting. Although exercise decreased craving, it did not affect smoking behavior. Exercise plus CM was not more effective than CM alone. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

An economic analysis of conservative management versus active treatment for men with localized prostate cancer.

PubMed

Perlroth, Daniella J; Bhattacharya, Jay; Goldman, Dana P; Garber, Alan M

2012-12-01

Comparative effectiveness research suggests that conservative management (CM) strategies are no less effective than active initial treatment for many men with localized prostate cancer. We estimate longer-term costs of initial management strategies and potential US health expenditure savings by increased use of conservative management for men with localized prostate cancer. Five-year total health expenditures attributed to initial management strategies for localized prostate cancer were calculated using commercial claims data from 1998 to 2006, and savings were estimated from a US population health-care expenditure model. Our analysis finds that patients receiving combinations of active treatments have the highest additional costs over conservative management at $63 500, followed by $48 550 for intensity-modulated radiation therapy, $37 500 for primary androgen deprivation therapy, and $28 600 for brachytherapy. Radical prostatectomy ($15 200) and external beam radiation therapy ($18 900) were associated with the lowest costs. The population model estimated that US health expenditures could be lowered by 1) use of initial CM over all active treatment ($2.9-3.25 billion annual savings), 2) shifting patients receiving intensity-modulated radiation therapy to CM ($680-930 million), 3) foregoing primary androgen deprivation therapy($555 million), 4) reducing the use of adjuvant androgen deprivation in addition to local therapies ($630 million), and 5) using single treatments rather than combination local treatment ($620-655 million). In conclusion, we find that all active treatments are associated with higher longer-term costs than CM. Substantial savings, representing up to 30% of total costs, could be realized by adopting CM strategies, including active surveillance, for initial management of men with localized prostate cancer.

Challenges in diagnosis and management of Cryptococcal immune reconstitution inflammatory syndrome (IRIS) in resource limited settings.

PubMed

Musubire, A K; Meya, B D; Mayanja-Kizza, H; Lukande, R; Wiesner, L D; Bohjanen, P; R Boulware, R D

2012-06-01

In many resource-limited settings, cryptococcal meningitis (CM) contributes up to 20% of all deaths with further complications due to Immune Reconstitution Inflammatory Syndrome (IRIS). We present a case report on a patient who developed CM-IRIS and then subsequent CM-relapse with a fluconazole-resistant organism and then later CM-IRIS once again, manifesting as cystic cryptococcomas, hydrocephalus, and sterile CSF. In this case we, demonstrate that CM-IRIS and persistent low level cryptococcal infection are not mutually exclusive phenomena. The management of IRIS with corticosteroids may increase the risk of culture positive CM-relapse which may further increase the risk of recurrent IRIS and resulting complications including death. We also highlight the role of imaging and fluconazole resistance testing in patients with recurrent meningitis and the importance of CSF cultures in guiding treatment decisions.

A large survey among European trainees in clinical microbiology and infectious disease on training systems and training adequacy: identifying the gaps and suggesting improvements.

PubMed

Yusuf, E; Ong, D S Y; Martin-Quiros, A; Skevaki, C; Cortez, J; Dedić, K; Maraolo, A E; Dušek, D; Maver, P J; Sanguinetti, M; Tacconelli, E

2017-02-01

The purpose of this investigation was to perform a survey among European clinical microbiology (CM) and infectious disease (ID) trainees on training satisfaction, training tools, and competency assessment. An online, anonymous survey in the English language was carried out between April and July 2015. There were 25 questions: seven in a 5-point Likert scale (1: worst scenario, 5: best scenario) and the remainder as closed multiple-choice questions in five areas (satisfaction, adequacy, system, mentorship, and evaluation of training). Included were 419 respondents (215 CM, 159 ID, and 45 combined CM/ID) from 31 European countries [mean age (standard deviation) 32.4 (5.3) years, 65.9 % women]. Regarding satisfaction on the training scheme, CM and ID scored 3.6 (0.9) and 3.2 (1.0), respectively. These scores varied between countries, ranging from 2.5 (1.0) for Italian ID to 4.3 (0.8) for Danish CM trainees. The majority of respondents considered training in management and health economics inadequate and e-learning and continuing medical education programs insufficient. Many trainees (65.3 % of CM and 62.9 % of ID) would like to have more opportunities to spend a part of their training abroad and expected their mentor to be more involved in helping with future career plans (63.5 % of CM and 53.4 % of ID) and practical skills (53.0 % of CM and 61.2 % of ID). Two-thirds of the respondents across the specialties agreed that a European exam should be developed, but half of them thought it should not be made mandatory. This survey shows high heterogeneity in training conditions in European countries, identifies perceived gaps in training, and suggests areas for improvements.

Ubiquitous CM and DM

NASA Technical Reports Server (NTRS)

Crowley, Sandra L.

2000-01-01

Ubiquitous is a real word. I thank a former Total Quality Coach for my first exposure some years ago to its existence. My version of Webster's dictionary defines ubiquitous as "present, or seeming to be present, everywhere at the same time; omnipresent." While I believe that God is omnipresent, I have come to discover that CM and DM are present everywhere. Oh, yes; I define CM as Configuration Management and DM as either Data or Document Management. Ten years ago, I had my first introduction to the CM world. I had an opportunity to do CM for the Space Station effort at the NASA Lewis Research Center. I learned that CM was a discipline that had four areas of focus: identification, control, status accounting, and verification. I was certified as a CMIl graduate and was indoctrinated about clear, concise, and valid. Off I went into a world of entirely new experiences. I was exposed to change requests and change boards first hand. I also learned about implementation of changes, and then of technical and CM requirements.

Effect of preweaning nutritional management on yearling weight response in an open-herd selection program.

PubMed

Hough, J D; Benyshek, L L

1988-10-01

Records on 276 progeny were collected in the final 2 yr (1984 and 1985) of an 8-yr Hereford cattle selection project. Selection was practiced using the top sires from the American Hereford Association's National Cattle Evaluation based on yearling weight expected progeny difference. An unselected control line was maintained to monitor environmental change. One-half of each line was creep-fed during the preweaning period for the last 2 yr to evaluate genotype x environment interactions. Direct response to yearling weight selection averaged 28 +/- 8 kg. Correlated response to selection amounted to .057 +/- .028 kg/d in preweaning ADG, 14 +/- 6 kg in weaning weight, .085 +/- .033 kg/d in postweaning ADG, 4.6 +/- 1.5 cm in yearling hip height and 11.2 +/- 3.0 cm2 in yearling pelvic area. Yearling fat thickness and scrotal circumference were not significantly affected by selection. Significant effects of creep feeding were observed for yearling weight (15 +/- 3 kg), preweaning ADG (.067 +/- .012 kg/d), weaning weight (13 +/- 2 kg), yearling hip height (1.2 +/- .5 cm) and yearling fat thickness (.07 +/- .03 cm). Postweaning ADG, yearling pelvic area and yearling scrotal circumference were not affected by creep feeding. No significant genetic group x creep feeding effects were found for any of the traits analyzed, indicating calves genetically superior for growth did not gain any additional advantage from creep feeding.

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

PubMed

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

2015-02-01

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

File format for normalizing radiological concentration exposure rate and dose rate data for the effects of radioactive decay and weathering processes

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

Kraus, Terrence D.

2017-04-01

This report specifies the electronic file format that was agreed upon to be used as the file format for normalized radiological data produced by the software tool developed under this TI project. The NA-84 Technology Integration (TI) Program project (SNL17-CM-635, Normalizing Radiological Data for Analysis and Integration into Models) investigators held a teleconference on December 7, 2017 to discuss the tasks to be completed under the TI program project. During this teleconference, the TI project investigators determined that the comma-separated values (CSV) file format is the most suitable file format for the normalized radiological data that will be outputted frommore » the normalizing tool developed under this TI project. The CSV file format was selected because it provides the requisite flexibility to manage different types of radiological data (i.e., activity concentration, exposure rate, dose rate) from other sources [e.g., Radiological Assessment and Monitoring System (RAMS), Aerial Measuring System (AMS), Monitoring and Sampling). The CSV file format also is suitable for the file format of the normalized radiological data because this normalized data can then be ingested by other software [e.g., RAMS, Visual Sampling Plan (VSP)] used by the NA-84’s Consequence Management Program.« less

School Asthma Screening and Case Management: Attendance and Learning Outcomes

ERIC Educational Resources Information Center

Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

2013-01-01

Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

Contingency Management Improves Abstinence and Quality of Life in Cocaine Abusers

ERIC Educational Resources Information Center

Petry, Nancy M.; Alessi, Sheila M.; Hanson, Tressa

2007-01-01

Contingency management (CM) treatments enhance drug abstinence. This study evaluated whether CM also improves quality of life and if these effects are mediated by abstinence. Across 3 independent trials, cocaine abusers in intensive outpatient treatment (n = 387) were randomly assigned to 12 weeks of standard treatment as usual or standard…

A Randomized Trial of Contingency Management Delivered in the Context of Group Counseling

ERIC Educational Resources Information Center

Petry, Nancy M.; Weinstock, Jeremiah; Alessi, Sheila M.

2011-01-01

Objective: Contingency management (CM) is efficacious in reducing drug use. Typically, reinforcers are provided on an individual basis to patients for submitting drug-negative samples. However, most treatment is provided in a group context, and poor attendance is a substantial concern. This study evaluated whether adding CM to group-based…

Application of gaseous core reactors for transmutation of nuclear waste

NASA Technical Reports Server (NTRS)

Schnitzler, B. G.; Paternoster, R. R.; Schneider, R. T.

1976-01-01

An acceptable management scheme for high-level radioactive waste is vital to the nuclear industry. The hazard potential of the trans-uranic actinides and of key fission products is high due to their nuclear activity and/or chemical toxicity. Of particular concern are the very long-lived nuclides whose hazard potential remains high for hundreds of thousands of years. Neutron induced transmutation offers a promising technique for the treatment of problem wastes. Transmutation is unique as a waste management scheme in that it offers the potential for "destruction" of the hazardous nuclides by conversion to non-hazardous or more manageable nuclides. The transmutation potential of a thermal spectrum uranium hexafluoride fueled cavity reactor was examined. Initial studies focused on a heavy water moderated cavity reactor fueled with 5% enriched U-235-F6 and operating with an average thermal flux of 6 times 10 to the 14th power neutrons/sq cm-sec. The isotopes considered for transmutation were I-129, Am-241, Am-242m, Am-243, Cm-243, Cm-244, Cm-245, and Cm-246.

Spin Forming Aluminum Crew Module (CM) Metallic Aft Pressure Vessel Bulkhead (APVBH) - Phase II

NASA Technical Reports Server (NTRS)

Hoffman, Eric K.; Domack, Marcia S.; Torres, Pablo D.; McGill, Preston B.; Tayon, Wesley A.; Bennett, Jay E.; Murphy, Joseph T.

2015-01-01

The principal focus of this project was to assist the Multi-Purpose Crew Vehicle (MPCV) Program in developing a spin forming fabrication process for manufacture of the Orion crew module (CM) aft pressure vessel bulkhead. The spin forming process will enable a single piece aluminum (Al) alloy 2219 aft bulkhead resulting in the elimination of the current multiple piece welded construction, simplify CM fabrication, and lead to an enhanced design. Phase I (NASA TM-2014-218163 (1)) of this assessment explored spin forming the single-piece CM forward pressure vessel bulkhead. The Orion MPCV Program and Lockheed Martin (LM) recently made two critical decisions relative to the NESC Phase I work scope: (1) LM selected the spin forming process to manufacture a single-piece aft bulkhead for the Orion CM, and (2) the aft bulkhead will be manufactured from Al 2219. Based on the Program's new emphasis related to the spin forming process, the NESC was asked to conduct a Phase II assessment to assist in the LM manufacture of the aft bulkhead and to conduct a feasibility study into spin forming the Orion CM cone. This activity was approved on June 19, 2013. Dr. Robert Piascik, NASA Technical Fellow for Materials at the Langley Research Center (LaRC), was selected to lead this assessment. The project plan was approved by the NASA Engineering and Safety Center (NESC) Review Board (NRB) on July 18, 2013. The primary stakeholders for this assessment were the NASA and LM MPCV Program offices. Additional benefactors are commercial launch providers developing CM concepts.

Spin Forming Aluminum Crew Module (CM) Metallic Aft Pressure Vessel Bulkhead (APVBH) - Phase II

NASA Technical Reports Server (NTRS)

Hoffman, Eric K.; Domack, Marcia S.; Torres, Pablo D.; McGill, Preston B.; Tayon, Wesley A.; Bennett, Jay E.; Murphy, Joseph T.

2015-01-01

The principal focus of this project was to assist the Multi-Purpose Crew Vehicle (MPCV) program in developing a spin forming fabrication process for manufacture of the Orion crew module (CM) aft pressure vessel bulkhead. The spin forming process will enable a single piece aluminum (Al) alloy 2219 aft bulkhead resulting in the elimination of the current multiple piece welded construction, simplify CM fabrication, and lead to an enhanced design. Phase I (NASA TM-2014-218163, (1)) of this assessment explored spin forming the single-piece CM forward pressure vessel bulkhead. The MPCV Program and Lockheed Martin (LM) recently made two critical decisions relative to the NESC Phase I work scope: (1) LM selected the spin forming process to manufacture a singlepiece aft bulkhead for the Orion CM, and (2) the aft bulkhead will be manufactured from Al 2219. Based on the Program's new emphasis related to the spin forming process, the NESC was asked to conduct a Phase II assessment to assist in the LM manufacture of the aft bulkhead and to conduct a feasibility study into spin forming the Orion CM cone. This activity was approved on June 19, 2013. Dr. Robert Piascik, NASA Technical Fellow for Materials at the Langley Research Center (LaRC), was selected to lead this assessment. The project plan was approved by the NASA Engineering and Safety Center (NESC) Review Board (NRB) on July 18, 2013. The primary stakeholders for this assessment are the NASA and LM MPCV Program offices. Additional benefactors are commercial launch providers developing CM concepts.

Conservative management of CIN2: National Audit of British Society for Colposcopy and Cervical Pathology members' opinion.

PubMed

Macdonald, Madeleine; Smith, John H F; Tidy, John A; Palmer, Julia E

2018-04-01

There is no doubt that organised cervical screening programmes have significantly reduced the rates of cervical cancer by detection and treatment of high-grade cervical intraepithelial neoplasia (CIN2, CIN3). National UK guidelines do not differentiate between CIN2 and CIN3 as separate entities and recommend treatment for both, although a degree of uncertainty exists regarding the natural history of CIN2. This national survey of British Society for Colposcopy and Cervical Pathology members aimed to assess attitudes towards conservative management (CM) of CIN2 in the UK and identify potential selection criteria. In total, 511 members responded (response rate 32%); 55.6% offered CM for selective cases; 12.4% for all cases; 16.4% had formal guidelines. Most agreed age group was >40yrs (83%), HPV 16/18 positive (51.4%), smoking (60%), immuno-compromise (74.2%), and large lesion size (80.8%) were relative contraindications for CM. 75.9% favoured six-monthly monitoring, with 80.2% preferring excisional treatment for persistent high-grade disease. Many UK colposcopists manage CIN2 conservatively without formal guidelines. Potential selection criteria should be investigated by a multicentre study. Impact statement Although anecdotally some colposcopists manage many women with CIN2 conservatively, this National Audit of British Society for Colposcopy and Cytopathology members, we believe, is the first time this has been formally recorded. The survey assesses current attitudes towards conservative management (CM) of CIN2 and seeks to identify potential selection criteria that could be used to identify suitable women. It received over 500 responses and significantly, identified many colposcopists recommending CM of CIN2 for patients despite the lack of any formal guidance regarding this approach. The greater majority of respondents were keen to consider participating in a multicentre trial on CM of CIN2 targeting the UK screening population (25-64 years). The paper has international relevance as ACOG and ASCCP have recently changed their guidance for the management of CIN2 in younger women and now recommend CM with monitoring rather than first line ablative or excisional treatment due to concerns regarding overtreatment, especially in women who have not yet completed their family.

Process evaluation of a patient-centred, patient-directed, group-based education program for the management of type 2 diabetes mellitus.

PubMed

Odgers-Jewell, Kate; Isenring, Elisabeth; Thomas, Rae; Reidlinger, Dianne P

2017-07-01

The present study developed and evaluated a patient-centred, patient-directed, group-based education program for the management of type 2 diabetes mellitus. Two frameworks, the Medical Research Council (MRC) framework for developing and evaluating complex interventions and the RE-AIM framework were followed. Data to develop the intervention were sourced from scoping of the literature and formative evaluation. Program evaluation comprised analysis of primary recruitment of participants through general practitioners, baseline and end-point measures of anthropometry, four validated questionnaires, contemporaneous facilitator notes and telephone interviews with participants. A total of 16 participants enrolled in the intervention. Post-intervention results were obtained from 13 participants, with an estimated mean change from baseline in weight of -0.72 kg (95%CI -1.44 to -0.01), body mass index of -0.25 kg/m 2 (95%CI -0.49 to -0.01) and waist circumference of -1.04 cm (95%CI -4.52 to 2.44). The group education program was acceptable to participants. The results suggest that recruitment through general practitioners is ineffective, and alternative recruitment strategies are required. This patient-centred, patient-directed, group-based intervention for the management of type 2 diabetes mellitus was both feasible and acceptable to patients. Health professionals should consider the combined use of the MRC and RE-AIM frameworks in the development of interventions to ensure a rigorous design process and to enable the evaluation of all phases of the intervention, which will facilitate translation to other settings. Further research with a larger sample trialling additional recruitment strategies, evaluating further measures of effectiveness and utilising lengthier follow-up periods is required. © 2016 Dietitians Association of Australia.

Conceptualizing Community Mobilization for HIV Prevention: Implications for HIV Prevention Programming in the African Context

PubMed Central

Lippman, Sheri A.; Maman, Suzanne; MacPhail, Catherine; Twine, Rhian; Peacock, Dean; Kahn, Kathleen; Pettifor, Audrey

2013-01-01

Introduction Community mobilizing strategies are essential to health promotion and uptake of HIV prevention. However, there has been little conceptual work conducted to establish the core components of community mobilization, which are needed to guide HIV prevention programming and evaluation. Objectives We aimed to identify the key domains of community mobilization (CM) essential to change health outcomes or behaviors, and to determine whether these hypothesized CM domains were relevant to a rural South African setting. Method We studied social movements and community capacity, empowerment and development literatures, assessing common elements needed to operationalize HIV programs at a community level. After synthesizing these elements into six essential CM domains, we explored the salience of these CM domains qualitatively, through analysis of 10 key informant in-depth-interviews and seven focus groups in three villages in Bushbuckridge. Results CM domains include: 1) shared concerns, 2) critical consciousness, 3) organizational structures/networks, 4) leadership (individual and/or institutional), 5) collective activities/actions, and 6) social cohesion. Qualitative data indicated that the proposed domains tapped into theoretically consistent constructs comprising aspects of CM processes. Some domains, extracted from largely Western theory, required little adaptation for the South African context; others translated less effortlessly. For example, critical consciousness to collectively question and resolve community challenges functioned as expected. However, organizations/networks, while essential, operated differently than originally hypothesized - not through formal organizations, but through diffuse family networks. Conclusions To date, few community mobilizing efforts in HIV prevention have clearly defined the meaning and domains of CM prior to intervention design. We distilled six CM domains from the literature; all were pertinent to mobilization in rural South Africa. While some adaptation of specific domains is required, they provide an extremely valuable organizational tool to guide CM programming and evaluation of critically needed mobilizing initiatives in Southern Africa. PMID:24147121

Considerations for applying VARSKIN mod 2 to skin dose calculations averaged over 10 cm2.

PubMed

Durham, James S

2004-02-01

VARSKIN Mod 2 is a DOS-based computer program that calculates the dose to skin from beta and gamma contamination either directly on skin or on material in contact with skin. The default area for calculating the dose is 1 cm2. Recently, the U.S. Nuclear Regulatory Commission issued new guidelines for calculating shallow dose equivalent from skin contamination that requires the dose be averaged over 10 cm2. VARSKIN Mod 2 was not filly designed to calculate beta or gamma dose estimates averaged over 10 cm2, even though the program allows the user to calculate doses averaged over 10 cm2. This article explains why VARSKIN Mod 2 overestimates the beta dose when applied to 10 cm2 areas, describes a manual method for correcting the overestimate, and explains how to perform reasonable gamma dose calculations averaged over 10 cm2. The article also describes upgrades underway in Varskin 3.

Integrated injury prevention program improves balance and vertical jump height in children.

PubMed

DiStefano, Lindsay J; Padua, Darin A; Blackburn, J Troy; Garrett, William E; Guskiewicz, Kevin M; Marshall, Stephen W

2010-02-01

Implementing an injury prevention program to athletes under age 12 years may reduce injury rates. There is limited knowledge regarding whether these young athletes will be able to modify balance and performance measures after completing a traditional program that has been effective with older athletes or whether they require a specialized program for their age. The purpose of this study was to compare the effects of a pediatric program, which was designed specifically for young athletes, and a traditional program with no program in the ability to change balance and performance measures in youth athletes. We used a cluster-randomized controlled trial to evaluate the effects of the programs before and after a 9-week intervention period. Sixty-five youth soccer athletes (males: n = 37 mass = 34.16 +/- 5.36 kg, height = 143.07 +/- 6.27 cm, age = 10 +/- 1 yr; females: n = 28 mass = 33.82 +/- 5.37 kg, height = 141.02 +/- 6.59 cm) volunteered to participate and attended 2 testing sessions in a research laboratory. Teams were cluster-randomized to either a pediatric or traditional injury prevention program or a control group. Change scores for anterior-posterior and medial-lateral time-to-stabilization measures and maximum vertical jump height and power were calculated from pretest and post-test sessions. Contrary with our original hypotheses, the traditional program resulted in positive changes, whereas the pediatric program did not result in any improvements. Anterior-posterior time-to-stabilization decreased after the traditional program (mean change +/- SD = -0.92 +/- 0.49 s) compared with the control group (-0.49 +/- 0.59 s) (p = 0.003). The traditional program also increased vertical jump height (1.70 +/- 2.80 cm) compared with the control group (0.20 +/- 0.20 cm) (p = 0.04). There were no significant differences between control and pediatric programs. Youth athletes can improve balance ability and vertical jump height after completing an injury prevention program. Training specificity appears to affect improvements and should be considered with future program design.

Legacy effects of grassland management on soil carbon to depth.

PubMed

Ward, Susan E; Smart, Simon M; Quirk, Helen; Tallowin, Jerry R B; Mortimer, Simon R; Shiel, Robert S; Wilby, Andrew; Bardgett, Richard D

2016-08-01

The importance of managing land to optimize carbon sequestration for climate change mitigation is widely recognized, with grasslands being identified as having the potential to sequester additional carbon. However, most soil carbon inventories only consider surface soils, and most large-scale surveys group ecosystems into broad habitats without considering management intensity. Consequently, little is known about the quantity of deep soil carbon and its sensitivity to management. From a nationwide survey of grassland soils to 1 m depth, we show that carbon in grassland soils is vulnerable to management and that these management effects can be detected to considerable depth down the soil profile, albeit at decreasing significance with depth. Carbon concentrations in soil decreased as management intensity increased, but greatest soil carbon stocks (accounting for bulk density differences), were at intermediate levels of management. Our study also highlights the considerable amounts of carbon in subsurface soil below 30 cm, which is missed by standard carbon inventories. We estimate grassland soil carbon in Great Britain to be 2097 Tg C to a depth of 1 m, with ~60% of this carbon being below 30 cm. Total stocks of soil carbon (t ha(-1) ) to 1 m depth were 10.7% greater at intermediate relative to intensive management, which equates to 10.1 t ha(-1) in surface soils (0-30 cm), and 13.7 t ha(-1) in soils from 30 to 100 cm depth. Our findings highlight the existence of substantial carbon stocks at depth in grassland soils that are sensitive to management. This is of high relevance globally, given the extent of land cover and large stocks of carbon held in temperate managed grasslands. Our findings have implications for the future management of grasslands for carbon storage and climate mitigation, and for global carbon models which do not currently account for changes in soil carbon to depth with management. © 2016 John Wiley & Sons Ltd.

Using the Experience Sampling Method in the Context of Contingency Management for Substance Abuse Treatment

ERIC Educational Resources Information Center

Husky, Mathilde M.; Mazure, Carolyn M.; Carroll, Kathleen M.; Barry, Danielle; Petry, Nancy M.

2008-01-01

Contingency management (CM) treatments have been shown to be effective in reducing substance use. This manuscript illustrates how the experience sampling method (ESM) can depict behavior and behavior change and can be used to explore CM treatment mechanisms. ESM characterizes idiosyncratic patterns of behavior and offers the potential to determine…

THE MANAGEMENT OF AN ORAL ANAPLASTIC SARCOMA IN A PYGMY HIPPOPOTAMUS (CHOEROPSIS LIBERIENSIS) USING INTRALESIONAL CHEMOTHERAPY.

PubMed

Franklinos, Lydia H V; Masters, Nicholas; Feltrer, Yedra; Pocknell, Ann; Bolt, David M; Dakin, Stephanie; Berry, Karla; Molenaar, Fieke M

2017-03-01

An adult female captive pygmy hippopotamus (Choeropsis liberiensis) was diagnosed with an oral anaplastic sarcoma. The tumor was surgically debulked and intralesional chemotherapy with mitomycin C (0.4 mg/cm 3 of tumor) and cisplatin (1 mg/cm 3 of tumor) was administered. Chemotherapeutic treatment proved difficult due to the risks of repeated anesthetics and unknown drug efficacies. Marked proliferation of the mass was observed during estrus, and chemotherapy was repeated as an experimental treatment to slow tumor progression in order for the animal to remain in the species breeding program. Tumor proliferation was detected during the first trimester of pregnancy; however, in the lactation period, the mass became quiescent. No adverse reactions to chemotherapeutic drugs were observed and the animal continues to be monitored for tumor progression. This is the first report of an anaplastic sarcoma and of chemotherapy use in a pygmy hippopotamus and it highlights logistical considerations for treating neoplasia in this species.

Advances in solid polymer electrolyte fuel cell technology with low-platinum-loading electrodes

NASA Technical Reports Server (NTRS)

Srinivasan, Supramaniam; Ticianelli, E. A.; Derouin, C. R.; Redondo, A.

1987-01-01

The Gemini Space program demonstrated the first major application of fuel cell systems. Solid polymer electrolyte fuel cells were used as auxiliary power sources in the spacecraft. There has been considerable progress in this technology since then, particularly with the substitution of Nafion for the polystyrene sulfonate membrane as the electrolyte. Until recently the performance was good only with high platinum loading (4 mg/sq cm) electrodes. Methods are presented to advance the technology by (1) use of low platinum loading (0.35 mg/sq cm) electrodes; (2) optimization of anode/membrane/cathode interfaces by hot pressing; (3) pressurization of reactant gases, which is most important when air is used as cathodic reactant; and (4) adequate humidification of reactant gases to overcome the water management problem. The high performance of the fuel cell with the low loading of platinum appears to be due to the extension of the three dimensional reaction zone by introduction of a proton conductor, Nafion. This was confirmed by cyclic voltammetry.

Establishment of an Italian chronic migraine database: a multicenter pilot study.

PubMed

Barbanti, Piero; Fofi, L; Cevoli, S; Torelli, P; Aurilia, C; Egeo, G; Grazzi, L; D'Amico, D; Manzoni, G C; Cortelli, P; Infarinato, F; Vanacore, N

2018-05-01

To optimize chronic migraine (CM) ascertainment and phenotype definition, provide adequate clinical management and health care procedures, and rationalize economic resources allocation, we performed an exploratory multicenter pilot study aimed at establishing a CM database, the first step for developing a future Italian CM registry. We enrolled 63 consecutive CM patients in four tertiary headache centers screened with face-to-face interviews using an ad hoc dedicated semi-structured questionnaire gathering detailed information on life-style, behavioral and socio-demographic factors, comorbidities, and migraine features before and after chronicization and healthcare resource use. Our pilot study provided useful insights revealing that CM patients (1) presented in most cases symptoms of peripheral trigeminal sensitization, a relatively unexpected feature which could be useful to unravel different CM endophenotypes and to predict trigeminal-targeted treatments' responsiveness; (2) had been frequently admitted to emergency departments; (3) had undergone, sometime repeatedly, unnecessary or inappropriate investigations; (4) got rarely illness benefit exemption or disability allowance only. We deem that the expansion of the database-shortly including many other Italian headache centers-will contribute to more precisely outline CM endophenotypes, hence improving management, treatment, and economic resource allocation, ultimately reducing CM burden on both patients and health system.

Comments on Contingency Management and Conditional Cash Transfers

PubMed Central

Higgins, Stephen T.

2009-01-01

This essay discusses research on incentive-based interventions to promote healthy behavior change, contingency management (CM) and conditional cash transfers (CCT). The overarching point of the essay is that CM and CCT are often treated as distinct areas of inquiry when at their core they represent a common approach. Some potential bi-directional benefits of recognizing this commonality are discussed. Distinct intellectual traditions probably account for the separate paths of CM and CCT to date, with the former being rooted in behavioral psychology and the latter in microeconomics. It is concluded that the emerging field of behavioral economics, which is informed by and integrates principles of each of those disciplines, may provide the proper conceptual framework for integrating CM and CCT. PMID:19670269

Comments on contingency management and conditional cash transfers.

PubMed

Higgins, Stephen T

2010-10-01

This essay discusses research on incentive-based interventions to promote healthy behavior change, contingency management (CM) and conditional cash transfers (CCT). The overarching point of the essay is that CM and CCT are often treated as distinct areas of inquiry when at their core they represent a common approach. Some potential bi-directional benefits of recognizing this commonality are discussed. Distinct intellectual traditions probably account for the separate paths of CM and CCT to date, with the former being rooted in behavioral psychology and the latter in microeconomics. It is concluded that the emerging field of behavioral economics, which is informed by and integrates principles of each of those disciplines, may provide the proper conceptual framework for integrating CM and CCT.

Effect of PTSD diagnosis and contingency management procedures on cocaine use in dually cocaine and opioid-dependent individuals maintained on LAAM: A retrospective analysis

PubMed Central

Mancino, M.; McGaugh, J.; Feldman, Z.; Poling, J.; Oliveto, A.

2012-01-01

This randomized clinical trial retrospectively examined the effect of Post Traumatic Stress Disorder (PTSD) and contingency management (CM) on cocaine use in opioid and cocaine dependent individuals maintained on high or low-dose LAAM randomly assigned to CM or a yoked-control condition. Cocaine-positive urines decreased more rapidly over time in those without PTSD versus those with PTSD in the non-contingency condition. In participants with PTSD, CM resulted in fewer cocaine positive urines compared to the non-contingent condition. This suggests that CM may help improve the potentially worse outcomes in opioid-and cocaine dependent individuals with PTSD compared to those without PTSD. PMID:20163389

Weed management and cotton yield under two row spacings, conventional and conservation tillage systems utilizing conventional, glufosinate-, and glyphosate-based weed management systems

USDA-ARS?s Scientific Manuscript database

A field experiment was conducted in 2005 and 2006, to evaluate weed control in conventional, Liberty Link® (LL), and Roundup Ready® (RR) herbicide systems under standard [102 cm (40 inch)] and narrow [38 cm (15 inch)] row-spacings utilizing conventional and high-residue conservation tillage systems....

Case Studies to Deepen Understanding and Enhance Classroom Management Skills in Preschool Teacher Training

ERIC Educational Resources Information Center

Tal, Clodie

2010-01-01

This article adds to the existing body of data that demonstrates how the use of in-depth case studies that include social episode analysis can deepen the teaching students' and researchers' understanding of the perceptions and skills needed for Classroom Management (CM). In this article, CM is defined as a meta-skill that integrates cognitive…

School asthma screening and case management: attendance and learning outcomes.

PubMed

Moricca, Michelle L; Grasska, Merry A; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C; Galant, Stanley P

2013-04-01

Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided to link these students to medical care and assure asthma action plans at school. In the 40 children with confirmed diagnosis who received CM, academic performance on standardized testing postintervention was similar to the 76 children who were low risk for asthma. Average days absent due to illness in the CM group were reduced from 5.8 to 3.7 days in the postintervention school year. School nurse screening, CM, and collaboration with a medical provider resulted in early identification, referral, and subsequent treatment of students at risk for asthma and may have contributed to reduced illness absences.

Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management

PubMed Central

de Vries, Marlene M.; Joubert, Belinda; Cloete, Marise; Roux, Sumien; Baca, Beth A.; Hasken, Julie M.; Barnard, Ronel; Buckley, David; Kalberg, Wendy O.; Snell, Cudore L.; Marais, Anna-Susan; Seedat, Soraya; Parry, Charles D. H.; May, Philip A.

2015-01-01

In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD. PMID:26703708

SU-E-T-216: TPS QC Supporting Program by a Third-Party Evaluation Agency in Japan.

PubMed

Fukata, K; Minemura, T; Kurokawa, C; Miyagishi, T; Itami, J

2012-06-01

To equalize the quality of radiation therapy in Japan by supporting quality control of radiation treatment planning system. Center for Cancer Control and Information Service in National Cancer Center supports the QA-QC of the cancer core hospitals in Japan as a third-party evaluation agency. Recently, a program for assessing the quality of treatment planning system (TPS) began as a part of our QA-QC supporting activities. In this program, a questionnaire about TPS was sent to 45 prefectural cancer core hospitals in Japan. The object of this questionnaire is to assess the proper commissioning, implement and applications of TPSs. The contents of the questionnaire are as follows; 1) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth with field sizes ranging from 5×5 to 30 × 30 cm 2 , and obtain doses at several depths for the calculated MUs, 2) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth for wedge fields whose angles are from 15 to 60 degrees, and obtain doses at several depths with the MUs, 3) calculate MU which deliver 1000 cGy to the point of STD = 100 cm, 10 cm depth with 10×10 cm 2 field size and obtain doses at several depths with the MU. In this program, 179 beam data from 44 facilities were collected. Data were compared in terms of dose per MU, output factor, wedge factor and TMR. It was found that 90% of the data agreed within 2%. The quality of the treatment planning system was investigated through the questionnaire including the information of essential beam data. We compared 179 beam data in TPSs sent from 44 facilities and 90% of the data showed good agreement. © 2012 American Association of Physicists in Medicine.

The effects of Nordic Walking training on selected upper-body muscle groups in female-office workers: A randomized trial.

PubMed

Kocur, Piotr; Pospieszna, Barbara; Choszczewski, Daniel; Michalowski, Lukasz; Wiernicka, Marzena; Lewandowski, Jacek

2017-01-01

Regular Nordic Walking training could improve fitness and reduce tenderness in selected muscle groups in office workers. An assessment of the effects of a 12-week Nordic Walking training program on the perceived pain threshold (PPT) and the flexibility of selected upper-body muscle groups in postmenopausal female office workers. 39 office workers were selected at random for the treatment group (NWg, n = 20) and the control group (Cg, n = 19). The persons from the NW group completed a 12-week Nordic Walking training program (3 times a week/1 hour). PPTs measurements in selected muscles and functional tests evaluating upper-body flexibility (Back Scratch - BS) were carried out twice in every participant of the study: before and after the training program. A significant increase in PPT (kg/cm2) was observed in the following muscles in the NW group only: upper trapezius (from 1,32 kg/cm2 to 1,99 kg/cm2), mid trapezius (from 2,92 kg/cm2 to 3,30 kg/cm2), latissimus dorsi (from 1,66 kg/cm2 to 2,21 kg/cm2) and infraspinatus (from 1,63 kg/cm2 to 2,93 kg/cm2). Moreover, a significant improvement in the BS test was noted in the NW group compared with the control group (from -1,16±5,7 cm to 2,18±5,1 cm in the NW group vs from -2,52±6,1 to -2,92±6,2 in the control group). A 12-week Nordic Walking training routine improves shoulder mobility and reduces tenderness in the following muscles: trapezius pars descendens and middle trapezius, infraspinatus and latissimus dorsi, in female office workers.

Contingency Management Abstinence Incentives: Cost and Implications for Treatment Tailoring.

PubMed

Cunningham, Colin; Stitzer, Maxine; Campbell, Aimee N C; Pavlicova, Martina; Hu, Mei-Chen; Nunes, Edward V

2017-01-01

To examine prize-earning costs of contingency management (CM) incentives in relation to participants' pre-study enrollment drug use status (baseline (BL) positive vs. BL negative) and relate these to previously reported patterns of intervention effectiveness. Participants were 255 substance users entering outpatient treatment who received the therapeutic educational system (TES), in addition to usual care counseling. TES included a CM component such that participants could earn up to $600 in prizes on average over 12-weeks for providing drug negative urines and completing web-based cognitive behavior therapy modules. We examined distribution of prize draws and value of prizes earned for subgroups that were abstinent (BL negative; N=136) or not (BL positive; N=119) at study entry based on urine toxicology and breath alcohol screen. Distribution of draws earned (median=119 vs. 17; p<.0001) and prizes redeemed (median=54 vs. 9; p<.001) for drug abstinence differed significantly for BL negative compared to BL positive participants. BL negative earned on average twice as much in prizes as BL positive participants ($245 vs. $125). Median value of prizes earned was 5.4 times greater for BL negative compared to BL positive participants ($237 vs. $44; p<.001). Two-thirds of expenditures in an abstinence incentive program were paid to BL negative participants. These individuals had high rates of drug abstinence during treatment and did not show improved abstinence outcomes with TES versus usual care (Campbell et al., 2014). Effectiveness of the abstinence-focused CM intervention included in TES may be enhanced by tailoring delivery based on patients' drug use status at treatment entry. Copyright © 2015 Elsevier Inc. All rights reserved.

Demographic Structure, Sex Ratio and Growth Rates of Southern Bluefin Tuna (Thunnus maccoyii) on the Spawning Ground

PubMed Central

Farley, Jessica H.; Eveson, J. Paige; Davis, Tim L. O.; Andamari, Retno; Proctor, Craig H.; Nugraha, Budi; Davies, Campbell R.

2014-01-01

The demographics of the southern bluefin tuna (SBT) Thunnus maccoyii spawning stock were examined through a large-scale monitoring program of the Indonesian longline catch on the spawning ground between 1995 and 2012. The size and age structure of the spawning population has undergone significant changes since monitoring began. There has been a reduction in the relative abundance of larger/older SBT in the catch since the early 2000s, and a corresponding decrease in mean length and age, but there was no evidence of a significant truncation of the age distribution. Pulses of young SBT appear in the catches in the early- and mid-2000s and may be the first evidence of increased recruitment into the spawning stock since 1995. Fish in these two recruitment pulses were spawned around 1991 and 1997. Size-related variations in sex ratio were also observed with female bias for fish less than 170 cm FL and male bias for fish greater than 170 cm FL. This trend of increasing proportion of males with size above 170 cm FL is likely to be related to sexual dimorphism in growth rates as male length-at-age is greater than that for females after age 10 years. Mean length-at-age of fish aged 8–10 years was greater for both males and females on the spawning ground than off the spawning ground, suggesting that size may be the dominant factor determining timing of maturation in SBT. In addition to these direct results, the data and samples from this program have been central to the assessment and management of this internationally harvested stock. PMID:24797529

First, keep it safe: Integration of a complementary medicine service within a hospital.

PubMed

Schiff, Elad; Levy, Ilana; Arnon, Zahi; Ben-Arye, Eran; Attias, Samuel

2018-05-01

This paper sought to explore risk/safety considerations associated with the integration of a complementary medicine (CM) service within a public academic medical centre in Israel. We reviewed various sources pertaining to the CM service (interviews with CM staff, patients' electronic charts, service guidelines, correspondence with hospital administration) and conducted a thematic analysis to evaluate safety-related incidents during the 7 years of operation. In addition, we systematically assessed the charts for reports of treatment-associated adverse effects, which were documented in an obligatory field on treatment reports. After reviewing transcripts of interviews with 12 CM practitioners and with the director and vice-director of the CM service as well as transcripts of 8560 consultations that included 7383 treatments, we categorised 3 major domains of CM safety management: (i) prevention of safety-related incidents by appropriate selection of CM practitioners and modalities, (ii) actual adverse incidents and (iii) prevention of their recurrence using both hospital and CM service safety protocols. CM staff reported 5 categories of adverse incidents, most of which were minor. Twenty-nine adverse incidents were documented in the 7383 treatment sessions (0.4%). Safety management needs to be addressed both before introducing CM services in hospitals and throughout their integration. Important considerations for the safe integration of CM practices in the hospital include communication between CM and conventional practitioners, adherence to hospital safety rules, implementing a systematic approach for detecting and reporting safety-related incidents and continuous adaptation of the CM service safety protocols. © 2018 John Wiley & Sons Ltd.

Exhaled air dispersion during noninvasive ventilation via helmets and a total facemask.

PubMed

Hui, David S; Chow, Benny K; Lo, Thomas; Ng, Susanna S; Ko, Fanny W; Gin, Tony; Chan, Matthew T V

2015-05-01

Noninvasive ventilation (NIV) via helmet or total facemask is an option for managing patients with respiratory infections in respiratory failure. However, the risk of nosocomial infection is unknown. We examined exhaled air dispersion during NIV using a human patient simulator reclined at 45° in a negative pressure room with 12 air changes/h by two different helmets via a ventilator and a total facemask via a bilevel positive airway pressure device. Exhaled air was marked by intrapulmonary smoke particles, illuminated by laser light sheet, and captured by a video camera for data analysis. Significant exposure was defined as where there was ≥ 20% of normalized smoke concentration. During NIV via a helmet with the simulator programmed in mild lung injury, exhaled air leaked through the neck-helmet interface with a radial distance of 150 to 230 mm when inspiratory positive airway pressure was increased from 12 to 20 cm H2O, respectively, while keeping the expiratory pressure at 10 cm H2O. During NIV via a helmet with air cushion around the neck, there was negligible air leakage. During NIV via a total facemask for mild lung injury, air leaked through the exhalation port to 618 and 812 mm when inspiratory pressure was increased from 10 to 18 cm H2O, respectively, with the expiratory pressure at 5 cm H2O. A helmet with a good seal around the neck is needed to prevent nosocomial infection during NIV for patients with respiratory infections.

Randomized Trial Comparing Two Treatment Strategies Using Prize-Based Reinforcement of Abstinence in Cocaine and Opiate Users

ERIC Educational Resources Information Center

Preston, Kenzie L.; Ghitza, Udi E.; Schmittner, John P.; Schroeder, Jennifer R.; Epstein, David H.

2008-01-01

We compared two strategies of prize-based contingency management (CM) in methadone-maintained outpatients. Urine was tested thrice weekly for 5 weeks pre-CM, 12 weeks CM, and 8 weeks post-CM. Participants were randomly assigned to a cocaine contingency (four prize draws for each cocaine-negative urine, N = 29) or an opiate-cocaine contingency (one…

Surgical management of pediatric urolithiasis

PubMed Central

Mishra, Shashi K.; Ganpule, A.; Manohar, T.; Desai, Mahesh R.

2007-01-01

Pediatric urolithiasis poses a technical challenge to the urologist. A review of the recent literature on the subject was performed to highlight the various treatment modalities in the management of pediatric stones. A Medline search was used to identify manuscripts dealing with management options such as percutaneous nephrolithotomy, shock wave lithotripsy, ureteroscopy and cystolithotripsy in pediatric stone diseases. We also share our experience on the subject. Shock wave lithotripsy should be the treatment modality for renal stone less than 1cm or < 150 mm2 and proximal non-impacted ureteric stone less than 1 cm with normal renal function, no infection and favorable anatomy. Indications for PCNL in children are large burden stone more than 2cm or more than 150mm2 with or without hydronephrosis, urosepsis and renal insufficiency, more than 1cm impacted upper ureteric stone, failure of SWL and significant volume of residual stones after open surgery. Shock wave lithotripsy can be offered for more soft (< 900 HU on CT scan) renal stones between 1-2cm. Primary vesical stone more than 1cm can be tackled with percutaneous cystolithomy or open cystolithotomy. Open renal stone surgery can be done for renal stones with associated structural abnormalities, large burden infective and staghorn stones, large impacted proximal ureteric stone. The role of laparoscopic surgery for stone disease in children still needs to be explored. PMID:19718300

Impact of soil type, moisture, and depth on swede midge (Diptera: Cecidomyiidae) pupation and emergence.

PubMed

Chen, Mao; Shelton, Anthony M

2007-12-01

Contarinia nasturtii (Kieffer) (Diptera: Cecidomyiidae), a common insect pest in Europe and a new invasive pest in North America, causes severe damage to cruciferous crops. Currently, many counties in Canada and the United States in which C. nasturtii has not been previously reported are at risk of being infested by C. nasturtii. Effectiveness of chemical control is limited, especially under high population pressure in fields, because the cryptic habits of C. nasturtii protect them from insecticidal sprays. Alternative management strategies against C. nasturtii that are needed to protect crucifers and soil management for the pupal stage were studied as one option. Six different types of soils (loam fine sand, fine sand, clay loam, muck, Chenango shale loam, and silt loam soil) were collected from commercial cabbage fields in New York and studied in the laboratory for their impact on C. nasturtii pupation and emergence. The results indicated that extremely wet or dry soils significantly hindered C. nasturtii emergence, regardless of soil type, suggesting that soil type alone may not be a major factor regulating C. nasturtii abundance. Optimal moisture content for C. nasturtii emergence varied for different soils. Most C. nasturtii pupated within the top 1 cm of soil. Furthermore, we found that >5 cm of soil cover effectively reduced the emergence number and delayed the time of emergence. Based on these results, we suggest that soil manipulation (moisture content and cultivation practices) should be considered as an important component in an overall integrated pest management program for C. nasturtii.

Workplace-based participatory approach to weight loss for correctional employees.

PubMed

Ferraro, Lindsay; Faghri, Pouran D; Henning, Robert; Cherniack, Martin

2013-02-01

To evaluate the effectiveness of a participatory approach using an employee design team for a 12-week weight-loss program with an 8-week follow-up. Twenty-four employees with mean [standard error (SE)] for weight 233.24 lb [8.16], body mass index 33.29 kg/cm [0.82], and age 42.7 years [1.5] participated in the study, among whom 75% were men and 25% women. Significant reductions in weight, body mass index, and waist circumference (among men) were observed before and after intervention (P < 0.05). About 73% and 68% of the variation in weight change (P < 0.01) and waist circumference (P < 0.01), respectively, were explained by Nutrition Knowledge and Exercise Confidence scores after controlling for gender and age. A participatory program with employee involvement resulted in positive outcomes. Increasing participants' knowledge and providing skills to manage their weight seem to change their attitudes, resulting in better outcomes.

[Study on incorporation of "management and guidance of home-visiting by a pharmacist" into a care plan -observation based on a survey of care managers-].

PubMed

Nanaumi, Yoko; Onda, Mitsuko; Sakurai, Hidehiko; Tanaka, Rie; Tsubota, Kenichi; Matoba, Shunya; Mukai, Yusuke; Arakawa, Yukio; Hayase, Yukitoshi

2010-11-01

A survey of care managers ("CMs") was conducted to identify top priority issues in promoting the management and guidance of home-visiting by a pharmacist ("management and guidance") by focusing on the experience in incorporating the management and guidance into a care plan and its relevant factors. Major survey items included (1) number of years working as a CM, (2) basic occupation, (3) experience in incorporating the management and guidance into care plans, (4) understanding the management and guidance content, and (5) an awareness of the need for pharmacists' involvement in care plans. A χ² test was conducted to determine if the experience in incorporating the management and guidance into care plans caused a difference in the distribution of the number of years as a CM, the basic occupation, understanding of the management and guidance content, and an awareness of the need for pharmacists' involvement in care plans. A regression analysis was conducted to determine the degree of association between the incorporation experience and each item. The numbers of years working as a CM, the basic occupation, understanding of the management and guidance content, and an awareness of the need for pharmacists' involvement in care plans, were found to be associated with the experience in incorporating the management and guidance into care plans. Understanding of the management and guidance content was most closely associated. To promote pharmacists' management and guidance for home-based care, CMs need to deepen their understanding of this service.

Management and diagnosis of gallbladder polyps: a systematic review.

PubMed

Babu, Benoy I; Dennison, Ashley R; Garcea, Giuseppe

2015-05-01

Recommendation for management of gallbladder polyps (GBPs) >1 cm is cholecystectomy. No consensus exists on management of GBPs <1 cm. This systematic review examines current evidence on management of GBPs. MEDLINE, EMBASE and Cochrane library databases were searched from January 1991 to June 2013 using specified terms. A predefined protocol for data extraction was used to retrieve specified end points. Literature search yielded 43 manuscripts with a dataset of 11,685 patients with GBPs. M:F ratio was 1.3:1. Average age (range) was 49 years (32-83). Patients with malignant GBPs had an average (range) age of 58 (50-66) years with M:F ratio of 0.78:1. Cholesterol polyps constituted 60.5% of GBPs followed by adenomas (15.2%) and cancer (11.6%). Malignant GBPs ≥1 cm, <1 cm and <5 mm constituted 8.5, 1.2 and 0% of GBPs, respectively. Majority of patients requiring surgical intervention had laparoscopic cholecystectomy. Presently employed policy of cholecystectomy for GBPs >1 cm is appropriate. For GBPs <1 cm, the authors propose (accepting existence of differing proposals) the following: 1. Surveillance may not be needed for GBPs <5 mm. 2. For GBPs between 5 and 10 mm, two scans at six monthly intervals is suggested and after that, tailor surveillance to age, growth and ethnicity. In the non-Asian population, if GBP remains the same size or number, discontinuation of surveillance may be considered. In the Asian population, if GBPs remain the same, yearly surveillance is continued for a suggested period of 3 years. 3. Discontinue surveillance if GBPs is/are smaller/ disappeared. Cholecystectomy is advised where size increases to >10 mm.

Experiment module concepts study. Volume 3: Module and subsystem design

NASA Technical Reports Server (NTRS)

Hunter, J. R.; Chiarappa, D. J.

1970-01-01

The final common module set exhibiting wide commonality is described. The set consists of three types of modules: one free flying module and two modules that operate attached to the space station. The common module designs provide for the experiment program as defined. The feasibility, economy, and practicality of these modules hinges on factors that do not affect the approach or results of the commonality process, but are important to the validity of the common module concepts. Implementation of the total experiment program requires thirteen common modules: five CM-1, five CM-3, and three CM-4 modules.

Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term.

PubMed

Ragusa, Antonio; Gizzo, Salvatore; Noventa, Marco; Ferrazzi, Enrico; Deiana, Sara; Svelato, Alessandro

2016-10-01

Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor. Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the "action line" in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention. Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p < 0.0005). The rate of amniotomy decreased from 41.7 % in the SM group to 7.4 % in the CM group (p < 0.0005). The percentage of newborns with 5-min Apgar score <7 and/or umbilical cord arterial pH ≤ 7.00 decreased from 2.3 % in SM cohort to 0.5 % in CM cohort (p = ns). The average length of labor did not differ between the two groups of patients (264 vs 277 min; p = ns). Comprehensive management of dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.

Titanium Aluminide Technologies Successfully Transferred From HSR Program to RLV VentureStar Program

NASA Technical Reports Server (NTRS)

Bartolotta, Paul A.

2000-01-01

Through a cost-share contract, BFGoodrich Aerostructures group successfully fabricated three titanium aluminide (gamma TiAl) truss core structures using technologies pioneered in the High-Speed Research (HSR) program at the NASA Glenn Research Center at Lewis Field. The truss core subelement is approximately 60-cm (24-in.) long by 14-cm (5.5-in.) wide by 6-cm (2.5-in.) deep. To fabricate this subelement, BFGoodrich first obtained gamma TiAl sheets from Plansee (Austria) which produced the sheets using techniques developed collaboratively by Glenn, Pratt & Whitney, and Plansee. This new gamma TiAl production technology has significantly lowered the cost of gamma TiAl sheet (approx. 75-percent decrease) and has made the production of larger gamma TiAl sheets possible (approx. 60-percent increase).

First Apollo 11 Lunar Samples Arrive at the Manned Spacecraft Center (MSC)

NASA Technical Reports Server (NTRS)

1969-01-01

The Apollo 11 mission, the first manned lunar mission, launched from the Kennedy Space Center, Florida via the Marshall Space Flight Center (MSFC) developed Saturn V launch vehicle on July 16, 1969 and safely returned to Earth on July 24, 1969. Aboard the space craft were astronauts Neil A. Armstrong, commander; Michael Collins, Command Module (CM) pilot; and Edwin E. Aldrin Jr., Lunar Module (LM) pilot. The CM, piloted by Michael Collins remained in a parking orbit around the Moon while the LM, named 'Eagle'', carrying astronauts Neil Armstrong and Edwin Aldrin, landed on the Moon. During 2½ hours of surface exploration, the crew collected 47 pounds of lunar surface material for analysis back on Earth. This photograph was taken as the mission's first loaded sample return container arrived at Ellington Air Force Base by air from the Pacific recovery area. The rock box was immediately taken to the Lunar Receiving Laboratory at the Manned Spacecraft Center (MSC) in Houston, Texas. Happily posing for the photograph with the rock container are (L-R) Richard S. Johnston (back), special assistant to the MSC Director; George M. Low, MSC Apollo Spacecraft Program manager; George S. Trimble (back), MSC Deputy Director; Lt. General Samuel C. Phillips, Apollo Program Director, Office of Manned Spaceflight at NASA headquarters; Eugene G. Edmonds, MSC Photographic Technology Laboratory; Dr. Thomas O. Paine, NASA Administrator; and Dr. Robert R. Gilruth, MSC Director.

Group-Based Randomized Trial of Contingencies for Health and Abstinence in HIV Patients

ERIC Educational Resources Information Center

Petry, Nancy M.; Weinstock, Jeremiah; Alessi, Sheila M.; Lewis, Marilyn W.; Dieckhaus, Kevin

2010-01-01

Objective: Contingency management (CM) treatments are usually applied individually for drug abstinence, but CM can also be targeted toward health behaviors and implemented in groups. This study evaluated effects of a group-based CM intervention that focused on reinforcing health behaviors. Method: HIV-positive patients with cocaine or opioid use…

Transport and fate of methyl iodide a its pest control in soils

USDA-ARS?s Scientific Manuscript database

For fumigants, information on transport and fate, as well as pest control, is needed to develop management practices with the fewest human and environmental health risks while offering sufficient pest control efficacy. For this purpose, a 2-D soil chamber (60 cm wide, 60 cm long, and 6 cm thick) wit...

Ground Systems Development Environment (GSDE) software configuration management

NASA Technical Reports Server (NTRS)

Church, Victor E.; Long, D.; Hartenstein, Ray; Perez-Davila, Alfredo

1992-01-01

This report presents a review of the software configuration management (CM) plans developed for the Space Station Training Facility (SSTF) and the Space Station Control Center. The scope of the CM assessed in this report is the Systems Integration and Testing Phase of the Ground Systems development life cycle. This is the period following coding and unit test and preceding delivery to operational use. This report is one of a series from a study of the interfaces among the Ground Systems Development Environment (GSDE), the development systems for the SSTF and the SSCC, and the target systems for SSCC and SSTF. This is the last report in the series. The focus of this report is on the CM plans developed by the contractors for the Mission Systems Contract (MSC) and the Training Systems Contract (TSC). CM requirements are summarized and described in terms of operational software development. The software workflows proposed in the TSC and MSC plans are reviewed in this context, and evaluated against the CM requirements defined in earlier study reports. Recommendations are made to improve the effectiveness of CM while minimizing its impact on the developers.

Using a randomized controlled trial to test whether modifications to contingency management improve outcomes for heavy drinkers with serious mental illness.

PubMed

Oluwoye, Oladunni; Skalisky, Jordan; Burduli, Ekaterina; Chaytor, Naomi S; McPherson, Sterling; Murphy, Sean M; Herron, Jalene; Hirchak, Katherine; Burley, Mason; Ries, Richard K; Roll, John M; McDonell, Michael G

2018-06-01

In contingency management (CM), individuals receive rewards for alcohol abstinence. CM is associated with reduced alcohol use in adults with co-occurring serious mental illnesses (SMI). Pre-treatment urine ethyl glucuronide (uEtG) levels equivalent to daily heavy drinking (uEtG >349ng/mL) are associated with poor response to CM. Modifications to CM are needed to improve outcomes for non-responders. To determine if pre-treatment heavy drinkers, defined by uEtG, with SMI achieve higher levels of alcohol abstinence when they receive an increased magnitude of reinforcement for abstinence (High-Magnitude CM) or reinforcers for reduced drinking, prior to receiving reinforcers for abstinence (Shaping CM), relative to those who receive typical low-magnitude abstinence based CM (Usual CM). Additionally, variables in the Addictions Neuroclinical Assessment model will be examined as treatment response moderators. Participants (N=400) will be recruited from two urban mental health organizations and complete a 4-week induction period where they will be reinforced for submitting samples for uEtG testing. Participants who attain a mean uEtG >349mg/mL will be randomized to receive either Usual CM, High-Magnitude CM, or Shaping CM for 16weeks. Differences in abstinence, assessed by uEtG, will be examined during treatment and during a 12-month follow-up. Measures of negative emotionality, alcohol reinforcer salience, and executive functioning will be gathered at study intake and used to predict treatment outcomes. This novel approach to CM will use an alcohol biomarker to identify those at risk for treatment non-response and determine if adaptations to CM might improve outcomes for this group. Copyright © 2018 Elsevier Inc. All rights reserved.

An overview of the catalog manager

NASA Technical Reports Server (NTRS)

Irani, Frederick M.

1986-01-01

The Catalog Manager (CM) is being used at the Goddard Space Flight Center in conjunction with the Land Analysis System (LAS) running under the Transportable Applications Executive (TAE). CM maintains a catalog of file names for all users of the LAS system. The catalog provides a cross-reference between TAE user file names and fully qualified host-file names. It also maintains information about the content and status of each file. A brief history of CM development is given and a description of naming conventions, catalog structure and file attributes, and archive/retrieve capabilities is presented. General user operation and the LAS user scenario are also discussed.

Contingency management: New directions and remaining challenges for an evidence-based intervention

PubMed Central

Rash, Carla J.; Stitzer, Maxine; Weinstock, Jeremiah

2016-01-01

This article introduces the special issue on contingency management (CM), an efficacious intervention for the treatment of substance use disorders with low uptake in clinical settings that is not commensurate with evidence for efficacy. In this special issue of the Journal of Substance Abuse Treatment, we present 16 articles representing the latest research in efficacy, implementation, and technological advances related to CM. Combined, this collection of articles highlights the diverse populations, settings, and applications of CM in the treatment of substance use disorders. We conclude by highlighting directions for future research, particularly those that may increase CM’s appeal and uptake in routine clinical care. PMID:27746057

Amount of earnings during prize contingency management treatment is associated with posttreatment abstinence outcomes.

PubMed

Petry, Nancy M; Roll, John M

2011-12-01

Contingency management (CM) treatments that provide patients with the opportunity to earn chances of winning prizes of varying magnitudes are becoming increasingly popular. In the CM literature, magnitude of reinforcement is linked with effect sizes, such that CM treatments that provide larger magnitude reinforcement are more efficacious than those that provide lower magnitude reinforcement. With prize CM, even when magnitudes of overall expected prize earnings are constant, some patients win more prizes than others. Thus, patients who win larger overall amounts of prizes during treatment may have better outcomes than those who win fewer prizes. This study evaluated the impact of overall amounts of prizes won on long-term abstinence outcomes. The dollar amount of prizes won during prize CM treatments was determined from 78 cocaine-abusing methadone-maintenance patients who were randomized to prize CM treatments in three clinical trials. Abstinence three months following the end of the CM intervention was the primary dependent variable. The dollar amount of prizes won during CM treatment was a significant predictor of submission of cocaine-negative urine samples and self-reports of cocaine abstinence at the follow-up evaluation, even after controlling for other variables associated with long-term abstinence, such as pretreatment urinalysis results and longest duration of abstinence achieved during treatment. These results suggest that magnitudes of earnings during prize CM may impact outcomes and call for further experimentation of parameters related to the efficacy of prize CM.

Management of Iatrogenic Pseudoaneurysms in Patients Undergoing Coronary Artery Bypass Grafting.

PubMed

Stone, Patrick A; Thompson, Stephanie N; Hanson, Brent; Masinter, David

2016-05-01

A plethora of papers have been written regarding postcatheterization femoral pseudoaneurysms. However, literature is lacking on pseudoaneurysmal management in patients undergoing coronary artery bypass grafting (CABG). Thus, we examined if pseudoaneurysms with subsequent CABG can be managed with the same strategies as those not exposed to the intense anticoagulation accompanying CABGs. During a 14-year study period, we retrospectively examined femoral iatrogenic pseudoaneurysms (IPSAs) diagnosed postheart catheterization in patients having a subsequent CABG. Patient information was obtained from electronic medical records and included pseudoaneurysm characteristics, treatment, and resolution. Outcomes of interest included the occurrence of IPSA treatment failures and complications. In the 66 patients (mean age, 66 ± 11 years, 46% male) meeting inclusion criteria, mean dose of heparin received during the CABG procedure was 34 000 ± 23 000 units. The IPSA size distribution was the following: 17% of IPSAs measured <1 cm, 55% between 1 and 3 cm, and 21% measured >3 cm. Pseudoaneurysms were managed with compression, duplex-guided thrombin injection, and surgical repair (1%, 27%, and 26% of cases, respectively). Thrombin injection and surgical repair were 100% effective at treating pseudoaneurysms, with 1 patient experiencing a surgical site infection postsurgical repair. Observation-only management was employed in 30 (45%) patients. Nine of 30 patients with no intervention beyond observation had duplex documented resolution/thrombosis during follow-up. One patient initially managed by observation required readmission and surgical repair of an enlarging pseudoaneurysm (6 cm growth) following CABG. Management of pseudoaneurysms in patients prior to CABG should be similar to those patients not undergoing intense anticoagulation. In appropriate cases, small aneurysms can be safely observed, while thrombin injections are effective and safe as well. Thus, routine open surgical repair is not routinely required in patients with femoral pseudoaneurysms at time of CABG. © The Author(s) 2016.

Outcomes after primary chemoradiotherapy for N3 (>6 cm) head and neck squamous cell carcinoma after an FDG-PET--guided neck management policy.

PubMed

Adams, Gerard; Porceddu, Sandro V; Pryor, David I; Panizza, Benedict; Foote, Matthew; Rowan, Ann; Burmeister, Bryan

2014-08-01

The purpose of this study was to assess whether a positron emission tomography (PET)-directed policy remains appropriate for managing neck nodes (N3; >6 cm) in head and neck squamous cell carcinoma (HNSCC). All patients with N3 (>6 cm) HNSCC treated with definitive chemoradiotherapy (CRT) at our institution between 2005 and 2012 were included in the analysis. Patients underwent PET assessment before and 12 weeks after CRT. Neck dissections were performed for PET-avid residual nodal abnormalities after complete response at the primary site. Rate of isolated nodal failure (INF) was the primary outcome. Median follow-up from diagnosis for 33 patients was 30 months (range, 6-76 months). INF occurred in 2 patients (6%) with neck dissections performed in 4 cases (12%). First failure was predominantly distant metastatic (10; 30%). The rate of INF remains low when following a PET-directed neck management policy after definitive CRT for N3 (>6 cm) HNSCC. Copyright © 2013 Wiley Periodicals, Inc.

Case management of individuals with long-term conditions by community matrons: report of qualitative findings of a mixed method evaluation.

PubMed

Randall, Sue; Daly, Guy; Thunhurst, Colin; Mills, Natalie; Guest, David A; Barker, Annette

2014-01-01

To consider findings from a study that evaluated case management of individuals with long-term conditions (LTCs) by a community matron (CM) service. The paper highlights issues related to the implementation of a new role and the impact this had on the experience of care across hospital and community settings for patients and their carers. The introduction of the role of CM was intended to increase effective management of patients with complex comorbid LTCs through the introduction of case management, thereby reducing unplanned hospital admissions. The overall methodological approach was one of mixed methods. This paper reports the qualitative findings from CMs (n = 15); patients (n = 13); family carers (n = 8); and secondary care staff who interface with the CM service (n = 7). Data were collected between October 2009 and May 2010. A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.

Potential for Using Acetic Acid Plus Pear Ester Combination Lures to Monitor Codling Moth in an SIT Program.

PubMed

Judd, Gary J R

2016-11-25

Studies were conducted in commercial apple orchards in British Columbia, Canada, to determine whether lures combining ethyl-( E , Z )-2,4-decadienoate, pear ester (PE), with either acetic acid (AA) or sex pheromone, ( E , E )-8,10-dodecadien-1-ol (codlemone), might improve monitoring of codling moth, Cydia pomonella (L.), in an area-wide programme integrating sterile insect technology (SIT) and mating disruption (MD). Catches of sterile and wild codling moths were compared in apple orchards receiving weekly delivery of sterile moths (1:1 sex ratio) using white delta traps baited with either AA or PE alone, and in combination. Sterile and wild codling moths responded similarly to these kairomone lures. For each moth sex and type (sterile and wild), AA-PE lures were significantly more attractive than AA or PE alone. Bisexual catches with AA-PE lures were compared with those of commercial bisexual lures containing 3 mg of codlemone plus 3 mg of PE (Pherocon CM-DA Combo lure, Trécé Inc., Adair, OK, USA), and to catches of males with standard codlemone-loaded septa used in SIT (1 mg) and MD (10 mg) programmes, respectively. CM-DA lures caught the greatest number of sterile and wild male moths in orchards managed with SIT alone, or combined with MD, whereas AA-PE lures caught 2-3× more females than CM-DA lures under both management systems. Sterile to wild (S:W) ratios for male versus female moths in catches with AA-PE lures were equivalent, whereas in the same orchards, male S:W ratios were significantly greater than female S:W ratios when measured with CM-DA lures. Male S:W ratios measured with CM-DA lures were similar to those with codlemone lures. CM-DA and codlemone lures appear to overestimate S:W ratios as measured by AA-PE lures, probably by attracting relatively more sterile males from long range. Using AA-PE lures to monitor codling moths in an SIT programme removes fewer functional sterile males and reduces the need for trap maintenance compared with using codlemone lures. AA-PE lures allow detection of wild female moths that may measure damage potential more accurately than detection of wild males. The short-range activity of AA-PE lures compared with that of codlemone-based lures appears to improve the ability to measure S:W ratios and the impact of SIT on population control near the site where wild moths are trapped.

Sockets and Pebbles

NASA Technical Reports Server (NTRS)

1997-01-01

This close-up Sojourner rover image of a small rock shows that weathering has etched-out pebbles to produce sockets. In the image, sunlight is coming from the upper left. Sockets (with shadows on top) are visible at the lower left and pebbles (with bright tops and shadowed bases) are seen at the lower center and lower right. Two pebbles (about 0.5 cm across) are visible at the lower center.

Mars Pathfinder is the second in NASA's Discovery program of low-cost spacecraft with highly focused science goals. The Jet Propulsion Laboratory, Pasadena, CA, developed and manages the Mars Pathfinder mission for NASA's Office of Space Science, Washington, D.C. JPL is a division of the California Institute of Technology (Caltech).

Pilot Field Test Study

NASA Technical Reports Server (NTRS)

Sherriff, Abigail

2015-01-01

The Field Test study is currently in full swing, preceded by the successful completion of the Pilot Field Test study that paved the way for collecting data on the astronauts in the medical tent in Kazakhstan. Abigail Sherriff worked alongside Logan Dobbe on one Field Test aspect to determine foot clearance over obstacles (5cm, 10cm, and 15cm) using APDM Inc. Internal Measurement Units (IMU) worn by the astronauts. They created a program to accurately calculate foot clearance using the accelerometer, magnetometer, and gyroscope data with the IMUs attached to the top of the shoes. To validate the functionality of their program, they completed a successful study on test subjects performing various tasks in an optical motion studio, considered a gold standard in biomechanics research. Future work will include further validation and expanding the program to include other analyses.

A Patient-Centered Transitional Care Case Management Program: Taking Case Management to the Streets and Beyond.

PubMed

Lovelace, Derenda; Hancock, Diane; Hughes, Sabrina S; Wyche, Phyllis R; Jenkins, Claire; Logan, Cindy

In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%. To examine the impact of the McGuire VAMC TCP on Veteran ED and hospital utilization and costs. Veterans being discharged to home following an inpatient admission, ED visit, and/or short rehab stay. The primary means of identifying patients for the program is through daily screening of the previous 24-hour admission and ED report, which the inpatient nurse practitioner performs. She completes an extensive review of each Veteran's electronic medical record to determine the number of ED visits and inpatient admissions at the VAMC and in the community. Initial criteria for consideration in the program included the following: more than two hospital admissions and/or ED visits in the past 90 days or at high risk for readmission based on a Care Assessment Need score of greater than 95. Two hundred Veterans participated in the program in fiscal year (FY) 2013, with 146 participating in FY 2014. A retrospective chart review of Veterans participating in the TCP in FYs 2013 and 2014 was conducted, with a focus on number of admissions and ED visits 90 days prior to admission to the TCP and 90 days following TCP admission. Average admission and ED costs for this VA were calculated to determine cost savings from pre- to post-90 days of admission and ED visits. Veterans who obtained TCP services in FYs 2013 and 2014 experienced a 67% decrease in hospital admissions and a 61% decrease in ED visits in the 90 days following participation in this program compared with the 90 days prior to participation. This produced an estimated net savings of $3,823,673 in medical center costs. In addition, registered nurse case managers (RN CMs) noted improved patient compliance and satisfaction with care and the licensed clinical social worker noted reduced caregiver burden. The results of this program demonstrate how using an interdisciplinary approach to develop patient-centered transition plans of care through intensive case management interventions improves resource utilization with substantial financial savings. This program represents a feasible option for other VAMCs as well as civilian hospitals seeking to provide cost-effective transitional care to patients upon discharge and prevent untimely readmissions. With an RN CM at the hub of patient care, this program successfully demonstrates the value of smooth care transitions.

Fourier Transform Spectroscopy of Carbonyl Sulfide from 3700 to 4800 cm -1and Selection of a Line-Pointing Program

NASA Astrophysics Data System (ADS)

Naı̈m, S.; Fayt, A.; Bredohl, H.; Blavier, J.-F.; Dubois, I.

1998-11-01

We have measured the Fourier transform spectrum of natural OCS from 3700 to 4800 cm-1with a near Doppler resolution and a line-position accuracy between 4 and 8 × 10-5cm-1. For the normal isotopic species, 37 vibrational transitions have been analyzed for both frequencies and intensities. We also report 15 bands of OC34S, eight bands of O13CS, nine bands of OC33S, and two bands of18OCS. Important effective Herman-Wallis terms are explained on the basis of eigenvectors. A comparison of different line-pointing programs is also presented.

A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength.

PubMed

Culligan, Patrick J; Scherer, Janet; Dyer, Keisha; Priestley, Jennifer L; Guingon-White, Geri; Delvecchio, Donna; Vangeli, Margi

2010-04-01

The purpose of this study is to determine whether a Pilates exercise program and a pelvic floor muscle-training (PFMT) program could provide similar improvements in pelvic muscle strength. Sixty-two women with little or no pelvic floor dysfunction were randomized to Pilates or PFMT. Each group had 24 biweekly 1-h sessions with either a physical therapist or Pilates instructor. Strength was measured via perineometry (cmH(2)O). Two questionnaires--pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7)--were also collected. At baseline, the Pilates and PFMT groups measured 14.9 +/- 12.5 and 12.5 +/- 10.4 cmH(2)O, respectively (p = 0.41). Both the Pilates and PFMT groups got stronger (6.2 +/- 7.5 cmH(2)O, p = 0.0002 and 6.6 +/- 7.4 cmH(2)O, p = 0.0002, respectively), with no difference between groups p = 0.85. PFIQ and PFDI scores improved from baseline but not between groups. Further study is required to determine if Pilates can actually treat pelvic floor dysfunction.

Experimental results for a prototype 3-D acoustic imaging system using an ultra-sparse planar array

NASA Astrophysics Data System (ADS)

Impagliazzo, John M.; Chiang, Alice M.; Broadstone, Steven R.

2002-11-01

A handheld high resolution sonar has been under development to provide Navy Divers with a 3-D acoustic imaging system for mine reconnaissance. An ultra-sparse planar array, consisting of 121 1 mm x1 mm, 2 MHz elements, was fabricated to provide 3-D acoustic images. The array was 10 cm x10 cm. A full array at this frequency with elements at half-wavelength spacing would consist of 16384 elements. The first phase of testing of the planar array was completed in September 2001 with the characterization of the array in the NUWC Acoustic Test Facility (ATF). The center frequency was 2 MHz with a 667 kHz bandwidth. A system-level technology demonstration will be conducted in July 2002 with a real-time beamformer and near real-time 3-D imaging software. The demonstration phase consists of imaging simple targets at a range of 3 m in the ATF. Experimental results obtained will be reported on. [Work supported by the Defense Applied Research Project Agency, Advance Technology Office, Dr. Theo Kooij, Program Manager.

A pilot test of the GoWoman weight management intervention for women with mobility impairments in the online virtual world of Second Life®.

PubMed

Nosek, Margaret A; Robinson-Whelen, Susan; Ledoux, Tracey A; Hughes, Rosemary B; O'Connor, Daniel P; Lee, Rebecca E; Goe, Rebecca; Silveira, Stephanie L; Markley, Rachel; Nosek, Thomas M

2018-06-11

Pilot test GoWoman, a small-group weight management intervention for mobility impaired women that was a disability- and gender-responsive adaptation of the Diabetes Prevention Program delivered in the online virtual world of Second Life ® . Objectives were to (1) examine pre-/post-intervention differences in weight, waist circumference, diet, physical activity, self-efficacy for diet and physical activity, nutrition knowledge and social support for weight management, (2) determine intervention feasibility (fidelity, attrition, engagement, acceptability). Single-group modified interrupted time series quasi-experimental design whereby participants served as their own controls. Thirteen women attended ≥8 of 16 GoWoman weekly sessions and lost an average of 5.97 pounds (2.71 kg) (3.31%) body weight (Cohen's d = 0.74) and 1.44 inches (3.66 cm) (3.58%) waist circumference (Cohen's d = 0.83). There were significant improvements in physical activity, diet and self-efficacy for diet and physical activity. All benchmarks for feasibility were met. Ratings of intervention content, group interactions and support and virtual world experiences were highly positive. Findings suggest that a disability- and gender-responsive weight management intervention with peer group support delivered in an online virtual world is feasible, meaningful and may assist with weight management for mobility impaired women. Implications for Rehabilitation This study addresses a gap in the general and rehabilitation research literature by addressing the disproportionately high rates of obesity among women with mobility impairments, who are generally excluded from tests of weight management interventions if they have limited ability to engage in vigorous physical activity. The GoWoman program is an adaptation of the Diabetes Prevention Program Lifestyle Change curriculum that is tailored to meet the unique weight management needs of women with mobility impairments, and was created to become a publicly available, disability- and gender-responsive intervention that can be used in community and rehabilitation settings. More rehabilitation and health promotion program should be offered in the free, online, virtual world of Second Life ® since participants in this pilot study offered many favorable comments about the new learning and social opportunities available to them there and they did not have to deal with the disability-related environmental and health challenges that often prevent them from participating in face-to-face workshops. Preliminary indications of improvements in body weight, waist circumference, diet and physical activity after attending the GoWoman weight management intervention offered in Second Life ® tell us that these strategies are feasible for helping women with mobility impairments manage their weight and should undergo further testing.

A wood density and aboveground biomass variability assessment using pre-felling inventory data in Costa Rica.

PubMed

Svob, Sienna; Arroyo-Mora, J Pablo; Kalacska, Margaret

2014-12-01

The high spatio-temporal variability of aboveground biomass (AGB) in tropical forests is a large source of uncertainty in forest carbon stock estimation. Due to their spatial distribution and sampling intensity, pre-felling inventories are a potential source of ground level data that could help reduce this uncertainty at larger spatial scales. Further, exploring the factors known to influence tropical forest biomass, such as wood density and large tree density, will improve our knowledge of biomass distribution across tropical regions. Here, we evaluate (1) the variability of wood density and (2) the variability of AGB across five ecosystems of Costa Rica. Using forest management (pre-felling) inventories we found that, of the regions studied, Huetar Norte had the highest mean wood density of trees with a diameter at breast height (DBH) greater than or equal to 30 cm, 0.623 ± 0.182 g cm -3 (mean ± standard deviation). Although the greatest wood density was observed in Huetar Norte, the highest mean estimated AGB (EAGB) of trees with a DBH greater than or equal to 30 cm was observed in Osa peninsula (173.47 ± 60.23 Mg ha -1 ). The density of large trees explained approximately 50% of EAGB variability across the five ecosystems studied. Comparing our study's EAGB to published estimates reveals that, in the regions of Costa Rica where AGB has been previously sampled, our forest management data produced similar values. This study presents the most spatially rich analysis of ground level AGB data in Costa Rica to date. Using forest management data, we found that EAGB within and among five Costa Rican ecosystems is highly variable. Combining commercial logging inventories with ecological plots will provide a more representative ground level dataset for the calibration of the models and remotely sensed data used to EAGB at regional and national scales. Additionally, because the non-protected areas of the tropics offer the greatest opportunity to reduce rates of deforestation and forest degradation, logging inventories offer a promising source of data to support mechanisms such as the United Nations REDD + (Reducing Emissions from Tropical Deforestation and Degradation) program.

Manual vs. automatic capture management in implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators.

PubMed

Murgatroyd, Francis D; Helmling, Erhard; Lemke, Bernd; Eber, Bernd; Mewis, Christian; van der Meer-Hensgens, Judith; Chang, Yanping; Khalameizer, Vladimir; Katz, Amos

2010-06-01

The Secura ICD and Consulta CRT-D are the first defibrillators to have automatic right atrial (RA), right ventricular (RV), and left ventricular (LV) capture management (CM). Complete CM was evaluated in an implantable cardioverter defibrillator (ICD) population. Two prospective clinical studies were conducted in 28 centres in Europe and Israel. Automatic CM data were compared with manual threshold measurements, the CM applicability was determined, and adjustments to pacing outputs were analysed. In total, 160 patients [age 64.6 +/- 10.4 years, 77% male, 80 ICD and 80 cardiac resynchronization therapy defibrillator (CRT-D)] were included. The differences between automatic and manual measurements were 2.5 V) due to raised RA threshold in seven (4.4%), high RV threshold in nine (5.6%), and high LV threshold in three patients (3.8%). All high threshold detections and all automatic modulations of pacing output were adjudicated appropriate. Complete CM adjusts pacing output appropriately, permitting a reduction in office visits while it may maximize device longevity. The study was registered at ClinicalTrials.gov identifiers: NCT00526227 and NCT00526162.

A Loader for Executing Multi-Binary Applications on the Thinking Machines CM-5: It's Not Just for SPMD Anymore

NASA Technical Reports Server (NTRS)

Becker, Jeffrey C.

1995-01-01

The Thinking Machines CM-5 platform was designed to run single program, multiple data (SPMD) applications, i.e., to run a single binary across all nodes of a partition, with each node possibly operating on different data. Certain classes of applications, such as multi-disciplinary computational fluid dynamics codes, are facilitated by the ability to have subsets of the partition nodes running different binaries. In order to extend the CM-5 system software to permit such applications, a multi-program loader was developed. This system is based on the dld loader which was originally developed for workstations. This paper provides a high level description of dld, and describes how it was ported to the CM-5 to provide support for multi-binary applications. Finally, it elaborates how the loader has been used to implement the CM-5 version of MPIRUN, a portable facility for running multi-disciplinary/multi-zonal MPI (Message-Passing Interface Standard) codes.

Laparoendoscopic Management of Midureteral Strictures

PubMed Central

Komninos, Christos; Koo, Kyo Chul

2014-01-01

The incidence of ureteral strictures has increased worldwide owing to the widespread use of laparoscopic and endourologic procedures. Midureteral strictures can be managed by either an endoscopic approach or surgical reconstruction, including open or minimally invasive (laparoscopic/robotic) techniques. Minimally invasive surgical ureteral reconstruction is gaining in popularity in the management of midureteral strictures. However, only a few studies have been published so far regarding the safety and efficacy of laparoscopic and robotic ureteral reconstruction procedures. Nevertheless, most of the studies have reported at least equivalent outcomes with the open approach. In general, strictures more than 2 cm, injury strictures, and strictures associated either with radiation or with reduced renal function of less than 25% may be managed more appropriately by minimally invasive surgical reconstruction, although the evidence to establish these recommendations is not yet adequate. Defects of 2 to 3 cm in length may be treated with laparoscopic or robot-assisted uretero-ureterostomy, whereas defects of 12 to 15 cm may be managed either via ureteral reimplantation with a Boari flap or via transuretero-ureterostomy in case of low bladder capacity. Cases with more extended defects can be reconstructed with the incorporation of the ileum in ureteral repair. PMID:24466390

Case management for the elderly with complex needs: cross-linking the views of their role held by elderly people, their informal caregivers and the case managers.

PubMed

Balard, Frédéric; Gely-Nargeot, Marie-Christine; Corvol, Aline; Saint-Jean, Olivier; Somme, Dominique

2016-11-08

In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006-2010). People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users' (old people and their informal caregivers) and case managers' first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19), their informal caregivers (11) and the case managers (5) who participated in the program during the first 6 months. Thematic analysis of the data was carried out. The analysis revealed that each group of people generated its own representations of the case manager's role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual's projected expectations of this social service. Analyzing the first representations of the case manager's role during the implementation phase of the CM service appears as a necessary step before considering the effects of the services. The implementation and the success of a case management model have to be evaluated regarding the previous healthcare context and the expectations of the people involved.

A randomized factorial trial of disulfiram and contingency management to enhance cognitive behavioral therapy for cocaine dependence.

PubMed

Carroll, Kathleen M; Nich, Charla; Petry, Nancy M; Eagan, Dorothy A; Shi, Julia M; Ball, Samuel A

2016-03-01

This study evaluated the extent to which the addition of disulfiram and contingency management for adherence and abstinence (CM), alone and in combination, might enhance the effects of cognitive behavioral therapy (CBT) for cocaine use disorders. Factorial randomized double blind (for medication condition) clinical trial where CBT served as the platform and was delivered in weekly individual sessions in a community-based outpatient clinic. 99 outpatients who met DSM-IV criteria for current cocaine dependence were assigned to receive either disulfiram or placebo, and either CM or no CM. Cocaine and other substance use was assessed via a daily calendar with thrice weekly urine sample testing for 12 weeks with a one-year follow-up (80% interviewed at one year). The primary hypothesis that CM and disulfiram would produce the best cocaine outcomes was not confirmed, nor was there a main effect for disulfiram. For the primary outcome (percent days of abstinence, self report), there was a significant interaction, with the best cocaine outcomes were seen for the combination of CM and placebo, with the two groups assigned to disulfiram associated with intermediate outcomes, and poorest cocaine outcome among those assigned to placebo and no CM. The secondary outcome (urinalysis) indicated a significant effect favoring CM over no CM but the interaction effect was not significant. One year follow-up data indicated sustained treatment effects across conditions. CM enhances outcomes for CBT treatment of cocaine dependence, but disulfiram provided no added benefit to the combination of CM and CBT. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Effect of feeder space during the growing and laying periods and the rate of feed increase at the onset of lay on broiler breeder female reproductive function.

PubMed

Leksrisompong, N; Romero-Sanchez, H; Oviedo-Rondón, E O; Brake, J

2014-07-01

A study was conducted to examine how 2 feeder space allocations during the rearing period followed by 2 feeder space allocations after photostimulation and 2 female feeding to peak programs (fast or slow) affected female broiler breeder reproductive performance and mortality. Sixteen pens of 76 breeder females each were equipped with either 4 tube feeders with a 132 cm circumference pan (7.0 cm/female) or 6 feeders (10.4 cm/female) to 21 wk of age. Thereafter, 64 females were moved to breeding pens, photostimulated, and fed sex-separate from either 3 (6.2 cm/female) or 5 (10.3 cm/female) feeders with either fast or slow feeding to peak feeding programs applied to complete a 2 × 2 × 2 factorial design. Seven males that were separately reared in a similar manner were added per pen. Individual female BW was determined at 6, 20, and 32 wk of age and BW uniformity assessed. Greater feeder space during rearing increased BW at 32 wk of age, whereas greater feeder space during lay or slow feeding to peak decreased BW at 32 wk. There were no differences in BW uniformity. Hens from the 10.4 to 10.3 cm/female combination produced a significantly greater number of eggs as compared with the 7.0 to 10.3 cm/female and 10.4 to 6.2 cm/female combinations with the 7.0 to 6.2 cm/female combination intermediate. Percentage hen-day egg production of the 10.4 to 10.3 cm/female combination hens was significantly greater than all other combinations. Livability was improved in the 10.4 to 10.3 cm/female combination relative to the 7.0 to 10.3 cm/female combination with the others intermediate. The fast feeding to peak program increased yolk weight as well as yolk:albumen ratio at 28 and 30 wk of age, but egg weight did not differ. These data indicated that increased or decreased feeder space between the growing and laying periods did not affect broiler breeder female BW, uniformity, egg weight, fertility, or hatchability. The 10.3 cm/female laying feeder space exhibited the best hen-day egg production in combination with 10.4 cm/pullet rearing but not with 7.0 cm/pullet rearing space. In a similar manner, hen mortality was greater in the 7.0 to 10.3 cm/female feeder space combination that the 10.4 to 10.3 cm/female combination. © 2014 Poultry Science Association Inc.

Duration effects in contingency management treatment of methamphetamine disorders.

PubMed

Roll, John M; Chudzynski, Joy; Cameron, Jennifer M; Howell, Donelle N; McPherson, Sterling

2013-09-01

The primary aim of this study was to determine whether different durations of contingency management (CM) in conjunction with psychosocial treatment produced different rates of abstinence among methamphetamine dependent individuals. Participants were randomized to one of the four 16-week treatment conditions: standard psychosocial treatment or psychosocial treatment plus one of the three durations of CM (one-month, two-month, or four-month). A total of 118 participants were randomized to the four treatment conditions. There were significant differences across treatment conditions for number of consecutive days of methamphetamine abstinence (p<0.05). These differences were in the hypothesized direction, as participants were more likely to remain abstinent through the 16-week trial as CM duration increased. A significant effect of treatment condition (p<0.05) and time (p<0.05) on abstinence over time was also found. Longer durations of CM were more effective for maintaining methamphetamine abstinence. Copyright © 2013 Elsevier Ltd. All rights reserved.

Duration Effects in Contingency Management Treatment of Methamphetamine Disorders

PubMed Central

Roll, John M.; Chudzynski, Joy; Cameron, Jennifer M.; Howell, Donelle N.; McPherson, Sterling

2013-01-01

The primary aim of this study was to determine whether different durations of contingency management (CM) in conjunction with psychosocial treatment produced different rates of abstinence among methamphetamine dependent individuals. Participants were randomized to one of four 16-week treatment conditions: standard psychosocial treatment or psychosocial treatment plus one of three durations of CM (one-month, two-month, or four-month). A total of 118 participants were randomized to the four treatment conditions. There were significant differences across treatment conditions for number of consecutive days of methamphetamine abstinence (p < 0.05). These differences were in the hypothesized direction, as participants were more likely to remain abstinent through the 16-week trial as CM duration increased. A significant effect of treatment condition (p < 0.05) and time (p < 0.05) on abstinence over time was also found. Longer durations of CM were more effective for maintaining methamphetamine abstinence. PMID:23708468

Population Dynamics and Flight Phenology Model of Codling Moth Differ between Commercial and Abandoned Apple Orchard Ecosystems.

PubMed

Joshi, Neelendra K; Rajotte, Edwin G; Naithani, Kusum J; Krawczyk, Greg; Hull, Larry A

2016-01-01

Apple orchard management practices may affect development and phenology of arthropod pests, such as the codling moth (CM), Cydia pomonella (L.) (Lepidoptera: Tortricidae), which is a serious internal fruit-feeding pest of apples worldwide. Estimating population dynamics and accurately predicting the timing of CM development and phenology events (for instance, adult flight, and egg-hatch) allows growers to understand and control local populations of CM. Studies were conducted to compare the CM flight phenology in commercial and abandoned apple orchard ecosystems using a logistic function model based on degree-days accumulation. The flight models for these orchards were derived from the cumulative percent moth capture using two types of commercially available CM lure baited traps. Models from both types of orchards were also compared to another model known as PETE (prediction extension timing estimator) that was developed in 1970s to predict life cycle events for many fruit pests including CM across different fruit growing regions of the United States. We found that the flight phenology of CM was significantly different in commercial and abandoned orchards. CM male flight patterns for first and second generations as predicted by the constrained and unconstrained PCM (Pennsylvania Codling Moth) models in commercial and abandoned orchards were different than the flight patterns predicted by the currently used CM model (i.e., PETE model). In commercial orchards, during the first and second generations, the PCM unconstrained model predicted delays in moth emergence compared to current model. In addition, the flight patterns of females were different between commercial and abandoned orchards. Such differences in CM flight phenology between commercial and abandoned orchard ecosystems suggest potential impact of orchard environment and crop management practices on CM biology.

Contingency management improves smoking cessation treatment outcomes among highly impulsive adolescent smokers relative to cognitive behavioral therapy.

PubMed

Morean, Meghan E; Kong, Grace; Camenga, Deepa R; Cavallo, Dana A; Carroll, Kathleen M; Pittman, Brian; Krishnan-Sarin, Suchitra

2015-03-01

Impulsive adolescents have difficulty quitting smoking. We examined if treatments that provide behavioral incentives for abstinence improve treatment outcomes among impulsive adolescent smokers, who have been shown to be highly sensitive to reward. We ran secondary data analyses on 64 teen smokers (mean age=16.36 [1.44]; cigarettes/day=13.97 [6.61]; 53.1% female; 90.6% Caucasian) who completed a four-week smoking cessation trial to determine whether impulsive adolescents differentially benefit from receiving cognitive behavioral therapy (CBT), contingency management (CM), or the combination of the two (CM/CBT). Indices of treatment efficacy included self-report percent days abstinent and end of treatment biochemically-confirmed 7-day point prevalence abstinence (EOT abstinence). We assessed self-reported impulsivity using the Brief Barratt Impulsiveness Scale. We used univariate Generalized Linear Modeling to examine main effects and interactions of impulsivity and treatment condition as predictors of self-reported abstinence, and exact logistic regression to examine EOT abstinence. CM/CBT and CM were comparably effective in promoting abstinence, so analyses were conducted comparing the efficacy of CBT to treatments with a CM component (i.e., CM and CM/CBT). CBT and deficient self-regulation predicted lower self-reported abstinence rates within the total analytic sample. Treatments containing CM were more effective than CBT in predicting 1) self-reported abstinence among behaviorally impulsive adolescents (% days abstinent: CM 77%; CM/CBT 81%; CBT 30%) and 2) EOT point prevalence abstinence among behaviorally impulsive adolescents and adolescents with significant deficits in self-regulation. CM-based interventions may improve the low smoking cessation rates previously observed among impulsive adolescent smokers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Population Dynamics and Flight Phenology Model of Codling Moth Differ between Commercial and Abandoned Apple Orchard Ecosystems

PubMed Central

Joshi, Neelendra K.; Rajotte, Edwin G.; Naithani, Kusum J.; Krawczyk, Greg; Hull, Larry A.

2016-01-01

Apple orchard management practices may affect development and phenology of arthropod pests, such as the codling moth (CM), Cydia pomonella (L.) (Lepidoptera: Tortricidae), which is a serious internal fruit-feeding pest of apples worldwide. Estimating population dynamics and accurately predicting the timing of CM development and phenology events (for instance, adult flight, and egg-hatch) allows growers to understand and control local populations of CM. Studies were conducted to compare the CM flight phenology in commercial and abandoned apple orchard ecosystems using a logistic function model based on degree-days accumulation. The flight models for these orchards were derived from the cumulative percent moth capture using two types of commercially available CM lure baited traps. Models from both types of orchards were also compared to another model known as PETE (prediction extension timing estimator) that was developed in 1970s to predict life cycle events for many fruit pests including CM across different fruit growing regions of the United States. We found that the flight phenology of CM was significantly different in commercial and abandoned orchards. CM male flight patterns for first and second generations as predicted by the constrained and unconstrained PCM (Pennsylvania Codling Moth) models in commercial and abandoned orchards were different than the flight patterns predicted by the currently used CM model (i.e., PETE model). In commercial orchards, during the first and second generations, the PCM unconstrained model predicted delays in moth emergence compared to current model. In addition, the flight patterns of females were different between commercial and abandoned orchards. Such differences in CM flight phenology between commercial and abandoned orchard ecosystems suggest potential impact of orchard environment and crop management practices on CM biology. PMID:27713702

[Gross characteristics of placentas from an assisted reproduction program].

PubMed

Tabs, Dunja; Vejnović, Tihomir; Lalosević, Dusan; Radunović, Nebojsa

2006-01-01

Even though placentas from assisted reproduction programs often differ from placentas of women who conceived naturally, they are rarely examined. The aim of our investigation was to determine some gross characteristics of placentas of women who conceived with assisted reproduction. We examined 30 placentas from an assisted reproduction program (20 from in vitro fertilization and 10 from intrauterine insemination) and 30 placentas of women who conceived naturally. All women were age matched. All the women were at term. The mean weight of placentas from assisted reproduction program was 573 g and of those after natural conception--582.67g. The mean length of the umbilical cords was 64.3cm after assisted reproduction and 66.3cm after natural conception. The mean placenta thickness after assisted reproduction was 2,22 cm and after natural conception 2.28 cm. Eight placentas of the study group had a marginal insertion of the umbilical cord, which lead to a statistically significant difference when compared to placentas of women who conceived naturally: chi-square = 7.07; p>0.01. Marginal cord insertion into the placenta after assisted reproduction is also often described in the literature (as a possible "consequence" of embryo-transfer). There were no statistically significant differences in the mean weight and dimensions of placentas, length of the umbilical cord, gross pathological features of placentas and cords, mean birth weight of babies and placental/fetal ratios between women from assisted reproduction program and those who conceived naturally.

A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong.

PubMed

Lam, Linda C W; Lee, Jenny S W; Chung, Jenny C C; Lau, Anna; Woo, Jean; Kwok, Timothy C Y

2010-04-01

To evaluate a case management (CM) model for people with mild dementia, whereby resources within the family and in the community were mobilized and optimally used. Community dwelling psychiatric and geriatrics outpatients with mild dementia were randomized to receive CM by a trained occupational therapist for 4 months (CM group, N = 59) or usual care only (control group, N = 43). Primary outcome indicators included the Zarit Burden Scale (ZBI), General Health Questionnaire (GHQ), and Personal Well-Being Index for Adult (PWI-A) of the family caregivers. Secondary outcome indicators included the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), and Personal Well-Being Index for Intellectually Disabled (PWI-ID) of the demented subjects as measured at fourth and twelfth months. CSDDis reduced in the CM group at fourth month, but not at twelfth month. The changes in outcome variables of persons with dementia did not differ between the groups (Mann-Whitney U-test, p > 0.05). At follow-up, CM group used more day care and domestic helpers than control group (chi (2), p > 0.05). Case management for Chinese persons with mild dementia outpatients did not show significant effects in reducing caregiver burden, but encouraged family caregivers to seek external support.

Pancreatic islet cell tumor metastasis in multiple endocrine neoplasia type 1: correlation with primary tumor size.

PubMed

Lowney, J K; Frisella, M M; Lairmore, T C; Doherty, G M

1998-12-01

Islet cell tumor (ICT) metastasis is one of the potentially lethal outcomes of multiple endocrine neoplasia type 1 (MEN 1). Management of ICT in patients with MEN 1 is controversial; some advocate resection based on biochemical evidence of progression, whereas others use tumor size to predict the risk of metastasis and the need for resection. This study correlates the size of primary ICT with the presence of metastases. Forty-eight patients with MEN 1 with ICT, from 34 kindreds followed up in our multiple endocrine neoplasia program, were evaluated; 43 of the 48 have been explored for ICT. Metastases to the lymph nodes and liver were documented. Thirty-three percent of patients with pancreatic tumors less than 1 cm in greatest diameter had metastatic disease at surgery and in follow-up, whereas 34.8% of patients with tumors greater than 2 cm in diameter had metastases to lymph nodes or liver. The 2 patients with liver metastases each had primary tumors greater than 2 cm. Follow-up revealed subsequent metastasis in 1 patient. The size of primary tumors in MEN 1 does not correlate with metastatic potential. This is not a good criterion for exploration. Continued follow-up of these patients will be necessary to define the effect of operation on the course of ICT in MEN 1.

Spectral line and continuum studies using Haystack antenna

NASA Technical Reports Server (NTRS)

1973-01-01

During the last half of 1972, the Haystack antenna was utilized 88% of the time. Of this useful time, 81% was devoted to radio astronomy investigations, 8% was spent on radar-related research and 11% was scheduled for maintenance and system improvements. Thirteen programs were completed of which 10 were spectral-line studies involving primarily recombination lines and H2O vapor investigations. The others involved 2 cm and 1.3 cm continuum observations. Fifteen new programs were accepted and the currently active radio observing programs totalled 24 as of 31 December 1973. The last radar measurements in the lunar topography program have now been completed. Radar activity, including measurements on Mercury, Venus and synchronous satellites has continued.

Obesity and Dyslipidemia in South Asians

PubMed Central

Misra, Anoop; Shrivastava, Usha

2013-01-01

Obesity and dyslipidemia are emerging as major public health challenges in South Asian countries. The prevalence of obesity is more in urban areas than rural, and women are more affected than men. Further, obesity in childhood and adolescents is rising rapidly. Obesity in South Asians has characteristic features: high prevalence of abdominal obesity, with more intra-abdominal and truncal subcutaneous adiposity than white Caucasians. In addition, there is greater accumulation of fat at “ectopic” sites, namely the liver and skeletal muscles. All these features lead to higher magnitude of insulin resistance, and its concomitant metabolic disorders (the metabolic syndrome) including atherogenic dyslipidemia. Because of the occurrence of type 2 diabetes, dyslipidemia and other cardiovascular morbidities at a lower range of body mass index (BMI) and waist circumference (WC), it is proposed that cut-offs for both measures of obesity should be lower (BMI 23–24.9 kg/m2 for overweight and ≥25 kg/m2 for obesity, WC ≥80 cm for women and ≥90 cm for men for abdominal obesity) for South Asians, and a consensus guideline for these revised measures has been developed for Asian Indians. Increasing obesity and dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition. Dietary guidelines for prevention of obesity and diabetes, and physical activity guidelines for Asian Indians are now available. Intervention programs with emphasis on improving knowledge, attitude and practices regarding healthy nutrition, physical activity and stress management need to be implemented. Evidence for successful intervention program for prevention of childhood obesity and for prevention of diabetes is available for Asian Indians, and could be applied to all South Asian countries with similar cultural and lifestyle profiles. Finally, more research on pathophysiology, guidelines for cut-offs, and culturally-specific lifestyle management of obesity, dyslipidemia and the metabolic syndrome are needed for South Asians. PMID:23863826

Contingency management for college student smokers: The role of drinking as a moderator and mediator of smoking abstinence during treatment.

PubMed

Cassidy, Rachel N; Jackson, Kristina M; Rohsenow, Damaris J; Tidey, Jennifer W; Tevyaw, Tracy O' L; Barnett, Nancy P; Monti, Peter M; Miller, Mollie E; Colby, Suzanne M

2018-05-01

Contingency management (CM) is effective for promoting smoking abstinence; however, moderators and mediators of CM treatment efficacy in young adult populations are under-explored. We leveraged fine-grained data from a large randomized controlled trial: 1) to determine whether early attainment of sustained abstinence mediated the effect of treatment on abstinence; 2) to test whether heavy drinking moderated the effect of treatment on abstinence; and 3) to test a serial mediation model of the effects of drinking during early treatment on sustained smoking abstinence. College student smokers (N=110) were randomized to receive either CM treatment or noncontingent reinforcement (NR) over a 21-day treatment period. All participants received $5 for providing twice-daily breath carbon monoxide (CO) samples. In CM, additional money was provided for samples that indicated smoking reduction (Initial Phase; first 7days), and for samples ≤5ppm (Abstinence Phase; following 14days). CM treatment led to greater sustained abstinence relative to NR. Longer sustained abstinence in the Initial Phase partially mediated the effect of treatment on sustained abstinence in the Abstinence Phase. Heavier pretreatment drinkers had shorter periods of sustained abstinence in the Abstinence Phase; this effect was greater in CM. A serial mediation model determined that increased drinking during the Initial Phase led to decreased sustained abstinence, which then led to decreased sustained abstinence in the Abstinence Phase. These data provide a greater understanding of how heavy drinking and early sustained abstinence may affect success during treatment in young adults undergoing contingency management treatment for smoking. Copyright © 2018. Published by Elsevier Ltd.

Miscanthus Establishment and Overwintering in the Midwest USA: A Regional Modeling Study of Crop Residue Management on Critical Minimum Soil Temperatures

PubMed Central

Kucharik, Christopher J.; VanLoocke, Andy; Lenters, John D.; Motew, Melissa M.

2013-01-01

Miscanthus is an intriguing cellulosic bioenergy feedstock because its aboveground productivity is high for low amounts of agrochemical inputs, but soil temperatures below −3.5°C could threaten successful cultivation in temperate regions. We used a combination of observed soil temperatures and the Agro-IBIS model to investigate how strategic residue management could reduce the risk of rhizome threatening soil temperatures. This objective was addressed using a historical (1978–2007) reconstruction of extreme minimum 10 cm soil temperatures experienced across the Midwest US and model sensitivity studies that quantified the impact of crop residue on soil temperatures. At observation sites and for simulations that had bare soil, two critical soil temperature thresholds (50% rhizome winterkill at −3.5°C and −6.0°C for different Miscanthus genotypes) were reached at rhizome planting depth (10 cm) over large geographic areas. The coldest average annual extreme 10 cm soil temperatures were between −8°C to −11°C across North Dakota, South Dakota, and Minnesota. Large portions of the region experienced 10 cm soil temperatures below −3.5°C in 75% or greater for all years, and portions of North and South Dakota, Minnesota, and Wisconsin experienced soil temperatures below −6.0°C in 50–60% of all years. For simulated management options that established varied thicknesses (1–5 cm) of miscanthus straw following harvest, extreme minimum soil temperatures increased by 2.5°C to 6°C compared to bare soil, with the greatest warming associated with thicker residue layers. While the likelihood of 10 cm soil temperatures reaching −3.5°C was greatly reduced with 2–5 cm of surface residue, portions of the Dakotas, Nebraska, Minnesota, and Wisconsin still experienced temperatures colder than −3.5°C in 50–80% of all years. Nonetheless, strategic residue management could help increase the likelihood of overwintering of miscanthus rhizomes in the first few years after establishment, although low productivity and biomass availability during these early stages could hamper such efforts. PMID:23844244

Contemporary occurrence of hydrocephalus and Chiari I malformation in sagittal craniosynostosis. Case report and review of the literature.

PubMed

Sgulò, Francesco Giovanni; Spennato, Pietro; Aliberti, Ferdinando; Di Martino, Giuliana; Cascone, Daniele; Cinalli, Giuseppe

2017-01-01

Chiari malformation type I (CM-I) and hydrocephalus are often associated with complex craniosynostosis. On the contrary, their simultaneous occurrence in monosutural synostosis is extremely rare. The pathophysiological hypothesis is that they may alter posterior fossa growth and lead to cerebellar tonsil herniation also without skull base primary involvement. Hydrocephalus is multifactorial and may be secondary to fourth ventricle outlet obstruction. The management of these cases is quite complex and not well defined. Cranial vault remodeling should be the only treatment when CM-I is asymptomatic and not related to syringomyelia. Suboccipital decompression should be reserved only in complicated CM-I, usually as a second surgical step following the correction of the supratentorial deformity. In our opinion, the associated hydrocephalus should be treated first in order to normalize intracranial hypertension before opening the cranial sutures. We report the case of a 26-month-old child that presented with sagittal craniosynostosis, hydrocephalus, and CM-I. He was managed by performing endoscopic third ventriculostomy (ETV) first and cranial vault remodeling thereafter. Clinico-radiological outcome was very satisfying. Concerning literature is reviewed; physiopathology and surgical management are discussed.

Seed germination of cirsium arvense and Lepidium latifolium: Implications for management of montane wetlands

USGS Publications Warehouse

Laubhan, M.K.; Shaffer, T.L.

2006-01-01

Cirsium arvense and Lepidium latifolium are species that can aggressively invade wetland margins and potentially reduce biodiversity and alter ecosystem function. Although expansion of these species primarily occurs via rhizomatous growth, seeds are thought to be important in initial establishment. We conducted this study to investigate differences in seed germination of C. arvense and L. latifolium in montane wetlands of Colorado and Wyoming, USA. We used germination chambers to simulate environmental conditions (photoperiod, day/night temperature) during three periods of the growing season at each site and evaluated seed germination in relation to three soil moisture levels and two soil depths. A combination of shallow (<1 cm) seed burial and wet conditions resulted in the greatest germination probability of C. arvense (x = 63.0%), 95% CI = 41.2-80.5%), whereas deep (2-3 cm) seed burial and saturated moisture conditions resulted in almost no germination (x?? = 0.3%, 95% CI = 0.1-1.3%). The maximum germination probability of 44.0% (CI = 28.1-61.4%) for L. latifolium also occurred in the shallow burial and wet treatment; however, only effects of seed burial were significant (P < 0.05). The estimated mean germination probability of deeply buried seeds was <1.0% (CI = 0.3-1.4%) compared to 32% (CI = 19.7-47.9%) for shallowly buried seeds. Our results suggest that each species has the ability to germinate at similar rates throughout the growing season and across a large portion of the moisture gradient. This suggests that management actions, including water-level manipulations, at any time during the growing season may stimulate germination. Although burial of seed to depths of 2-3 cm reduced the germination potential of both species, the use of mechanical implements may be problematic in established stands because new plants of both species easily sprout from root buds. Further, disturbance resulting from such actions diminishes the density and vigor of other plants already present, which may ultimately decrease the competitive resistance of the disturbed environment to invasion by outside species. Detection of new invasions is a critical component of any integrated weed management program. Our results indicate that the incidence of C. arvense and L. latifolium germination is most likely in areas with seeds that are within 1 cm of the soil surface and soil moisture is 75-100% of field capacity for extended periods. ?? 2006, The Society of Wetland Scientists.

Contingency Management Requirements Document: Preliminary Version. Revision F

NASA Technical Reports Server (NTRS)

2005-01-01

This is the High Altitude, Long Endurance (HALE) Remotely Operated Aircraft (ROA) Contingency Management (CM) Functional Requirements document. This document applies to HALE ROA operating within the National Airspace System (NAS) limited at this time to enroute operations above 43,000 feet (defined as Step 1 of the Access 5 project, sponsored by the National Aeronautics and Space Administration). A contingency is an unforeseen event requiring a response. The unforeseen event may be an emergency, an incident, a deviation, or an observation. Contingency Management (CM) is the process of evaluating the event, deciding on the proper course of action (a plan), and successfully executing the plan.

Large-scale performance and design for construction activity erosion control best management practices.

PubMed

Faucette, L B; Scholl, B; Beighley, R E; Governo, J

2009-01-01

The National Pollutant Discharge Elimination System (NPDES) Phase II requires construction activities to have erosion and sediment control best management practices (BMPs) designed and installed for site storm water management. Although BMPs are specified on storm water pollution prevention plans (SWPPPs) as part of the construction general permit (GP), there is little evidence in the research literature as to how BMPs perform or should be designed. The objectives of this study were to: (i) comparatively evaluate the performance of common construction activity erosion control BMPs under a standardized test method, (ii) evaluate the performance of compost erosion control blanket thickness, (iii) evaluate the performance of compost erosion control blankets (CECBs) on a variety of slope angles, and (iv) determine Universal Soil Loss Equation (USLE) cover management factors (C factors) for these BMPs to assist site designers and engineers. Twenty-three erosion control BMPs were evaluated using American Society of Testing and Materials (ASTM) D-6459, standard test method for determination of ECB performance in protecting hill slopes from rainfall induced erosion, on 4:1 (H:V), 3:1, and 2:1 slopes. Soil loss reduction for treatments exposed to 5 cm of rainfall on a 2:1 slope ranged from-7 to 99%. For rainfall exposure of 10 cm, treatment soil loss reduction ranged from 8 to 99%. The 2.5 and 5 cm CECBs significantly reduced erosion on slopes up to 2:1, while CECBs < 2.5 cm are not recommended on slopes >or= 4:1 when rainfall totals reach 5 cm. Based on the soil loss results, USLE C factors ranged from 0.01 to 0.9. These performance and design criteria should aid site planners and designers in decision-making processes.

Satellite tracking and Earth dynamics research programs

NASA Technical Reports Server (NTRS)

Pearlman, M. R.

1984-01-01

Following an upgrading program, ranging performance capabilities of a satellite-tracking pulsed laser system were assessed in terms of range accuracy, range noise, data yield, and reliability. With a shorter laser pulse duration (2.5 to 3.0 NSEC) and a new analog pulse processing system, the systematic range errors were reduced to 3 to 5 cm and range noise was reduced to 5 to 16 cm and range noise was reduced to 5 to 15 cm on Starlette and BE-C, and 10 to 18 cm on LAGEOS. Maximum pulse repetition rate was increased to 30 pulses per minute and significant improvement was made in signal to noise ratio by installing a 3 A interference filter and by reducing the range gate window to 200 to 400 nsec. The solution to a problem involving leakage of a fraction of the laser oscillator pulse through the pulse chopper was outlined.

Computer-aided design evaluation of harvestable mandibular bone volume: a clinical and tomographic human study.

PubMed

Verdugo, Fernando; Simonian, Krikor; Raffaelli, Luca; D'Addona, Antonio

2014-06-01

To evaluate and compare the volume of bone graft material that can be safely harvested from the mandibular symphysis and rami using a computer-aided design (CAD) software program. Preoperative computerized tomography scans from 40 patients undergoing bone augmentation procedures were analyzed. Symphysis and rami cross sections were mapped using a CAD software program (AutoCAD(®), Autodesk, Inc., San Rafael, CA, USA) to evaluate the bone volume that can be safely harvested. CAD calculations were contrasted to intrasurgical measurements in a subgroup of 20 individuals. CAD calculations yielded a safe harvestable osseous volume of 1.44 cm(3) ± 0.49 for the symphysis and 0.82 cm(3) ± 0.21 for each ramus (p < .0001, confidence interval [CI] 95%: 0.47-0.78). These measurements were significantly lower (p < .0001) than the bone volumes harvested intrasurgically for both symphysis and ramus, respectively (2.40 cm(3) ± 0.50 vs. 2.65 cm(3) ± 0.45). CAD calculations of harvestable symphysis and ramus bone translated into an average of 2.40 cm(3) ± 0.50 (range: 1.80-3.10 cm(3)) and 2.65 cm(3) ± 0.45 (range: 1.90-3.50) of particulate bone graft intrasurgically, respectively. Ramus cortical was significantly thicker than the symphysis cortical, 2.9 ± 0.4 mm versus 2.19 mm ± 0.4 mm (p < .0001, CI 95%: 0.45-1.03). The symphysis and rami are good harvesting sources to obtain dense corticocancellous bone. The significant volumetric CAD differences between the symphysis and ramus seem to balance out intrasurgically and may be due to the greater cortical bone volume at the ramus area. It is plausible to harvest an average of 7.70 cm(3) from the symphysis and rami alone. The use of a CAD software program can enhance surgical treatment planning prior to bone transplantation. © 2012 Wiley Periodicals, Inc.

Biodiversity management of organic orchard enhances both ecological and economic profitability.

PubMed

Meng, Jie; Li, Lijun; Liu, Haitao; Li, Yong; Li, Caihong; Wu, Guanglei; Yu, Xiaofan; Guo, Liyue; Cheng, Da; Muminov, Mahmud A; Liang, Xiaotian; Jiang, Gaoming

2016-01-01

Organic farming has been regarded as an alternative solution for both agricultural sustainability and human health maintenance. Few researches have concentrated on the differences of biodiversity and eco-economic benefits between organic and conventional orchards. Organic management (OM) of orchards mainly includes taking advantage of natural enemies and beneficial weeds as well as soil organisms and controlling harmful pests. Here we conducted a three-year experiment on the effects of managing biodiversity in an organic apple orchard, using cattle manure to enrich soil biota, propagating native plant to suppress weeds and applying ecological pest management to control pests. The effect was assessed against the conventional management (CM) model. We found that OM enhanced soil organic carbon, total nitrogen, microbial biomass carbon and nitrogen. The 16S rDNA high-throughput sequencing results indicated that the dominant bacterial phyla of the top soil were Proteobacteria and Actinobacteria, and OM had richer bacteria diversity with a 7% higher Shannon's index than the CM. In particular, the relative abundance of rhizobium in the OM was higher than that of the CM. For OM, Duchesnea indica was an ideal ground-cover plant to control weeds through winning the niche competition and thus decreased weeds' Simpson, Shannon-Wiener and Pielou index by 38.2%, 53.8% and 16.9% separately. The phototactic pests' weight and scarab beetle's population were effectively decreased by 35% and 86% respectively through long time control and prevention. OM had an average of 20 times more earthworms than CM, and the maximum density had reached 369 m(-2) (0-20 cm soil). The dominant earthworm species of the OM were detritivores which preferring soil with high organic matter content. Due to no synthetic chemicals being used, the OM produced much safer apple fruits which were sold at high prices. Economically, up to a 103% increase of output-input ratio had been achieved in the OM. Our study clearly demonstrated that biodiversity management without chemical pollution increased the biodiversity of beneficial organisms, reduced antagonists of the fruit tree, and enhanced economic benefits of the apple orchard.

Biodiversity management of organic orchard enhances both ecological and economic profitability

PubMed Central

Meng, Jie; Li, Lijun; Liu, Haitao; Li, Yong; Li, Caihong; Wu, Guanglei; Yu, Xiaofan; Guo, Liyue; Cheng, Da; Muminov, Mahmud A.; Liang, Xiaotian

2016-01-01

Organic farming has been regarded as an alternative solution for both agricultural sustainability and human health maintenance. Few researches have concentrated on the differences of biodiversity and eco-economic benefits between organic and conventional orchards. Organic management (OM) of orchards mainly includes taking advantage of natural enemies and beneficial weeds as well as soil organisms and controlling harmful pests. Here we conducted a three-year experiment on the effects of managing biodiversity in an organic apple orchard, using cattle manure to enrich soil biota, propagating native plant to suppress weeds and applying ecological pest management to control pests. The effect was assessed against the conventional management (CM) model. We found that OM enhanced soil organic carbon, total nitrogen, microbial biomass carbon and nitrogen. The 16S rDNA high-throughput sequencing results indicated that the dominant bacterial phyla of the top soil were Proteobacteria and Actinobacteria, and OM had richer bacteria diversity with a 7% higher Shannon’s index than the CM. In particular, the relative abundance of rhizobium in the OM was higher than that of the CM. For OM, Duchesnea indica was an ideal ground-cover plant to control weeds through winning the niche competition and thus decreased weeds’ Simpson, Shannon–Wiener and Pielou index by 38.2%, 53.8% and 16.9% separately. The phototactic pests’ weight and scarab beetle’s population were effectively decreased by 35% and 86% respectively through long time control and prevention. OM had an average of 20 times more earthworms than CM, and the maximum density had reached 369 m−2 (0–20 cm soil). The dominant earthworm species of the OM were detritivores which preferring soil with high organic matter content. Due to no synthetic chemicals being used, the OM produced much safer apple fruits which were sold at high prices. Economically, up to a 103% increase of output–input ratio had been achieved in the OM. Our study clearly demonstrated that biodiversity management without chemical pollution increased the biodiversity of beneficial organisms, reduced antagonists of the fruit tree, and enhanced economic benefits of the apple orchard. PMID:27366643

Contingency management for substance use disorders in Spain: Implications for research and practice.

PubMed

Secades-Villa, Roberto; García-Rodríguez, Olaya; Fernández-Hermida, José R

2015-11-01

We provide a narrative review of published studies evaluating voucher-based contingency management (CM) treatment for cocaine, nicotine and cannabis use disorders in Spain and discuss the concerns and future challenges. Published studies between 2008 and 2015 that evaluated the impact of incentives for SUD in Spain and included an appropriate control or comparison condition were identified and reviewed. Adding voucher-based CM to standard treatments obtained better treatment retention and cocaine abstinence than standard care alone. CM also improved psychosocial functioning. Economic status or depressive symptoms did not affect the results of CM treatment for cocaine dependence. The addition of a CM protocol to cognitive behavioral treatment (CBT) also improved treatment effectiveness for smoking cessation. Available data on the effect of CM on cannabis use disorders (CUD) with young people did not allow confirmation of its superiority to date. The research conducted to date in Spain confirms and expands the findings of studies conducted in the US supporting the effectiveness of CM in the context of community settings with cocaine- and nicotine-dependents. However, CM has not yet been readily adopted into general clinical practice in Spain or the rest of Europe. The limited effectiveness of CM for CUD is likely due to the scarcity of data and may change with more studies, taking into account recent research on this topic in the US. Continued efforts are warranted to further develop and disseminate incentive-based treatments for SUD across clinical settings and populations in Spain. Copyright © 2015 Elsevier Inc. All rights reserved.

Complementary Medicine and the Role of Oncology Nurses in an Acute Care Hospital: The Gap Between Attitudes and Practice.

PubMed

Admi, Hanna; Eilon-Moshe, Yael; Ben-Arye, Eran

2017-09-01

To describe hospital nurses' knowledge, attitudes, and practices regarding complementary medicine (CM); to compare the knowledge and attitudes of nurse managers to staff nurses with diverse oncology experience; and to assess attitudes toward integrating CM into the role of the hospital oncology nurse. 
. Descriptive, cross-sectional study.
. Rambam Health Care Campus in northern Israel.
. A convenience sample of 434 hospital nurses with varied oncology experience.
. Nurses completed a knowledge and attitude questionnaire developed for the current study. Data were analyzed using parametric and nonparametric statistical tests. 
. Hospital nurses' knowledge of and attitudes toward CM, and attitudes toward integrating CM into the role of the hospital oncology nurse.
. Nurses lack knowledge and are unaware of the risks associated with CM. However, they believe this approach can improve the quality of life of patients with cancer; 51% expressed an interest in receiving training. Oncology nurses were ambivalent about the feasibility of applying an integrative approach, whereas nurse managers expressed significantly more positive attitudes toward integrating CM within the scope of nursing practices.
. A large discrepancy remains between nurses' strong interest in CM and awareness of associated benefits, and their ambivalence toward its integration in their nursing practice. 
. Although improving nurses' knowledge should be mandatory, it remains insufficient; a shift in the approach to integrating CM into conventional health care is needed, from practitioners' responsibility to healthcare policymakers' responsibility. Legislations and policies are necessary, along with providing respectable infrastructures.

A Perfect Platform: Combining Contingency Management with Medications for Drug Abuse

PubMed Central

Carroll, Kathleen M.; Rounsaville, Bruce J.

2008-01-01

Contingency management (CM) procedures, which provide concrete reinforcers or rewards contingent on verification of discrete targeted behaviors, such as drug-free urines, have been demonstrated to be effective in a number of clinical trials. However, to date there have been only a few that have capitalized on the unique strengths and capabilities of CM as an ideal platform to improve response to or address weaknesses of many pharmacotherapies used in the treatment of drug abuse. In this review, we describe the multiple potential uses of CM as a platform for pharmacotherapy, including reducing illicit drug use in the context of agonist therapies; fostering medication compliance with antagonists, aversive agents and HIV medications; fostering a period of abstinence prior to initiation of agents used to treat comorbid psychiatric conditions or in the context of vaccines to foster adequate periods of abstinence while titer levels are building; and to enhance the effectiveness of anticraving agents through additive or synergistic effects. Although its multiple strengths render it an almost perfect platform, CM does have some weaknesses that have limited its use to date, including cost, the short-term nature of its effects, and need for training. Future treatment development of CM as a medication platform needs to counter these issues by focusing on CM applications with large potential benefit, developing simple or automated methods for CM delivery and placing greater emphasis on the process of transitioning away from formal CM treatment. PMID:17613963

[Payment by performance to improve the nutritional status of children: impact of budget support agreements in three peruvian regions with a high prevalence of chronic malnutrition in children in 2010-2014].

PubMed

Cruzado de la Vega, Viviana

2017-01-01

To estimate the impact of a payment scheme by performance, known as a budget support agreement, applied by the government in three regions in Peru with the highest rates of chronic malnutrition (CM) in children in 2008-Apurimac, Ayacucho, and Huancavelica-on indicators of health service coverage (immunization, childhood growth and development, and iron supplementation) and the nutritional status of children (malnutrition, anemia, and diarrhea). These agreements were used to transfer resources to the budgets of these regions with the condition of fulfilling management commitments and coverage goals with a view toward improving the nutritional status of children. Based on data from the Demographic and Family Health Survey conducted from 2008 to 2014, evolution of the indicators in a sample of children residing in the areas where the support programs were signed was compared to that of a control sample in the period in which the agreements were in force and in the subsequent years to estimate differences in the impact of this support strategy. There was a positive impact of the programs on the increase in vaccination coverage provided by the basic health system and rotavirus vaccination, which consequently reduced the rates of diarrhea and malnutrition. The scheme was effective in increasing the vaccination coverage and reducing CM but did not seem to improve the coverage of other benefits, including childhood growth and iron supplementation to children and mothers.

A review of the literature on contingency management in the treatment of substance use disorders, 2009–2014

PubMed Central

Davis, Danielle R.; Kurti, Allison N.; Skelly, Joan M.; Redner, Ryan; White, Thomas J.; Higgins, Stephen T.

2017-01-01

This report describes a systematic literature review of voucher and related monetary-based contingency management (CM) interventions for substance use disorders (SUDs) over 5.2 years (November 2009 through December 2014). Reports were identified using the search engine PubMed, expert consultations, and published bibliographies. For inclusion, reports had to (a) involve monetary-based CM; (b) appear in a peer-reviewed journal; (c) include an experimental comparison condition; (d) describe an original study; (e) assess efficacy using inferential statistics; (f) use a research design allowing treatment effects to be attributed to CM. Sixty-nine reports met inclusion criteria and were categorized into 7 research trends: (1) extending CM to special populations, (2) parametric studies, (3) extending CM to community clinics, (4) combining CM with pharmacotherapies, (5) incorporating technology into CM, (6) investigating longer-term outcomes, (7) using CM as a research tool. The vast majority (59/69, 86%) of studies reported significant (p < 0.05) during-treatment effects. Twenty-eight (28/59, 47%) of those studies included at least one follow-up visit after CM was discontinued, with eight (8/28, 29%) reporting significant (p < 0.05) effects. Average effect size (Cohen’s d) during treatment was 0.62 (95% CI: 0.54, 0.70) and post-treatment it was 0.26 (95% CI: 0.11, 0.41). Overall, the literature on voucher-based CM over the past 5 years documents sustained growth, high treatment efficacy, moderate to large effect sizes during treatment that weaken but remain evident following treatment termination, and breadth across a diverse set of SUDs, populations, and settings consistent with and extending results from prior reviews. PMID:27514250

Condensation-nuclei (Aitken Particle) measurement system used in NASA global atmospheric sampling program

NASA Technical Reports Server (NTRS)

Nyland, T. W.

1979-01-01

The condensation-nuclei (Aitken particle) measuring system used in the NASA Global Atmospheric Sampling Program is described. Included in the paper is a description of the condensation-nuclei monitor sensor, the pressurization system, and the Pollack-counter calibration system used to support the CN measurement. The monitor has a measurement range to 1000 CN/cm cubed and a noise level equivalent to 5 CN/cm cubed at flight altitudes between 6 and 13 km.

Biomarkers of cardiometabolic risk in obese/overweight children: effect of lifestyle intervention.

PubMed

Vrablík, M; Dobiášová, M; Zlatohlávek, L; Urbanová, Z; Češka, R

2014-01-01

Obesity is a strong cardiometabolic (CM) risk factor in children. We tested potential CM risk in obese/overweight children and the effect of an intensive lifestyle intervention using newer CM markers: atherogenic index of plasma AIP [Log(TG/HDL-C)], apoB/apoAI ratio and a marker of insulin resistance HOMA-IR. The participants (194 girls, 115 boys, average age 13) were enrolled in an intensive, one-month, inpatient weight reduction program. The program consisted of individualised dietary changes and the exercise program comprised aerobic and resistance training. Anthropometrical and biochemical parameters in plasma and CM risk biomarkers - (AIP, apoB/apoAI ratio and HOMA-IR) were examined before and after the intervention. AIP and HOMA-IR significantly correlated with BMI while apoB/apoAI ratio did not. Only AIP and HOMA-IR showed systematic increases according to the level of obesity by BMI quartiles. Lifestyle intervention significantly improved anthropometrical and biochemical values and the biomarkers too. The response of lipid parameters to the intervention was considerably higher in boys than in girls. The children were stratified into three risk categories according to AIP, where 13.8 % of boys and 5.3 % of girls fell into high risk category. The monitored biomarkers may complement each other in the prognosis of CM risk. AIP was strongly related to obesity and to lipid and glycid metabolism, while the relationship of the apoB/apoAI ratio to obesity and glycid metabolism was not significant. The obese children benefited from the intensive lifestyle intervention which improved the anthropometrical and biochemical parameters and CM risk biomarkers.

Saturn Apollo Program

NASA Image and Video Library

1969-07-16

From the right, NASA administrator, Dr. Thomas O. Paine talks with U.S. Vice President Spiro T. Agnew while awaiting the launch of Saturn V (AS-506) that carried the Apollo 11 spacecraft to the Moon for man’s historic first landing on the lunar surface. At center is astronaut William Anders, a member of the first crew to orbit the moon during the Apollo 8 mission. At left is Lee B. James, director of Program Management at the NASA Marshall Space Flight Center (MSFC) where the Saturn V was developed. The craft lifted off from launch pad 39 at Kennedy Space Flight Center (KSC) on July 16, 1969. The moon bound crew included astronauts Neil A. Armstrong, commander; Michael Collins, Command Module (CM) pilot; and Edwin E. Aldrin Jr., Lunar Module (M) pilot. The mission finalized with splashdown in the Pacific Ocean on July 24, 1969. With the success of Apollo 11, the national objective to land men on the Moon and return them safely to Earth had been accomplished.

Effect of case management on glycemic control and behavioral outcomes for chinese people with type 2 diabetes: A 2-year study.

PubMed

Yuan, Xiaodan; Wang, Fengmei; Fish, Anne Folta; Xue, Cunyi; Chen, Tao; Liu, Chao; Lou, Qingqing

2016-08-01

To examine the effect of case management on glycemic control and behavioral outcomes in adults with Type 2 diabetes in China. Participants were randomly assigned to a 1-year case management (CM) group (n=60) or control group (n=60). Monthly case management visits included identifying individuals' diabetes-related problems, setting goals, planning self-care, and evaluating progress. During a 1-year follow-up, all participants attended visits every 3 months without intervention. In the CM vs. the control group, HbA1c was reduced at 6 months compared to baseline (P=0.034), with trends at 12 and 24 months, and empowerment ability improved (P<0.05). Also in the CM vs. controls, total self-care behaviors, the frequency of exercise, blood glucose testing, and foot care were higher (P<0.001) at 12 months, and the percentage of individuals with HbA1c ≤7.0% was higher (P=0.035) at 24 months. The case management intervention in China was effective at 6 months and, based on trends in HbA1c at 12 and 24 months and results for behavioral outcomes, the intervention shows promise and warrants more research. A case management approach can enhance behavior change and glycemic control in Chinese with diabetes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Fabrication and Vibration Results of 30-cm Pyrolytic Graphite Ion Optics

NASA Technical Reports Server (NTRS)

DePano, Michael K.; Hart, Stephen L.; Hanna, Andrew A.; Schneider, Analyn C.

2004-01-01

Boeing Electron Dynamic Devices, Inc. is currently developing pyrolytic graphite (PG) grids designed to operate on 30-cm NSTAR-type thrusters for the Carbon Based Ion Optics (CBIO) program. The PG technology effort of the CBIO program aims to research PG as a flightworthy material for use in dished ion optics by designing, fabricating, and performance testing 30-cm PG grids. As such, PG grid fabrication results will be discussed as will PG design considerations and how they must differ from the NSTAR molybdenum grid design. Surface characteristics and surface processing of PG will be explored relative to effects on voltage breakdown. Part of the CBIO program objectives is to understand the erosion of PG due to Xenon ion bombardment. Discussion of PG and CC sputter yields will be presented relative to molybdenum. These sputter yields will be utilized in the life modeling of carbon-based grids. Finally, vibration results of 30-cm PG grids will be presented and compared to a first-order model generated at Boeing EDD. Performance testing results of the PG grids will not be discussed in this paper as it has yet to be completed.

Sojourner Rover View of Cloddy Deposits near Pooh Bear

NASA Technical Reports Server (NTRS)

1997-01-01

Sojourner's observations in the Ares region on Mars raise and answer questions about the origins of the rocks and other deposits found there. Deposits are not the same everywhere. Bright, fine-grained drifts (right center) are abundant as thin (less than a few centimeters), discontinuous ridged sheets and wind tails that overlie cloddy deposits of dust, clods, and tiny (less than 1 cm) rocks.

NOTE: original caption as published in Science Magazine

Mars Pathfinder is the second in NASA's Discovery program of low-cost spacecraft with highly focused science goals. The Jet Propulsion Laboratory, Pasadena, CA, developed and manages the Mars Pathfinder mission for NASA's Office of Space Science, Washington, D.C. JPL is a division of the California Institute of Technology (Caltech).

Sensitivity and specificity of waist circumference as a single screening tool for identification of overweight and obesity among Malaysian adults.

PubMed

Kee, C C; Jamaiyah, H; Geeta, A; Ali, Z Ahmad; Safiza, M N Noor; Suzana, S; Khor, G L; Rahmah, R; Jamalludin, A R; Sumarni, M G; Lim, K H; Faudzi, Y Ahmad; Amal, N M

2011-12-01

Generalised obesity and central obesity are risk factors for Type II diabetes mellitus and cardiovascular diseases. Waist circumference (WC) has been suggested as a single screening tool for identification of overweight or obese subjects in lieu of the body mass index (BMI) for weight management in public health program. Currently, the recommended waist circumference cut-off points of > or = 94cm for men and > or =80cm for women (waist action level 1) and > or = 102cm for men and > or = 88cm for women (waist action level 2) used for identification of overweight and obesity are based on studies in Caucasian populations. The objective of this study was to assess the sensitivity and specificity of the recommended waist action levels, and to determine optimal WC cut-off points for identification of overweight or obesity with central fat distribution based on BMI for Malaysian adults. Data from 32,773 subjects (14,982 men and 17,791 women) aged 18 and above who participated in the Third National Health Morbidity Survey in 2006 were analysed. Sensitivity and specificity of WC at waist action level 1 were 48.3% and 97.5% for men; and 84.2% and 80.6% for women when compared to the cut-off points based on BMI > or = 25kg/m2. At waist action level 2, sensitivity and specificity were 52.4% and 98.0% for men, and 79.2% and 85.4% for women when compared with the cut-off points based on BMI (> or = 30 kg/m2). Receiver operating characteristic analyses showed that the appropriatescreening cut-off points for WC to identify subjects with overweight (> or = 25kg/m2) was 86.0cm (sensitivity=83.6%, specificity=82.5%) for men, and 79.1cm (sensitivity=85.0%, specificity=79.5%) for women. Waist circumference cut-off points to identify obese subjects (BMI > or = 30 kg/m2) was 93.2cm (sensitivity=86.5%, specificity=85.7%) for men and 85.2cm (sensitivity=77.9%, specificity=78.0%) for women. Our findings demonstrated that the current recommended waist circumference cut-off points have low sensitivity for identification of overweight and obesity in men. We suggest that these newly identified cut-off points be considered.

Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: the Program to Reduce Incontinence by Diet and Exercise (PRIDE) trial.

PubMed

Richter, Holly E; Creasman, Jennifer M; Myers, Deborah L; Wheeler, Thomas L; Burgio, Kathryn L; Subak, Leslee L

2008-12-01

The purpose of this study was to describe urodynamic characteristics of overweight or obese women with urinary incontinence and explore the relationship between urodynamic parameters, body mass index (BMI), and abdominal circumference (AC). One hundred ten women underwent a standardized cough stress test and urodynamic study. Eighty-six percent of women had urodynamic stress incontinence and 15% detrusor overactivity. Intra-abdominal pressure (Pabd) at maximum cystometric capacity (MCC) increased 0.4 cm H(2)O per kg/m(2) unit of BMI (95% confidence interval [CI] = 0.0,0.7, p = 0.04) and 0.4 cm H(2)O per 2 cm increase in AC (CI = 0.2, 0.7, p < 0.01). Intravesical pressure (Pves) at MCC increased 0.4 cm H(2)O per 2 cm increase in AC (CI = 0.0, 0.8, p = 0.05) but was not associated with BMI (p = 0.18). BMI and AC had a stronger association with Pabd than with Pves, suggesting a possible mechanism for the association between obesity and urinary incontinence.

A novel symbiotic organisms search algorithm for congestion management in deregulated environment

NASA Astrophysics Data System (ADS)

Verma, Sumit; Saha, Subhodip; Mukherjee, V.

2017-01-01

In today's competitive electricity market, managing transmission congestion in deregulated power system has created challenges for independent system operators to operate the transmission lines reliably within the limits. This paper proposes a new meta-heuristic algorithm, called as symbiotic organisms search (SOS) algorithm, for congestion management (CM) problem in pool based electricity market by real power rescheduling of generators. Inspired by interactions among organisms in ecosystem, SOS algorithm is a recent population based algorithm which does not require any algorithm specific control parameters unlike other algorithms. Various security constraints such as load bus voltage and line loading are taken into account while dealing with the CM problem. In this paper, the proposed SOS algorithm is applied on modified IEEE 30- and 57-bus test power system for the solution of CM problem. The results, thus, obtained are compared to those reported in the recent state-of-the-art literature. The efficacy of the proposed SOS algorithm for obtaining the higher quality solution is also established.

A novel symbiotic organisms search algorithm for congestion management in deregulated environment

NASA Astrophysics Data System (ADS)

Verma, Sumit; Saha, Subhodip; Mukherjee, V.

2017-01-01

In today's competitive electricity market, managing transmission congestion in deregulated power system has created challenges for independent system operators to operate the transmission lines reliably within the limits. This paper proposes a new meta-heuristic algorithm, called as symbiotic organisms search (SOS) algorithm, for congestion management (CM) problem in pool-based electricity market by real power rescheduling of generators. Inspired by interactions among organisms in ecosystem, SOS algorithm is a recent population-based algorithm which does not require any algorithm specific control parameters unlike other algorithms. Various security constraints such as load bus voltage and line loading are taken into account while dealing with the CM problem. In this paper, the proposed SOS algorithm is applied on modified IEEE 30- and 57-bus test power system for the solution of CM problem. The results, thus, obtained are compared to those reported in the recent state-of-the-art literature. The efficacy of the proposed SOS algorithm for obtaining the higher quality solution is also established.

Adaptability of contingency management in justice settings: survey findings on attitudes toward using rewards.

PubMed

Murphy, Amy; Rhodes, Anne Giuranna; Taxman, Faye S

2012-09-01

Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, 5 federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (N = 186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that most of the respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not probation officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards. Copyright © 2012 Elsevier Inc. All rights reserved.

Adaptability of Contingency Management in Justice Settings: Survey Findings on Attitudes Towards Using Rewards

PubMed Central

Murphy, Amy; Rhodes, Anne Giuranna; Taxman, Faye S.

2011-01-01

Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, five federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (n=186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that the majority of respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not Probation Officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards. PMID:22209658

The Use of Art and Music Therapy in Substance Abuse Treatment Programs

PubMed Central

Aletraris, Lydia; Paino, Maria; Edmond, Mary Bond; Roman, Paul M.; Bride, Brian E.

2014-01-01

While the implementation of evidence-based practices (EBPs) in the treatment of substance use disorders (SUD) has attracted substantial research attention, little consideration has been given to parallel implementation of complementary and alternative medical (CAM) practices. Using data from a nationally representative sample (N = 299) of U.S. substance abuse treatment programs, this study modeled organizational factors falling in the domains of patient characteristics, treatment ideologies, and structural characteristics, associated with the use of art therapy and music therapy. We found that 36.8% of treatment programs offered art therapy and 14.7% of programs offered music therapy. Programs with a greater proportion of women were more likely to use both therapies, and programs with larger proportions of adolescents were more likely to offer music therapy. In terms of other treatment ideologies, programs’ use of Motivational Enhancement Therapy (MET) was positively related to offering art therapy, while use of Contingency Management (CM) was positively associated with offering music therapy. Finally, our findings showed a significant relationship between requiring 12-step meetings and the use of both art therapy and music therapy. With increasing use of CAM in a diverse range of medical settings, and recent federal legislation likely to reduce barriers in accessing CAM, the inclusion of CAM in addiction treatment is growing in importance. Our findings suggest treatment programs may be utilizing art and music therapies to address unique patient needs of women and adolescents. PMID:25514689

6 CFR 29.5 - Requirements for protection.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PCII Program Manager or the PCII Program Manager's designee; (2) The information is submitted for... information initially provided received by the PCII Program Manager or the PCII Program Manager's designee... provided, to be received by the PCII Program Manager or the PCII Program Manager's designee within a...

Department of the Army Procurement Programs. Committee Staff Procurement Backup Book FY 2001 Budget Estimate. Procurement of Ammunition, Army.

DTIC Science & Technology

2000-02-01

tD c...UJ _i UJ 2 o o UJ 1- 2 O o 2 o w «N o 0. § >- u. Ü u z til < V 3 _i < 2 u. a. -b o 3 CN i 0. o a. CO ci a. T- T- 1^ tD ...Tf <=f >- CM CN CN u_ © CD •a a> J3 o o CD CO to Z c CM Ö Ö Ö £ E >• "*" T~ JB tD u_ ~ UJ a. E E ɘ o a. o c i o o CM CM CM W a CM

Effects of a Short-Term Plyometric and Resistance Training Program on Fitness Performance in Boys Age 12 to 15 Years

PubMed Central

Faigenbaum, Avery D.; McFarland, James E.; Keiper, Fred B.; Tevlin, William; Ratamess, Nicholas A.; Kang, Jie; Hoffman, Jay R.

2007-01-01

The purpose of this study was to compare the effects of a six week training period of combined plyometric and resistance training (PRT, n = 13) or resistance training alone (RT, n = 14) on fitness performance in boys (12-15 yr). The RT group performed static stretching exercises followed by resistance training whereas the PRT group performed plyometric exercises followed by the same resistance training program. The training duration per session for both groups was 90 min. At baseline and after training all participants were tested on the vertical jump, long jump, medicine ball toss, 9.1 m sprint, pro agility shuttle run and flexibility. The PRT group made significantly (p < 0.05) greater improvements than RT in long jump (10.8 cm vs. 2.2 cm), medicine ball toss (39.1 cm vs. 17.7 cm) and pro agility shuttle run time (-0.23 sec vs. -0.02 sec) following training. These findings suggest that the addition of plyometric training to a resistance training program may be more beneficial than resistance training and static stretching for enhancing selected measures of upper and lower body power in boys. Key pointsYouth conditioning programs which include different types of training and different loading schemes (e.g., high velocity plyometrics and resistance training) may be most effective for enhancing power performance.The effects of resistance training and plyometric training may be synergistic in children, with their combined effects being greater that each program performed alone. PMID:24149486

Quality in translation: case management in the international marketplace.

PubMed

Beichl, Lisa; Craig, Kathy

2009-01-01

This article identifies three categories of case management (CM), in-country, international, and micro, that are poised to serve as the quality proxy for the international medical patient in the rapidly emerging globalized healthcare marketplace. The content concentrates on describing in-country CM and international CM (ICM). Because CM professionals are the providers of patient-centered quality and safety improvements, they are capable of filling the chasm between the travel industry and the regulators who specialize in accrediting hospital systems. In-country and ICM case managers are equipped to perform surveillance and intervention at the level of the international patient's bedside, activate network connections, and use culture-sensitive communication skills to safeguard patients in their individual sojourns abroad. The article discusses useful concepts and sources, including an algorithmic tool under development that is geared to identify and quantify risks for lay and business individuals who seek to engage the global medical market. The article's information is provided for front-line and front-office healthcare practitioners to understand or enter the worldwide medical marketplace. Content is targeted to CM generalists, specialists, and business developers interested in learning about safeguarding the patients who travel internationally to receive medical care. It can also be applied by those within and outside the healthcare practice arena, particularly those interested in the development of quality initiatives. All research and syntheses were executed by the authors. Sources included scholarly treatises, business correspondence, medical tourism literature, corporate Internet profiles, news releases, and healthcare industry investigative and monitoring agencies. International health insurance, economics, and financing expertise stems from one author (L.B.). Clinical competencies stem from the international practice experiences of one author (K.C.). This article identifies Web sites and sources that constitute high-quality resources for ongoing reference by ICM practitioners. Two strategic tools are introduced: one for assessing the readiness of the regional marketplace for CM and the Beichl-Craig Medical Travel Risk Evaluator for international medical consumer risk identification. The emerging global healthcare marketplace is certain to change the way case managers anticipate and respond to care delivery concerns in different regional systems. A systematic structure for analyzing specific country and CM "readiness" is introduced. For case managers who assist clients to receive care internationally, the application of these concepts will help them know where a range of potential obstacles lie and how to calibrate risks and set realistic expectations. For healthcare product developers and quality analysts, the information will help stimulate discourse regarding innovative strategies, tools, and metrics geared to identify, measure, and mitigate risks for patients in the global medical marketplace.

Predicting use of case management support services for adolescents and adults living in community following brain injury: A longitudinal Canadian database study with implications for life care planning.

PubMed

Baptiste, B; Dawson, D R; Streiner, D

2015-01-01

To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions.

Managing complex, high-output, enterocutaneous fistulas: a case study.

PubMed

Hahler, Barbara; Schassberger, Debra; Novakovic, Rachel; Lang, Stephanie

2009-10-15

Gastrointestinal (GI) fistulas are an uncommon but serious complication. Following diagnosis, management strategies may have to be adapted frequently to address changes in fistula output, surrounding skin or wound condition, overall patient clinical and nutritional status, mobility level, and body contours. Following a motor vehicle accident, a 49-year-old man with a body mass index of 36.8 and a history of multiple previous surgeries, including gastric bypass, experienced excessive output from a fistula within a large open abdominal wound measuring 45 cm x 40 cm x 5 cm. Abdominal creases and the need to protect a split-thickness skin graft of the wound surrounding his fistula complicated wound management. During his prolonged 4-month hospital stay, the patient underwent several surgical procedures, repeated wound debridement, and various nutritional support interventions; a wide variety of wound and fistula management systems were utilized. One year after the initial trauma, the fistula was surgically closed. One week later, the patient died from a cardiac event. This case study confirms that GI fistulas increase costs of care and hospital length of stay and require the experience and expertise of a wide array of patient support staff members and clinicians.

Tailored minimally invasive management of complex calculi in horseshoe kidney.

PubMed

Ding, Jie; Zhang, Yuanyuan; Cao, Qifeng; Huang, Tao; Xu, Wei; Huang, Kai; Fang, Jing; Bai, Qiang; Qi, Jun; Huang, Yunteng

2015-01-01

Complex calculi in horseshoe kidney (HK) present a significant management challenge. Here, we report the clinical efficacy of extracorporeal shock wave lithotripsy (ESWL), minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS), combined with holmium laser lithotripsy, in the treatment of calculi in HK. From January 2005 to May 2014, 62 HK patients with renal calculi were reviewed in terms of medical history, treatment modality and therapeutic outcome in a single tertiary care hospital. Among the patients, 11 with a solitary stone ≤ 1.5 cm in diameter received ESWL, leading to overall stone-free rate of 72.7%; 18 with stone diameter ≤ 2-3 cm received retrograde flexible ureteroscopy, with a recorded mean digitized surface area (DSA) of 339.6 ± 103.9 mm2, mean operation time of 93.1 ± 11.5 minutes and overall stone-free rate of 88.9%; and 33 with staghorn or complex calculi (d ≥ 2 cm) had MPCNL or MPCNL-FURS, with a recorded mean DSA of 691.0 ± 329.9 vs. 802.9 ± 333.3 mm2, mean operation time of 106.4 ± 16.6 vs. 124.4 ± 15.1 min and overall stone-free rate of 89.5% vs. 92.9%. For complex calculi (d ≥ 2 cm), MPCNL combined with antegrade FURS was superior in terms of reducing number of tracts, controlling mean hemoglobin drop, but required longer operation time, comparing with MPCNL alone. As minimally invasive treatments, a combination of MPCNL and antegrade FURS provides a safe and effective modality in the management of staghorn or complex calculi (d ≥ 2 cm) in HK with significantly reduced blood loss comparing to MPCNL alone, and retrograde FURS alone is favorable for stones with a diameter ≤ 2-3 cm. ESWL is effective for viable small solitary stones (d ≤ 1.5 cm). Treatment modality should be tailored based on individual condition.

Preventive medicine for von Hippel-Lindau disease-associated pancreatic neuroendocrine tumors.

PubMed

Krauss, Tobias; Ferrara, Alfonso Massimiliano; Links, Thera P; Wellner, Ulrich; Bancos, Irina; Kvachenyuk, Andrey; Villar Gómez de Las Heras, Karina; Yukina, Marina; Petrov, Roman; Bullivant, Garrett; von Duecker, Laura; Jadhav, Swati S; Ploeckinger, Ursula; Welin, Staffan; Schalin-Jantti, Camilla; Gimm, Oliver; Pfeifer, Marija; Ngeow, Joanne; Hasse-Lazar, Kornelia; Sanso, Gabriela; Qi, Xiao-Ping; Ugurlu, Umit; Diaz, Rene Eduardo; Wohllk, Nelson; Peczkowska, Mariola; Aberle, Jens; Lourenço, Delmar Muniz; Pereira, Maria Adelaide; Fragoso, Maria Candida Barisson Villares; Hoff, Ana O; Almeida, Madson Queiroz; Violante, Alice H D; Quidute, Ana R P; Zhang, Zheiwei; Recasens, Monica; Robles Diaz, Luis; Kunavisarut, Tada; Wannachalee, Taweesak; Sirinvaravong, Sirinart; Jonasch, Eric; Grozinsky-Glasberg, Simona; Fraenkel, Merav; Beltsevich, Dmitry; Egorov, Viacheslav I; Bausch, Dirk; Schott, Matthias; Tiling, Nikolaus; Pennelli, Gianmaria; Zschiedrich, Stefan; Därr, Roland; Ruf, Juri; Denecke, Timm; Link, Karl-Heinrich; Zovato, Stefania; von Dobschuetz, Ernst; Yaremchuk, Svetlana; Amthauer, Holger; Makay, Ozer; Patocs, Attila; Walz, Martin K; Huber, Tobias B; Seufert, Jochen; Hellman, Per; Kim, Raymond H; Kuchinskaya, Ekaterina; Schiavi, Francesca; Malinoc, Angelica; Reisch, Nicole; Jarzab, Barbara; Barontini, Marta; Januszewicz, Andrzej; Shah, Nalini; Young, William; Opocher, Giuseppe; Eng, Charis; Neumann, Hartmut P H; Bausch, Birke

2018-05-10

Pancreatic neuroendocrine tumors (PanNETs) are rare in von Hippel-Lindau disease (VHL) but cause serious morbidity and mortality. Management guidelines for VHL-PanNETs continue to be based on limited evidence, and survival data to guide surgical management are lacking. We established the European-American-Asian-VHL-PanNET-Registry to assess data for risks for metastases, survival and long-term outcomes to provide best management recommendations. Of 2,330 VHL patients, 273 had a total of 484 PanNETs. Median age at diagnosis of PanNET was 35 years (range 10-75). Fifty-five (20%) patients had metastatic PanNETs. Metastatic PanNETs were significantly larger (median size 5 vs 2 cm; P<0.001) and tumor volume doubling time (TVDT) was faster (22 vs 126 months; P=0.001). All metastatic tumors were ≥2.8 cm. Codons 161 and 167 were hotspots for VHL germline mutations with enhanced risk for metastatic PanNETs. Multivariate prediction modeling disclosed maximum tumor diameter and TVDT as significant predictors for metastatic disease (positive and negative predictive values of 51% and 100% for diameter cutoff ≥2.8 cm, 44% and 91% for TVDT cutoff of ≤24 months). In 117/273 patients, PanNETs >1.5 cm in diameter were operated. Ten-year survival was significantly longer in operated vs non-operated patients, in particular for PanNETs <2.8cm vs ≥2.8 cm (94% vs 85% by 10 years; P=0.020; 80% vs 50% at 10 years; P=0.030). This study demonstrates that patients with PanNET approaching the cut-off diameter of 2.8 cm should be operated. Mutations in exon 3, especially of codons 161/167 are at enhanced risk for metastatic PanNETs. Survival is significantly longer in operated non-metastatic VHL-PanNETs.

Toxicity of vegetable oils to the coconut mite Aceria guerreronis and selectivity against the predator Neoseiulus baraki.

PubMed

Oliveira, Natália N F C; Galvão, Andreia S; Amaral, Ester A; Santos, Auderes W O; Sena-Filho, José G; Oliveira, Eugenio E; Teodoro, Adenir V

2017-05-01

The coconut mite, Aceria guerreronis (Acari: Eriophyidae), is a major tropical pest of coconut. Here, we assessed the chemical profiles and the potential use of babassu, degummed soybean, and coconut oils to control A. guerreronis as well as their side-effects on the predatory mite Neoseiulus baraki (Acari: Phytoseiidae), a key natural enemy of the coconut mite. Babassu and coconut oils had similar fatty acids chemical profiles. All vegetable oils showed toxicity to A. guerreronis; degummed soybean oil exhibited the highest toxicity (LC 50  = 0.15 µL/cm 2 ). Although all oils were less toxic to N. baraki, their potential to attract/repel this predatory mite differed. Whereas N. baraki females were unresponsive to coconut oil at both concentrations (i.e., LC 50 and LC 99 estimated for A. guerreronis), irrespective of exposure period (i.e., 1 or 24 h), the babassu oil repelled the predator, independent of exposure period, when applied at its LC 99 (1.48 µL/cm 2 ). Intriguingly, this oil also exhibited attractiveness to N. baraki 24 h after exposure when applied at its LC 50 (0.26 µL/cm 2 ). A similar attractiveness pattern was recorded 24 h after N. baraki was exposed to degummed soybean oil at both concentrations tested (LC 50  = 0.15 µL/cm 2 ; LC 99  = 1.39 µL/cm 2 ). However, N. baraki was repelled by degummed soybean oil at its LC 50 after 1 h of exposure. Therefore, the present study demonstrated that all the vegetable oils used here had higher toxicity to the coconut mite and considerable selectivity to the predator N. baraki, indicating they are promising tools that can potentially be included in management programs to control A. guerreronis in commercial coconut plantations.

Dead or Alive? Factors Affecting the Survival of Victims during Attacks by Saltwater Crocodiles (Crocodylus porosus) in Australia.

PubMed

Fukuda, Yusuke; Manolis, Charlie; Saalfeld, Keith; Zuur, Alain

2015-01-01

Conflicts between humans and crocodilians are a widespread conservation challenge and the number of crocodile attacks is increasing worldwide. We identified the factors that most effectively decide whether a victim is injured or killed in a crocodile attack by fitting generalized linear models to a 42-year dataset of 87 attacks (27 fatal and 60 non-fatal) by saltwater crocodiles (Crocodylus porosus) in Australia. The models showed that the most influential factors were the difference in body mass between crocodile and victim, and the position of victim in relation to the water at the time of an attack. In-water position (for diving, swimming, and wading) had a higher risk than on-water (boating) or on-land (fishing, and hunting near the water's edge) positions. In the in-water position a 75 kg person would have a relatively high probability of survival (0.81) if attacked by a 300 cm crocodile, but the probability becomes much lower (0.17) with a 400 cm crocodile. If attacked by a crocodile larger than 450 cm, the survival probability would be extremely low (<0.05) regardless of the victim's size. These results indicate that the main cause of death during a crocodile attack is drowning and larger crocodiles can drag a victim more easily into deeper water. A higher risk associated with a larger crocodile in relation to victim's size is highlighted by children's vulnerability to fatal attacks. Since the first recently recorded fatal attack involving a child in 2006, six out of nine fatal attacks (66.7%) involved children, and the average body size of crocodiles responsible for these fatal attacks was considerably smaller (384 cm, 223 kg) than that of crocodiles that killed adults (450 cm, 324 kg) during the same period (2006-2014). These results suggest that culling programs targeting larger crocodiles may not be an effective management option to improve safety for children.

Dead or Alive? Factors Affecting the Survival of Victims during Attacks by Saltwater Crocodiles (Crocodylus porosus) in Australia

PubMed Central

Fukuda, Yusuke

2015-01-01

Conflicts between humans and crocodilians are a widespread conservation challenge and the number of crocodile attacks is increasing worldwide. We identified the factors that most effectively decide whether a victim is injured or killed in a crocodile attack by fitting generalized linear models to a 42-year dataset of 87 attacks (27 fatal and 60 non-fatal) by saltwater crocodiles (Crocodylus porosus) in Australia. The models showed that the most influential factors were the difference in body mass between crocodile and victim, and the position of victim in relation to the water at the time of an attack. In-water position (for diving, swimming, and wading) had a higher risk than on-water (boating) or on-land (fishing, and hunting near the water's edge) positions. In the in-water position a 75 kg person would have a relatively high probability of survival (0.81) if attacked by a 300 cm crocodile, but the probability becomes much lower (0.17) with a 400 cm crocodile. If attacked by a crocodile larger than 450 cm, the survival probability would be extremely low (<0.05) regardless of the victim’s size. These results indicate that the main cause of death during a crocodile attack is drowning and larger crocodiles can drag a victim more easily into deeper water. A higher risk associated with a larger crocodile in relation to victim’s size is highlighted by children’s vulnerability to fatal attacks. Since the first recently recorded fatal attack involving a child in 2006, six out of nine fatal attacks (66.7%) involved children, and the average body size of crocodiles responsible for these fatal attacks was considerably smaller (384 cm, 223 kg) than that of crocodiles that killed adults (450 cm, 324 kg) during the same period (2006–2014). These results suggest that culling programs targeting larger crocodiles may not be an effective management option to improve safety for children. PMID:25961294

OECD MMCI 2-D Core Concrete Interaction (CCI) tests : CCCI-1 test data report-thermalhydraulic results. Rev 0 January 31, 2004.

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

Farmer, M. T.; Lomperski, S.; Aeschlimann, R. W.

The Melt Attack and Coolability Experiments (MACE) program addressed the issue of the ability of water to cool and thermally stabilize a molten core-concrete interaction when the reactants are flooded from above. These tests provided data regarding the nature of corium interactions with concrete, the heat transfer rates from the melt to the overlying water pool, and the role of noncondensable gases in the mixing processes that contribute to melt quenching. As a follow-on program to MACE, The Melt Coolability and Concrete Interaction Experiments (MCCI) project is conducting reactor material experiments and associated analysis to achieve the following objectives: (1)more » resolve the ex-vessel debris coolability issue through a program that focuses on providing both confirmatory evidence and test data for the coolability mechanisms identified in MACE integral effects tests, and (2) address remaining uncertainties related to long-term two-dimensional molten coreconcrete interactions under both wet and dry cavity conditions. Achievement of these two program objectives will demonstrate the efficacy of severe accident management guidelines for existing plants, and provide the technical basis for better containment designs for future plants. In terms of satisfying these objectives, the Management Board (MB) approved the conduct of two long-term 2-D Core-Concrete Interaction (CCI) experiments designed to provide information in several areas, including: (i) lateral vs. axial power split during dry core-concrete interaction, (ii) integral debris coolability data following late phase flooding, and (iii) data regarding the nature and extent of the cooling transient following breach of the crust formed at the melt-water interface. This data report provides thermal hydraulic test results from the CCI-1 experiment, which was conducted on December 19, 2003. Test specifications for CCI-1 are provided in Table 1-1. This experiment investigated the interaction of a fully oxidized 400 kg PWR core melt, initially containing 8 wt % calcined siliceous concrete, with a specially designed two-dimensional siliceous concrete test section with an initial cross-sectional area of 50 cm x 50 cm. The report begins by providing a summary description of the CCI-1 test apparatus and operating procedures, followed by presentation of the thermal-hydraulic results. The posttest debris examination results will be provided in a subsequent publication. Observations drawn within this report regarding the overall cavity erosion behavior may be subject to revision once the posttest examinations are completed, since these examinations will fully reveal the final cavity shape.« less

OECD MCCI 2-D Core Concrete Interaction (CCI) tests : CCI-2 test data report-thermalhydraulic results, Rev. 0 October 15, 2004.

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

Farmer, M. T.; Lomperski, S.; Kilsdonk, D. J.

The Melt Attack and Coolability Experiments (MACE) program addressed the issue of the ability of water to cool and thermally stabilize a molten core-concrete interaction when the reactants are flooded from above. These tests provided data regarding the nature of corium interactions with concrete, the heat transfer rates from the melt to the overlying water pool, and the role of noncondensable gases in the mixing processes that contribute to melt quenching. As a follow-on program to MACE, The Melt Coolability and Concrete Interaction Experiments (MCCI) project is conducting reactor material experiments and associated analysis to achieve the following objectives: (1)more » resolve the ex-vessel debris coolability issue through a program that focuses on providing both confirmatory evidence and test data for the coolability mechanisms identified in MACE integral effects tests, and (2) address remaining uncertainties related to long-term two-dimensional molten core-concrete interactions under both wet and dry cavity conditions. Achievement of these two program objectives will demonstrate the efficacy of severe accident management guidelines for existing plants, and provide the technical basis for better containment designs for future plants. In terms of satisfying these objectives, the Management Board (MB) approved the conduct of two long-term 2-D Core-Concrete Interaction (CCI) experiments designed to provide information in several areas, including: (i) lateral vs. axial power split during dry core-concrete interaction, (ii) integral debris coolability data following late phase flooding, and (iii) data regarding the nature and extent of the cooling transient following breach of the crust formed at the melt-water interface. This data report provides thermal hydraulic test results from the CCI-2 experiment, which was conducted on August 24, 2004. Test specifications for CCI-2 are provided in Table 1-1. This experiment investigated the interaction of a fully oxidized 400 kg PWR core melt, initially containing 8 wt % Limestone/Common Sand (LCS) concrete, with a specially designed two-dimensional LCS concrete test section with an initial cross-sectional area of 50 cm x 50 cm. The report begins by providing a summary description of the CCI-2 test apparatus and operating procedures, followed by presentation of the thermal-hydraulic results. Detailed posttest debris examination results will be provided in a subsequent publication. Observations drawn within this report regarding the overall cavity erosion behavior may be subject to revision once the posttest examinations are completed, since these examinations will fully reveal the final cavity shape.« less

Sedimentation rates in the marshes of Sand Lake National Wildlife Refuge

USGS Publications Warehouse

Gleason, R.A.; Euliss, N.H.; Holmes, C.W.

2003-01-01

Impoundments located within river systems in the Northern Great Plains are vulnerable to sediment inputs because intensive agriculture in watersheds has increased soil erosion and sediments in rivers. At the request of the U.S. Fish and Wildlife Service (FWS), we evaluated the vertical accretion of sediment in the Mud Lake impoundment of Sand Lake National Wildlife Refuge (NWR), Brown County, South Dakota. The Mud Lake impoundment was created in 1936 by constructing a low-head dam across the James River. We collected sediment cores from the Mud Lake impoundment during August 2000 for determination of vertical accretion rates. Accretion rates were estimated using cesium-13 7 and lead-210 isotopic dating techniques to estimate sediment accretion over the past 100 years. Accretion rates were greatest near the dam (1.3 cm yr-1) with less accretion (0.2 cm yr-1) occurring in the upper reaches of Mud Lake. As expected, accretion was highest near the dam where water velocities and greater water depth facilitates sediment deposition. Higher rates of sedimentation (accretion> 2.0 cm year-1) occurred during the 1990s when river flows were especially high. Since 1959, sediment accretion has reduced maximum pool depth of Mud Lake near the dam by 55 cm. Assuming that sediment accretion rates remain the same in the future, we project Mud Lake will have a maximum pool depth of 77 and 51 cm by 2020 and 2040, respectively. Over this same time frame, water depths in the upper reaches of Mud Lake would be reduced to< 2 cm. Projected future loss of water depth will severely limit the ability of managers to manipulate pool levels in Mud Lake to cycle vegetation and create interspersion of cover and water to meet current wildlife habitat management objectives. As predicted for major dams constructed on rivers throughout the world, Mud Lake will have a finite life span. Our data suggests that the functional life span of Mud Lake since construction will be < 100 years. We anticipate that over the next 20 years, sediments entering Mud Lake will reduce water depths to the point that current wildlife management objectives cannot be achieved through customary water-level manipulations. Sedimentation impacts are not unique to the Sand Lake NWR. It is widely accepted that impoundments trap sediments and shallow impoundments, such as those managed by the FWS, are especially vulnerable. Given the ecological impacts associated with loss of water depths, we recommend that managers begin evaluating the long-term wildlife management goals for the refuge relative to associated costs and feasibility of options available to enhance and maximize the life span of existing impoundments, including upper watershed management.

14 CFR 91.1017 - Amending program manager's management specifications.

Code of Federal Regulations, 2014 CFR

2014-01-01

... proposed amendment. (2) The Flight Standards District Office that issued the program manager's management... presented, the Flight Standards District Office that issued the program manager's management specifications... Standards District Office that issued the program manager's management specifications issues an amendment of...

14 CFR 91.1017 - Amending program manager's management specifications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... proposed amendment. (2) The Flight Standards District Office that issued the program manager's management... presented, the Flight Standards District Office that issued the program manager's management specifications... Standards District Office that issued the program manager's management specifications issues an amendment of...

Configuration management and software measurement in the Ground Systems Development Environment (GSDE)

NASA Technical Reports Server (NTRS)

Church, Victor E.; Long, D.; Hartenstein, Ray; Perez-Davila, Alfredo

1992-01-01

A set of functional requirements for software configuration management (CM) and metrics reporting for Space Station Freedom ground systems software are described. This report is one of a series from a study of the interfaces among the Ground Systems Development Environment (GSDE), the development systems for the Space Station Training Facility (SSTF) and the Space Station Control Center (SSCC), and the target systems for SSCC and SSTF. The focus is on the CM of the software following delivery to NASA and on the software metrics that relate to the quality and maintainability of the delivered software. The CM and metrics requirements address specific problems that occur in large-scale software development. Mechanisms to assist in the continuing improvement of mission operations software development are described.

The role of the case manager in a disease management program.

PubMed

Huston, Carol J

2002-01-01

Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.

The role of the case manager in a disease management program.

PubMed

Huston, C J

2001-01-01

Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.

Evaluation of adverse reactions to contrast media in the hospital

PubMed Central

Ryu, J-H; Kim, E-Y

2013-01-01

Objective: To determine and analyse the characteristics of contrast media adverse reactions (CM-ARs) reported in a hospital. Methods: A retrospective review of CM-ARs from the electronic spontaneous adverse drug reaction (ADR) report system between January 2011 and August 2012 was conducted. CM-ARs were evaluated in terms of causality, severity, preventability and affected organs. Also, agreement and correlation among the tools used to evaluate CM-ARs were analysed. Results: The overall reaction rate was 1.5% (n = 286). In total, 269 CM-ARs were identified. For ADR causality, 96.7% (n = 260) and 98.5% (n = 265) were evaluated as “probable” ADR using the Naranjo probability scale and the World Health Organization–Uppsala Monitoring Centre causality categories, whereas 98.1% (n = 264) were evaluated as “certain” with Korean algorithm v. II. Of these, 91.4% (n = 246) were mild in severity and 96.7% (n = 260) were unpreventable. Most patients (n = 233, 86.7%) could be managed with observation and/or simple treatment. The most frequent reaction (n = 383, 79.5%) was dermatological. Spearman's correlation coefficient was 0.667 (p < 0.01), and the agreement was 98.1% between the Naranjo scale and the World Health Organization–Uppsala Monitoring Centre categories. No relationship was seen between CM-AR severity and gender or between in- and outpatients. Conclusion: In our study, most CM-ARs were mild and managed with simple treatment. However, as the number of patients undergoing CT procedures continues to increase, it is essential to identify and observe patients at risk for CM-ARs to prevent severe ADRs. Advances in knowledge: Continuous careful review of reporting and treatment protocols of CM-ARs is needed to prevent morbidity and mortality. PMID:24191123

The discriminatory cost of ICD-10-CM transition between clinical specialties: metrics, case study, and mitigating tools

PubMed Central

Boyd, Andrew D; Li, Jianrong ‘John’; Burton, Mike D; Jonen, Michael; Gardeux, Vincent; Achour, Ikbel; Luo, Roger Q; Zenku, Ilir; Bahroos, Neil; Brown, Stephen B; Vanden Hoek, Terry; Lussier, Yves A

2013-01-01

Objective Applying the science of networks to quantify the discriminatory impact of the ICD-9-CM to ICD-10-CM transition between clinical specialties. Materials and Methods Datasets were the Center for Medicaid and Medicare Services ICD-9-CM to ICD-10-CM mapping files, general equivalence mappings, and statewide Medicaid emergency department billing. Diagnoses were represented as nodes and their mappings as directional relationships. The complex network was synthesized as an aggregate of simpler motifs and tabulation per clinical specialty. Results We identified five mapping motif categories: identity, class-to-subclass, subclass-to-class, convoluted, and no mapping. Convoluted mappings indicate that multiple ICD-9-CM and ICD-10-CM codes share complex, entangled, and non-reciprocal mappings. The proportions of convoluted diagnoses mappings (36% overall) range from 5% (hematology) to 60% (obstetrics and injuries). In a case study of 24 008 patient visits in 217 emergency departments, 27% of the costs are associated with convoluted diagnoses, with ‘abdominal pain’ and ‘gastroenteritis’ accounting for approximately 3.5%. Discussion Previous qualitative studies report that administrators and clinicians are likely to be challenged in understanding and managing their practice because of the ICD-10-CM transition. We substantiate the complexity of this transition with a thorough quantitative summary per clinical specialty, a case study, and the tools to apply this methodology easily to any clinical practice in the form of a web portal and analytic tables. Conclusions Post-transition, successful management of frequent diseases with convoluted mapping network patterns is critical. The http://lussierlab.org/transition-to-ICD10CM web portal provides insight in linking onerous diseases to the ICD-10 transition. PMID:23645552

Sudden unexpected nocturnal death in Chiari type 1 malformation and potential role of opioid analgesics

PubMed Central

Roohi, Fereydoon; Gropen, Toby; Kula, Roger W.

2014-01-01

Background: Chiari malformation type 1 (CM1) is a common congenital anomaly of the craniocervical junction. CM1 is reported to run a usually benign course and patients typically experience no symptoms or chronic, slowly progressive symptoms. However, recent reports indicate that a subset of patients with CM1 may present with acute deterioration and sudden unexpected death (SUD). We report a case of SUD during sleep in a young man with CM1, which we believe was related to the administration of common and therapeutic doses of narcotic analgesics for the management of pain. We will clarify the pathophysiology of acute deterioration and SUD in CM1 and the possibility that the adverse effects of opiate analgesics likely were the leading cause of death in our patient. Case Description: In this review, we present a 29-year-old male with worsening headache secondary to previously diagnosed CM1. The patient died suddenly and unexpectedly after administration of common and therapeutic doses of narcotic analgesics for the management of pain. Conclusion: The mechanism(s) of acute neurological deterioration and sudden death in patients with CM1 remains poorly understood. We believe the rapid fatal deterioration in our patient following administration of opioids suggests that this category of medication may cause sudden unexpected “neurogenic” cardiac death in CM1 patients by inducing sleep-related breathing difficulties and associated hypercapnia. Hypercapnia by further increasing intracranial pressure can result in a sudden pressure-induced decompensation of the cardiopulmonary control centers in the brain stem and cause instantaneous cardiorespiratory arrest. PMID:24778905

14 CFR 91.1411 - Continuous airworthiness maintenance program use by fractional ownership program manager.

Code of Federal Regulations, 2010 CFR

2010-01-01

... program use by fractional ownership program manager. 91.1411 Section 91.1411 Aeronautics and Space FEDERAL... airworthiness maintenance program use by fractional ownership program manager. Fractional ownership program... through 91.1443. Any program manager who elects to maintain the program aircraft using a continuous...

Department of Defense In-House RDT and E Activities: Management Analysis Report for Fiscal Year 1993

DTIC Science & Technology

1994-11-01

A worldwide unique lab because it houses a high - speed modeling and simulation system, a prototype...E Division, San Diego, CA: High Performance Computing Laboratory providing a wide range of advanced computer systems for the scientific investigation...Machines CM-200 and a 256-node Thinking Machines CM-S. The CM-5 is in a very large memory, ( high performance 32 Gbytes, >4 0 OFlop) coafiguration,

OECD MCCI project 2-D Core Concrete Interaction (CCI) tests : CCI-3 test data report-thermalhydraulic results. Rev. 0 October 15, 2005.

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

Farmer, M. T.; Lomperski, S.; Kilsdonk, D. J.

The Melt Attack and Coolability Experiments (MACE) program addressed the issue of the ability of water to cool and thermally stabilize a molten core-concrete interaction when the reactants are flooded from above. These tests provided data regarding the nature of corium interactions with concrete, the heat transfer rates from the melt to the overlying water pool, and the role of noncondensable gases in the mixing processes that contribute to melt quenching. As a follow-on program to MACE, The Melt Coolability and Concrete Interaction Experiments (MCCI) project is conducting reactor material experiments and associated analysis to achieve the following objectives: (1)more » resolve the ex-vessel debris coolability issue through a program that focuses on providing both confirmatory evidence and test data for the coolability mechanisms identified in MACE integral effects tests, and (2) address remaining uncertainties related to long-term two-dimensional molten core-concrete interactions under both wet and dry cavity conditions. Achievement of these two program objectives will demonstrate the efficacy of severe accident management guidelines for existing plants, and provide the technical basis for better containment designs for future plants. In terms of satisfying these objectives, the Management Board (MB) approved the conduct of a third long-term 2-D Core-Concrete Interaction (CCI) experiment designed to provide information in several areas, including: (i) lateral vs. axial power split during dry core-concrete interaction, (ii) integral debris coolability data following late phase flooding, and (iii) data regarding the nature and extent of the cooling transient following breach of the crust formed at the melt-water interface. This data report provides thermal hydraulic test results from the CCI-3 experiment, which was conducted on September 22, 2005. Test specifications for CCI-3 are provided in Table 1-1. This experiment investigated the interaction of a fully oxidized 375 kg PWR core melt, initially containing 15 wt% siliceous concrete, with a specially designed two-dimensional siliceous concrete test section with an initial cross-sectional area of 50 cm x 50 cm. The sand and aggregate constituents for this particular siliceous concrete were provided by CEA as an in-kind contribution to the program. The report begins by providing a summary description of the CCI-3 test apparatus and operating procedures, followed by presentation of the thermal-hydraulic results. Detailed posttest debris examination results will be provided in a subsequent publication. Observations drawn within this report regarding the overall cavity erosion behavior may be subject to revision once the posttest examinations are completed, since these examinations will fully reveal the final cavity shape.« less

The Current Studies of Education for a Traditional and Complementary Medicine in Malaysia

PubMed Central

Kim, Yun Jin

2017-01-01

The aim of this study is to understand the current tradition and complementary medicine (T&CM) education in Malaysia. We referred to literature regarding to traditional medicine education in Malaysia, and collected the information via website or interview with faculty of T&CM in universities/colleges and Division of T&CM, Ministry of Health, Malaysia. T&CM education in Malaysia has been following China’s T&CM systems for 50 years. Currently, Division of T&CM, Ministry of Health; and Ministry of Higher Education has approved 11 institutions to offer T&CM education. Students may major in Chinese herbal medicine, acupuncture, or other T&CM subjects. Generally, clinical training programs in China, Taiwan, or Australia include substantial proportion of clinical training. We report on the general information of T&CM education in Malaysia. This result would be the first-stage information for the establishment of a strategy regarding the enhancement of T&CM education in Malaysia. PMID:28853309

Shaping Smoking Cessation in Hard-to-Treat Smokers

ERIC Educational Resources Information Center

Lamb, R. J.; Kirby, Kimberly C.; Morral, Andrew R.; Galbicka, Greg; Iguchi, Martin Y.

2010-01-01

Objective: Contingency management (CM) effectively treats addictions by providing abstinence incentives. However, CM fails for many who do not readily become abstinent and earn incentives. Shaping may improve outcomes in these hard-to-treat (HTT) individuals. Shaping sets intermediate criteria for incentive delivery between the present behavior…

A simple procedure for estimating soil porosity

NASA Astrophysics Data System (ADS)

Emmet-Booth, Jeremy; Forristal, Dermot; Fenton, Owen; Holden, Nick

2016-04-01

Soil degradation from mismanagement is of international concern. Simple, accessible tools for rapidly assessing impacts of soil management are required. Soil structure is a key component of soil quality and porosity is a useful indicator of structure. We outline a version of a procedure described by Piwowarczyk et al. (2011) used to estimate porosity of samples taken during a soil quality survey of 38 sites across Ireland as part of the Government funded SQUARE (Soil Quality Assessment Research) project. This required intact core (r = 2.5 cm, H = 5cm) samples taken at 5-10 cm and 10-20 cm depth, to be covered with muslin cloth at one end and secured with a jubilee clip. Samples were saturated in sealable water tanks for ≈ 64 hours, then allowed to drain by gravity for 24 hours, at which point Field Capacity (F.C.) was assumed to have been reached, followed by oven drying with weight determined at each stage. This allowed the calculation of bulk density and the estimation of water content at saturation and following gravitational drainage, thus total and functional porosity. The assumption that F.C. was reached following 24 hours of gravitational drainage was based on the Soil Moisture Deficit model used in Ireland to predict when soils are potentially vulnerable to structural damage and used nationally as a management tool. Preliminary results indicate moderately strong, negative correlations between estimated total porosity at 5-10 cm and 10-20 cm depth (rs = -0.7, P < 0.01 in both cases) and soil quality scores of the Visual Evaluation of Soil Structure (VESS) method which was conducted at each survey site. Estimated functional porosity at 5-10 cm depth was found to moderately, negatively correlate with VESS scores (rs = - 0.5, P < 0.05). This simple procedure requires inexpensive equipment and appears useful in indicating porosity of a large quantity of samples taken at numerous sites or if done periodically, temporal changes in porosity at a field scale, indicating the impacts of soil management. Reference Piwowarczyk, A., Giuliani, G. & Holden, N.M. 2011. Can soil moisture deficit be used to forecast when soils are at high risk of damage owing to grazing animals? Soil Use and Management, 27, 255-263.

Solar array synthesis computer program

NASA Technical Reports Server (NTRS)

Faith, T. J.

1973-01-01

Photovoltaic characteristics have been measured on solar cells irradiated by 1 MeV electrons to fluences ranging from 1 x 10 to the 13th power e/sq cm to 1 x 10 to the 16th power e/sq cm, for cell temperatures ranging from 123 K to 473 K and for illumination intensities ranging from 5m W/sq cm to 1830m W/sq cm. Empirical equations have been derived from these measurements to describe the behavior of light generated current, open circuit voltage and I-V curve shape over various portions of these temperature/illumination ranges. Both 10 ohms/cm and 17 ohms/cm n-p silicon solar cells were tested, and similar analytical expressions were formulated for easy comparison between the two resistivities.

Community-Based Psychosocial Treatment Has an Impact on Social Processing and Functional Outcome in Schizophrenia.

PubMed

Varga, Eszter; Endre, Szilvia; Bugya, Titusz; Tényi, Tamás; Herold, Róbert

2018-01-01

Schizophrenic patients have serious impairments in social cognition, which often persists after significant reduction in clinical symptoms. Community-based psychosocial treatments aim to recover social functioning for mentally ill individuals. Our aim was to examine prospective changes in social cognition and functional outcomes in two groups of schizophrenic patients involved in two forms of community-based psychosocial treatments namely case management (CM) and community-based club (CC) compared to a matched, treatment as usual (TAU) group of patients. We hypothesized that CC and CM groups would exhibit better functional and social cognitive outcomes after a 6-month long psychosocial treatment period. Seventy-five patients participated either in CC, CM or TAU. Both CC and CM took part in community-based psychosocial treatment programs including trainings, such as communication and assertiveness trainings. In addition, CC provided group therapeutic treatments and a continuously available day care where patients had the possibility to participate in various social interactions. All participants were in remission, and on maintenance antipsychotic treatment. Participants were assessed on all study variables at two time points: baseline and after 6 months with a battery of questionnaires that examined affective face perception, affective prosody perception, pragmatic language comprehension and ToM. Our results showed that functional outcomes improved significantly in the CC as well as in the CM groups, in contrast to the TAU group. While analyzing summary scores of social cognition, it was found that only the CC group increased its performance in social cognition. In addition, a significant between-group difference in social cognitive function was found after 6 months between the three groups, with the CC group performing best. When investigating associations between changes in social cognition and changes in functional outcomes during a 6-month long treatment period, we found significant correlations between the two variables both in the CC and in the CM groups. Based on our results, we suggest that a rich interpersonal network and social support have highly beneficial effects on social cognition and we would like to emphasize the necessity of offering community-based psychosocial treatments beside antipsychotic medications as early as possible as a crucial part of the complex therapy of schizophrenia.

Contingency management treatment in cocaine using methadone maintained patients with and without legal problems.

PubMed

Ginley, Meredith K; Rash, Carla J; Olmstead, Todd A; Petry, Nancy M

2017-11-01

Legal difficulties and cocaine use are prevalent in methadone maintenance patients, and they are related to one another, as well as to poor response to methadone treatment. Contingency management (CM) is efficacious for decreasing cocaine use, but the relation of CM treatment to criminal activities has rarely been studied. This study evaluated whether baseline legal problems are related to subsequent substance use and illegal activities for cocaine using methadone maintained patients and whether CM differentially improves outcomes depending on baseline legal problems. Using data from four randomized CM trials (N=323), we compared methadone maintained patients with legal problems at the start of study participation to those without initial legal problems. Overall, the addition of CM to standard methadone care improved substance use outcomes regardless of initial legal problems. Endorsement of legal problems within 30days of study initiation was associated with reduced proportion of negative samples submitted during the 12-week treatment period. A significant interaction effect of baseline legal problems and treatment condition was present for subsequent self-reports of illegal activities. Those with baseline legal problems who were assigned to CM had reduced self-reports of reengagement in illegal activity throughout a six month follow-up compared to their counterparts randomized to standard care. Adding CM to methadone treatment improves substance use outcomes and reduces subsequent illegal activity in cocaine-using methadone patients with legal problems. Copyright © 2017 Elsevier B.V. All rights reserved.

A new risk stratification algorithm for the management of patients with adrenal incidentalomas.

PubMed

Birsen, Onur; Akyuz, Muhammet; Dural, Cem; Aksoy, Erol; Aliyev, Shamil; Mitchell, Jamie; Siperstein, Allan; Berber, Eren

2014-10-01

Although adrenal incidentalomas (AI) are detected in ≤5% of patients undergoing chest and abdominal computed tomography (CT), their management is challenging. The current guidelines include recommendations from the National Institutes of Health, the American Association of Endocrine Surgeons (AAES), and the American Association for Cancer Education (AACE). The aim of this study was to develop a new risk stratification model and compare its performance against the existing guidelines for managing AI. A risk stratification model was designed by assigning points for adrenal size (1, 2, or 3 points for tumors <4, 4-6, or >6 cm, respectively) and Hounsfield unit (HU) density on noncontrast CT (1, 2, or 3 points for HU <10, 10-20, or >20, respectively). This model was applied retrospectively to 157 patients with AI managed in an endocrine surgery clinic to assign a score to each tumor. The utility of this model versus the AAES/AACE guidelines was assessed. Of the 157 patients, 54 (34%), had tumors <4 cm with HU <10 (a score of 2). One third of these were hormonally active on biochemical workup and underwent adrenalectomy. The remaining two thirds were nonsecretory lesions and have been followed conservatively with annual testing. In 103 patients (66%), the adrenal mass was >4 cm and/or had indeterminate features on noncontrast CT (HU >10, irregular borders, heterogeneity), and adrenalectomy was performed after hormonal evaluation was completed (10 were hormonally active on biochemical testing). Seven of these patients (7%) had adrenocortical cancer on final pathology with tumor size <4 cm in 0, 4-6 cm in 1, and >6 cm in 5 patients. Of the hormonally inactive patients, 32% had a score of 3, 38% 4, and 30% 5 or 6. The incidence of adrenocortical cancer in these subgroups was 0, 0, and 25%, respectively. This study shows that an algorithm that utilizes the hormonal activity at the first decision step followed by a consolidated risk stratification, based on tumor size and HU density, has a potential to spare a substantial number of patients from unnecessary "diagnostic" surgery for AI. Copyright © 2014 Elsevier Inc. All rights reserved.

Spectroscopic properties of heavily Ho3+-doped barium yttrium fluoride crystals

NASA Astrophysics Data System (ADS)

Ji, En-Cai; Liu, Qiang; Nie, Ming-Ming; Luo, Hui; Hu, Yu-Xi; Guan, Zhou-Guo; Gong, Ma-Li

2015-09-01

The 30 at.% Ho: BaY2F8 crystals were grown by the Czochralski method, and their spectroscopic properties are analyzed systematically by standard Judd-Ofelt theory. The Judd-Ofelt intensity parameters are estimated to be Ω2 = 6.74 × 10-20 cm2, Ω4 = 1.20 × 10-20 cm2, and Ω6 = 0.66 × 10-20 cm2, and the fluorescence branching ratios and radiative lifetimes for a series of excited state manifolds are also determined. The emission cross sections with our measured infrared luminescence spectra, especially important for 4.1 μm, are calculated to be about 4.37 × 10-21 cm2. The crystal quality is preliminarily tested through a mid-infrared laser emission experiment. Project supported by the National Natural Science Foundation of China (Grant No. 61275146), the Research Fund for the Doctoral Program of Higher Education of China (Grant No. 20120002110066), and the Special Program of the Co-construction with Beijing Municipal Government of China (Grant No. 20121000302).

Cow-specific risk factors for clinical mastitis in Brazilian dairy cattle.

PubMed

Oliveira, C S F; Hogeveen, H; Botelho, A M; Maia, P V; Coelho, S G; Haddad, J P A

2015-10-01

Information related to mastitis risk factors is useful for the design and implementation of clinical mastitis (CM) control programs. The first objective of our study was to model the risk of CM under Brazilian conditions, using cow-specific risk factors. Our second objective was to explore which risk factors were associated with the occurrence of the most common pathogens involved in Brazilian CM infections. The analyses were based on 65 months of data from 9,789 dairy cows and 12,464 CM cases. Cow-specific risk factors that could easily be measured in standard Brazilian dairy farms were used in the statistical analyses, which included logistic regression and multinomial logistic regression. The first month of lactation, high somatic cell count, rainy season and history of clinical mastitis cases were factors associated with CM for both primiparous and multiparous cows. In addition, parity and breed were also associated risk factors for multiparous cows. Of all CM cases, 54% showed positive bacteriological culturing results from which 57% were classified as environmental pathogens, with a large percentage of coliforms (35%). Coagulase-negative Staphylococcus (16%), Streptococcus uberis (9%), Streptococcus agalactiae (7%) and other Streptococci (9%) were also common pathogens. Among the pathogens analyzed, the association of cow-specific risk factors, such as Zebu breed (OR=5.84, 95%CI 3.77-10.77) and accumulated history of SCC (1.76, 95%CI 1.37-2.27), was different for CM caused by Coagulase-negative Staphylococcus and S. agalactiae in comparison to CM caused by coliforms. Our results suggest that CM control programs in Brazil should specially consider the recent history of clinical mastitis cases and the beginning of the lactations, mainly during the rainy season as important risk factor for mastitis. Copyright © 2015 Elsevier B.V. All rights reserved.

Testing piezoelectric sensors in a nuclear reactor environment

NASA Astrophysics Data System (ADS)

Reinhardt, Brian T.; Suprock, Andy; Tittmann, Bernhard

2017-02-01

Several Department of Energy Office of Nuclear Energy (DOE-NE) programs, such as the Fuel Cycle Research and Development (FCRD), Advanced Reactor Concepts (ARC), Light Water Reactor Sustainability, and Next Generation Nuclear Power Plants (NGNP), are investigating new fuels, materials, and inspection paradigms for advanced and existing reactors. A key objective of such programs is to understand the performance of these fuels and materials during irradiation. In DOE-NE's FCRD program, ultrasonic based technology was identified as a key approach that should be pursued to obtain the high-fidelity, high-accuracy data required to characterize the behavior and performance of new candidate fuels and structural materials during irradiation testing. The radiation, high temperatures, and pressure can limit the available tools and characterization methods. In this work piezoelectric transducers capable of making these measurements are developed. Specifically, three piezoelectric sensors (Bismuth Titanate, Aluminum Nitride, and Zinc Oxide) are tested in the Massachusetts Institute of Technology Research reactor to a fast neutron fluence of 8.65×1020 nf/cm2. It is demonstrated that Bismuth Titanate is capable of transduction up to 5 × 1020 nf/cm2, Zinc Oxide is capable of transduction up to at least 6.27 × 1020 nf/cm2, and Aluminum Nitride is capable of transduction up to at least 8.65 × 1020 nf/cm2.

20 CFR 632.76 - Program management systems.

Code of Federal Regulations, 2010 CFR

2010-04-01

... NATIVE AMERICAN EMPLOYMENT AND TRAINING PROGRAMS Program Design and Management § 632.76 Program management systems. (a) All Native American grantees shall establish management information systems to... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Program management systems. 632.76 Section...

How change management can prevent the failure of information systems implementation among Malaysian government hospitals?

NASA Astrophysics Data System (ADS)

ChePa, Noraziah; Jasin, Noorhayati Md; Bakar, Nur Azzah Abu

2017-10-01

Fail to prevent or control challenges of Information System (IS) implementation have led to the failure of its implementation. Successful implementation of IS has been a challenging task to any organization including government hospitals. Government has invested a big amount of money on information system (IS) projects to improve service delivery in healthcare. However, several of them failed to be implemented successfully due to several factors. This article proposes a prevention model which incorporated Change Management (CM) concepts to avoid the failure of IS implementation, hence ensuring the success of it. Challenges of IS implementation in government hospitals have been discovered. Extensive literature review and deep interview approaches were employed to discover these challenges. A prevention model has been designed to cater the challenges. The model caters three main phases of implementation; pre-implementation, during implementation, and post-implementation by adopting CM practices of Lewin's, Kotter's and Prosci's CM model. Six elements of CM comprising thirteen sub-elements adopted from the three CM models have been used to handle CFFs of Human and Support issues; guiding team, resistance avoidance, IS adoption, enforcement, monitoring, and IS sustainability. Successful practice of the proposed mapping is expected to prevent CFFs to occur, hence ensuring a successful implementation of IS in the hospitals. The proposed model has been presented and successfully evaluated by the domain experts from the selected hospitals. The proposed model is believed to be beneficial for top management, IT practitioners and medical practitioners in preventing IS implementation failure among government hospitals towards ensuring the success implementation.

48 CFR 1301.671 - Assignment of program and project managers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... project managers. 1301.671 Section 1301.671 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE..., and Responsibilities 1301.671 Assignment of program and project managers. The Department's Program and Project Manager certification program for the assignment and certification of Program and Project Managers...

KENNEDY SPACE CENTER, FLA. -- NASA and United Space Alliance (USA) Space Shuttle program managers attend a briefing, part of activities during a leadership workday. The day is intended to provide management with an in-depth, hands-on look at Shuttle processing activities at KSC. Starting third from left are NASA Deputy Associate Administrator for Space Station and Shuttle Programs Michael Kostelnik, USA Vice President and Space Shuttle Program Manager Howard DeCastro, NASA Space Shuttle Program Manager William Parsons, and USA Associate Program Manager of Ground Operations Andy Allen.

NASA Image and Video Library

2003-12-19

KENNEDY SPACE CENTER, FLA. -- NASA and United Space Alliance (USA) Space Shuttle program managers attend a briefing, part of activities during a leadership workday. The day is intended to provide management with an in-depth, hands-on look at Shuttle processing activities at KSC. Starting third from left are NASA Deputy Associate Administrator for Space Station and Shuttle Programs Michael Kostelnik, USA Vice President and Space Shuttle Program Manager Howard DeCastro, NASA Space Shuttle Program Manager William Parsons, and USA Associate Program Manager of Ground Operations Andy Allen.

Thirty-Eight Years of Autogenic, Woody Understory Dynamics in a Mature, Temperate Pine-Oak Forest

Treesearch

Michael D. Cain; Michael G. Shelton

1997-01-01

In 1935, 32 ha of a pine-hardwood forest were set aside from future timber management in southern Arkansas, U.S.A. Old-growth timber had been cut to a 36-cm stump diameter before 1915. Between 1952 and 1993, four inventories were made of the overstory and midstory components (number of live trees 29 cm in diameter breast height (DBH) taken at 1.37 m, by 2.54-cm DBH...

Lifestyle Intervention for Weight Loss: a group-based program for Emiratis in Ajman, United Arab Emirates

PubMed Central

Sadiya, Amena; Abdi, Sarah; Abusnana, Salah

2016-01-01

Background Lifestyle Intervention for Weight Loss (LIFE-8) is developed as a structured, group-based weight management program for Emiratis with obesity and type 2 diabetes. It is a 3-month program followed by a 1-year follow-up. The results from the first 2 years are presented here to indicate the possibility of its further adaptation and implementation in this region. Methodology We recruited 45 participants with obesity and/or type 2 diabetes based on inclusion/exclusion criteria. The LIFE-8 program was executed by incorporating dietary modification, physical activity, and behavioral therapy, aiming to achieve up to 5% weight loss. The outcomes included body weight, fat mass, waist circumference, blood pressure, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and nutritional knowledge at 3 months and 12 months. Results We observed a reduction of 5.0% in body weight (4.8±2.8 kg; 95% CI 3.7–5.8), fat mass (−7.8%, P<0.01), and waist circumference (Δ=4±4 cm, P<0.01) in the completed participants (n=28). An improvement (P<0.05) in HbA1c (7.1%±1.0% vs 6.6%±0.7%) and FBG (8.2±2.0 mmol/L vs 6.8±0.8 mmol/L) was observed in participants with obesity and type 2 diabetes after the program. Increase in nutritional knowledge (<0.01) and overall evaluation of the program (9/10) was favorable. On 1-year follow-up, we found that the participants could sustain weight loss (−4.0%), while obese, type 2 diabetic participants sustained HbA1c (6.6%±0.7% vs 6.4%±0.7%) and further improved (P<0.05) the level of FBG (6.8±0.8 mmol/L vs 6.7±0.4 mmol/L). Conclusion LIFE-8 could be an effective, affordable, acceptable, and adaptable lifestyle intervention program for the prevention and management of diabetes in Emiratis. It was successful not only in delivering a modest weight loss but also in improving glycemic control in diabetic participants. PMID:27051310

Chiari Malformation Type 1: A Systematic Review of Natural History and Conservative Management.

PubMed

Langridge, Benjamin; Phillips, Edward; Choi, David

2017-08-01

Chiari malformation type 1 (CM-1) is a variation of hindbrain development that can sometimes occur in asymptomatic individuals. Conventional treatment is surgical decompression, but little is known about the natural history of patients who do not undergo surgical management. This information is critical to determine how these patients should be managed. We conducted a systematic literature review to determine the natural history of CM-1, particularly in patients who did not undergo surgery and in asymptomatic individuals, to help patients and physicians determine when surgery is likely to be beneficial. The literature search was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the electronic databases PubMed, Scopus, Cochrane Library, and Web of Science. Inclusion and exclusion criteria were predefined. In symptomatic patients who did not undergo surgery, headaches and nausea often improved, whereas ataxia and sensory disturbance tended not to improve spontaneously. Of patients, 27%-47% had an improvement in symptoms after 15 months, and 37%-40% with cough headache and 89% with nausea who were managed nonoperatively improved at follow-up. Most asymptomatic individuals with CM-1 remained asymptomatic (93.3%) even in the presence of syringomyelia. The natural history of mild symptomatic and asymptomatic CM-1 in adults is relatively benign and nonprogressive; the decision to perform surgical decompression should be based on severity and duration of a patient's symptoms at presentation. It is reasonable to observe a patient with mild or asymptomatic symptoms even in the presence of significant tonsillar descent or syringomyelia. Copyright © 2017 Elsevier Inc. All rights reserved.

Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management. Part 1

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 in the operational phase. Portions of this standard are also useful for other DOE processes, activities, and programs. This Part 1 contains foreword, glossary, acronyms, bibliography, and Chapter 1 on operational configuration management program principles. Appendices are included on configuration management program interfaces, and background material and concepts for operational configuration management.

14 CFR 91.1049 - Personnel.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Management § 91.1049 Personnel. (a) Each program manager and each fractional owner must use in program... regulations. The program manager must provide oversight of those crews. (b) Each program manager must employ...) Program manager flight, duty, and rest time considerations, and in all cases within the limits set forth...

The Role of CMR and Others in Project Implementation using the CM Method to Support the Government

NASA Astrophysics Data System (ADS)

Tada, Hiroshi; Miyatake, Ichiro; Mouri, Junji; Endo, Kenji; Fueta, Toshiharu

In Japan, the construction management (CM) method has been introduced as a measure to support the governmental agencies, in developing and maintaining local infrastructures, or in executing public works projects in an appropriate manner, etc. The scope of work of the Construction Manager (CMR) of the CM method is specified as work items, in the special specification document for CM services contained in the contract documents, as a reflection of the client's expectations towards the performance of CMR. However, the CM services has been conducted as required on a case-by-case basis, because it is not possible to anticipate the actual construction status in advance, and thus the special specification document does not provide full detail of the scope of work of CMR. In such case, there may be a difference in the way the scope of work in the special specification document is recognized between the client and the CMR, which could make the CM method less effective. Moreover, there is a case in which the role sharing between the client and the CMR is not clearly defined, and both parties may engage in the same task in such case, causing an obstacle for smooth project implementation. For this reason, it is required to prepare the special specification document which clearly defines the scope of work of CMR, by examining the status of application of the CM method in actual project cases, and to improve the practices of the CM method as necessary. In view of this background, this study looks in to the actual project cases using the CM method, for the purpose of clarifying the actual scope of work of CMR for each task item defined in the special specification document, and the role sharing between the client and CMR, in the aim of contributing the promotion of the use and the effective application of the CM method.

Large-volume iodinated contrast medium extravasation: low frequency and good outcome after conservative management in a single-centre cohort of more than 67,000 patients.

PubMed

Ko, Chih-Hsiang; Tay, Shee Yen; Chang, Hsiu-Chin; Chan, Wing P

2018-06-12

Our aim was to retrospectively investigate the frequency and outcome of large-volume iodinated contrast medium (CM) extravasation in our institution and to compare our management protocol to current practice. Institutional review board approval was obtained, and informed consent was waived because the study was retrospective. From January 2008 to September 2016, radiological examinations with intravenous non-ionic iodinated CM administration were performed in 67,129 patients. Contrast medium extravasation events on CT scans and intravenous pyelograms but not on angiograms were included. All data were collected prospectively and stratified according to age, injection method (manual vs auto-injection), prevention of extravasation by various means (including intercom alarm), management of extravasation (routine application of silver sulfadiazine ointment, clobetasol propionate cream, and damp gauze at room temperature), etc. RESULTS: The incidence of large-volume CM extravasation was very low (0.04% [27/67,129] overall; 0.03% related to manual injection [age range, 59-92 years; mean, 75.4 years], and 0.045% related to auto-injection [age range, 36-86 years; mean, 65.8 years]). The CM extravasation volume in majority of patients was 20-40 ml in 5 of 9 patients (55.6%) in the manual injection group and 14 of 18 (77.8%) in the auto-injection group. Swelling and pain were the most common symptoms. No patient developed severe signs or needed surgical intervention. Results show a very low incidence of large-volume CM extravasation without severe complications or sequelae. The casual effect between our protocols and good outcome cannot be scrutinised thoroughly because the study lacks a control group and is retrospective. • The incidence of large-volume contrast medium extravasation (≥20 ml) was 0.04%. • No patient needed surgical intervention, and most recovered within 7 days. • Each element of our management protocol contributed to good outcome.

Scheduling Guide for Program Managers

DTIC Science & Technology

2001-10-01

58 Chapter 8 TIME MANAGEMENT ....................................................................................... 59...8.1 Time Management and the Program...60 8.2 Time Management and the Program Manager

Impact of Long-Term Forest Enrichment Planting on the Biological Status of Soil in a Deforested Dipterocarp Forest in Perak, Malaysia

PubMed Central

Karam, D. S.; Arifin, A.; Radziah, O.; Shamshuddin, J.; Majid, N. M.; Hazandy, A. H.; Zahari, I.; Nor Halizah, A. H.; Rui, T. X.

2012-01-01

Deforestation leads to the deterioration of soil fertility which occurs rapidly under tropical climates. Forest rehabilitation is one of the approaches to restore soil fertility and increase the productivity of degraded areas. The objective of this study was to evaluate and compare soil biological properties under enrichment planting and secondary forests at Tapah Hill Forest Reserve, Perak after 42 years of planting. Both areas were excessively logged in the 1950s and left idle without any appropriate forest management until 1968 when rehabilitation program was initiated. Six subplots (20 m × 20 m) were established within each enrichment planting (F1) and secondary forest (F2) plots, after which soil was sampled at depths of 0–15 cm (topsoil) and 15–30 cm (subsoil). Results showed that total mean microbial enzymatic activity, as well as biomass C and N content, was significantly higher in F1 compared to F2. The results, despite sample variability, suggest that the rehabilitation program improves the soil biological activities where high rate of soil organic matter, organic C, N, suitable soil acidity range, and abundance of forest litter is believed to be the predisposing factor promoting higher population of microbial in F1 as compared to F2. In conclusion total microbial enzymatic activity, biomass C and biomass N evaluation were higher in enrichment planting plot compared to secondary forest. After 42 years of planting, rehabilitation or enrichment planting helps to restore the productivity of planted forest in terms of biological parameters. PMID:22606055

Electric propulsion - Characteristics, applications, and status

NASA Technical Reports Server (NTRS)

Maloy, J. E.; Dulgeroff, C. R.; Poeschel, R. L.

1981-01-01

As chemical propulsion systems were achieving their ultimate capability for planetary exploration, space scientists were developing solar electric propulsion as the propulsion system need for future missions. This paper provides a comparative review of the principles of ion thruster and chemical rocket operations and discusses the current status of the 30-cm mercury ion thruster development and the specifications imposed on the 30-cm thruster by the Solar Electric Propulsion System program. The 30-cm thruster operating range, efficiency, wear out lifetime, and interface requirements are described. Finally, the areas of 30-cm thruster technology that remain to be refined are discussed.

Soil management practice in Croatian vineyard affect CO2 fluxes and soil degradation in trafficking zones. First results

NASA Astrophysics Data System (ADS)

Bogunovic, Igor; Bilandzija, Darija; Andabaka, Zeljko; Stupic, Domagoj; Cacic, Marija; Brezinscak, Luka; Maletic, Edi; Pereira, Paulo; Kisic, Ivica

2017-04-01

Vineyards represent one of the most degradation prone types of intensively managed land on Earth. Steep slopes encourage grape producers to adopt environmental friendly soil management like mulching or continuous no-tillage. In this context, producers have concerns about efficient fertilisation practices and water competitions between vine and grasses in continuous no-tillage inter rows. Vineyards in semi-humid areas like Continental Croatia mostly not suffer from water deficit during growth. Nevertheless, lack of research of different soil management practices open dilemma about soil compaction concerns in intensively trafficked soils in vineyard of semi-humid areas. Soil compaction, determined by bulk density (BD), soil water content (SWC) and CO2 fluxes from trafficked inter row positions were recorded in 2016 in an experiment in which four different soil management systems were compared in a vineyard raised on a silty clay loam soil, near Zagreb, Croatia: No-tillage (NT) system, continuous tillage (CT) and yearly inversed grass covered (INV-GC) and tillage managed (INV-T) inter rows are subjected to intensive traffic. Grape yield and must quality of grape variety Chardonnay was also monitored. Tractor traffic increased the soil BD at 0-10 and 10-20 cm, but especially at the 0-10 cm depth. CT treatment record lowest compaction at 0-10 cm because of tillage. Soil water content showed better conservation possibilities of INV-GC in drier period. In wet period SWC possibilities are similar between treatments. The results of soil compaction under different management indicate that vineyard soil differently response to traffic intensity and impact on microfauna activity and CO2 emissions. INV-GC and NT managed soils record lower CO2 fluxes from vineyard soil compared to CT and INV-T treatments. Management treatments did not statistically influenced on grape yields. Several years of investigation is needed to confirm the overall impact of different management treatments on the proportion of degradation process and their response to proportion of tractor circulation impacts.

The Advanced Communication Technology Satellite and ISDN

NASA Technical Reports Server (NTRS)

Lowry, Peter A.

1996-01-01

This paper depicts the Advanced Communication Technology Satellite (ACTS) system as a global central office switch. The ground portion of the system is the collection of earth stations or T1-VSAT's (T1 very small aperture terminals). The control software for the T1-VSAT's resides in a single CPU. The software consists of two modules, the modem manager and the call manager. The modem manager (MM) controls the RF modem portion of the T1-VSAT. It processes the orderwires from the satellite or from signaling generated by the call manager (CM). The CM controls the Recom Laboratories MSPs by receiving signaling messages from the stacked MSP shelves ro units and sending appropriate setup commands to them. There are two methods used to setup and process calls in the CM; first by dialing up a circuit using a standard telephone handset or, secondly by using an external processor connected to the CPU's second COM port, by sending and receiving signaling orderwires. It is the use of the external processor which permits the ISDN (Integrated Services Digital Network) Signaling Processor to implement ISDN calls. In August 1993, the initial testing of the ISDN Signaling Processor was carried out at ACTS System Test at Lockheed Marietta, Princeton, NJ using the spacecraft in its test configuration on the ground.

Okayama Astrophysical Observatory

NASA Astrophysics Data System (ADS)

Murdin, P.

2000-11-01

The Okayama Astrophysical Observatory (OAO) is a branch Observatory of the NATIONAL ASTRONOMICAL OBSERVATORY, JAPAN. Its main facilities are 188 cm and 91 cm telescopes, equipped with newly built instruments with CCD/IR cameras (e.g. OASIS). OAO accepts nearly 300 astronomers a year, according to the observation program scheduled by the committee....

Managing Appalachian hardwood stands using four management practices: 60-year results

Treesearch

Thomas M. Schuler; Melissa Thomas-Van Gundy; John P. Brown; Jan Wiedenbeck

2017-01-01

A long-term forest management case study on the Fernow Experimental Forest in West Virginia referred to as the Cutting Practice Level study is evaluated after 60 years. Treatments include a commercial clearcut (one time application), a 39 cm diameter-limit (applied 4 times), uneven-aged management using two variations of single-tree selection (applied 7 and 8 times,...

Sandia National Laboratories California Waste Management Program Annual Report February 2008.

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

Brynildson, Mark E.

The annual program report provides detailed information about all aspects of the Sandia National Laboratories, California (SNL/CA) Waste Management Program. It functions as supporting documentation to the SNL/CA Environmental Management System Program Manual. This annual program report describes the activities undertaken during the past year, and activities planned in future years to implement the Waste Management (WM) Program, one of six programs that supports environmental management at SNL/CA.

The impact of middle manager affective commitment on perceived improvement program implementation success.

PubMed

Fryer, Ashley-Kay; Tucker, Anita L; Singer, Sara J

Recent literature suggests that middle manager affective commitment (emotional attachment, identification, and involvement) to an improvement program may influence implementation success. However, less is known about the interplay between middle manager affective commitment and frontline worker commitment, another important driver of implementation success. We contribute to this research by surveying middle managers who directly manage frontline workers on nursing units. We assess how middle manager affective commitment is related to their perceptions of implementation success and whether their perceptions of frontline worker support mediate this relationship. We also test whether a set of organizational support factors foster middle manager affective commitment. We adapt survey measures of manager affective commitment to our research context of hospitals. We surveyed 67 nurse managers from 19 U.S. hospitals. We use hierarchical linear regression to assess relationships among middle manager affective commitment to their units' falls reduction program and their perceptions of three constructs related to the program: frontline worker support, organizational support, and implementation success. Middle manager affective commitment to their unit's falls reduction program is positively associated with their perception of implementation success. This relationship is mediated by their perception of frontline worker support for the falls program. Moreover, middle managers' affective commitment to their unit's falls program mediates the relationship between perceived organizational support for the program and perceived implementation success. We, through this research, offer an important contribution by providing empirical support of factors that may influence successful implementation of an improvement program: middle manager affective commitment, frontline worker support, and organizational support for an improvement program. Increasing levels of middle manager affective commitment to an improvement program could strengthen program implementation success by facilitating frontline worker support for the program. Furthermore, providing the organizational support items in our survey construct may bolster middle manager affective commitment.

12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Compliance and risk management programs... Practices and Procedures § 1710.19 Compliance and risk management programs; compliance with other laws. (a... management program. (1) An Enterprise shall establish and maintain a risk management program that is...

14 CFR 91.1003 - Management contract between owner and program manager.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Management contract between owner and... RULES Fractional Ownership Operations § 91.1003 Management contract between owner and program manager... the program manager pertaining to the operational safety of the program and those records required to...

Treatment of the neglected Achilles tendon rupture.

PubMed

Bevilacqua, Nicholas J

2012-04-01

Achilles tendon ruptures are best managed acutely. Neglected Achilles tendon ruptures are debilitating injuries and the increased complexity of the situation must be appreciated. Surgical management is recommended, and only in the poorest surgical candidate is conservative treatment entertained. Numerous treatment algorithms and surgical techniques have been described. A V-Y advancement flap and flexor halluces longus tendon transfer have been found to be reliable and achieve good clinical outcomes for defects ranging from 2 cm to 8 cm. This article focuses on the treatment options for the neglected Achilles tendon rupture. Copyright © 2012 Elsevier Inc. All rights reserved.

Optimizing Soft Tissue Management and Spacer Design in Segmental Bone Defects

DTIC Science & Technology

2016-12-01

proximal and distal bone segments. 3. Debride 10 grams of tibialis anterior and gastrocnemius muscles. 4. Place an interlocking intramedullary nail ...using a custom spacer to maintain 5-cm defect length. 5. Place a pre-molded 5 cm long x 2 cm diameter PMMA spacer around the nail in the defect. 6...tibia. 3. Open the IM surrounding the PMMA spacer using a “bomb bay door opening”. 4. Remove the spacer without damaging the membrane or nail . 5

Reaction to Reexamination: More on Type III Error in Program Evaluation.

ERIC Educational Resources Information Center

Cook, Thomas J.; Dobson, L. Douglas

1982-01-01

The authors respond to criticism and analyses by Eva Rezmovic (TM 507 851) of their experimental design, particularly the suggested use of information on the amount of program service received by the control group comparable to the treatment group in their study of the relationship between program implementation levels and program outcomes. (CM)

What do we get for our money? Cost-effectiveness of adding contingency management.

PubMed

Sindelar, Jody; Elbel, Brian; Petry, Nancy M

2007-02-01

To assess the relative cost-effectiveness of lower versus higher cost prize-based contingency management (CM) treatments for cocaine abuse. Cost-effectiveness analyses based on resource utilization, unit costs and outcomes from a previous CM efficacy trial. Two community-based treatment centers. Patients (n = 120) enrolled in out-patient treatment for cocaine abuse. Random assignment to one of three 12-week treatment conditions: standard treatment (STD) alone or two variants of STD combined with prize based CM. In CM, drawing for prizes was available to those submitting drug-free urine samples and completing goal-related activities. There were two levels of pay-out (referred to as $80 versus $240) based on the potential value of prizes won. Costs per participant associated with counseling utilization, urine and breathalyzer testing, and operation of the prize-drawing procedure were derived from a survey conducted at 16 clinics that had participated in CM studies. The three measures of effectiveness were: (1) longest duration of consecutive abstinence; (2) percentage completing treatment; and (3) percentage of samples drug-free. The higher magnitude CM produced outcomes at a lower per unit cost than did the lower magnitude prize CM treatment. This was the case for all three outcome measures examined and held across various assumptions in the sensitivity analysis. Cost-effectiveness analyses can inform policy decisions regarding selection of one treatment model over another. Decisions on adoption of new evidence-based treatments would be aided by more information on society's willingness to pay for incremental gains in effectiveness.

46th Annual Targets, UAVs and Range Operations Symposium and Exhibition

DTIC Science & Technology

2008-10-10

introduction  mr. Ken Hislop , QF-16 Program manager, eglin aFB, FL 1:40 Pm - 2:00 Pm U.s. navy  CaPt Pat Buckley, Usn, Program manager...Bruce Ringstad Subscale & TCS Flight Lead Mr. Jim Cornwell Program Manager Mr. Ken Hislop Program Manager Ms. Lee Neugin Program Manager & Lead...Missiles Fired / 18 Kills AAC/PA 09-26-08-429 18 QF-16 Air Superiority Target Program Manager: Mr. Ken Hislop Description Full Scale Target for Threat

Repository-Based Software Engineering Program: Working Program Management Plan

NASA Technical Reports Server (NTRS)

1993-01-01

Repository-Based Software Engineering Program (RBSE) is a National Aeronautics and Space Administration (NASA) sponsored program dedicated to introducing and supporting common, effective approaches to software engineering practices. The process of conceiving, designing, building, and maintaining software systems by using existing software assets that are stored in a specialized operational reuse library or repository, accessible to system designers, is the foundation of the program. In addition to operating a software repository, RBSE promotes (1) software engineering technology transfer, (2) academic and instructional support of reuse programs, (3) the use of common software engineering standards and practices, (4) software reuse technology research, and (5) interoperability between reuse libraries. This Program Management Plan (PMP) is intended to communicate program goals and objectives, describe major work areas, and define a management report and control process. This process will assist the Program Manager, University of Houston at Clear Lake (UHCL) in tracking work progress and describing major program activities to NASA management. The goal of this PMP is to make managing the RBSE program a relatively easy process that improves the work of all team members. The PMP describes work areas addressed and work efforts being accomplished by the program; however, it is not intended as a complete description of the program. Its focus is on providing management tools and management processes for monitoring, evaluating, and administering the program; and it includes schedules for charting milestones and deliveries of program products. The PMP was developed by soliciting and obtaining guidance from appropriate program participants, analyzing program management guidance, and reviewing related program management documents.

Physiotherapy interventions for ankylosing spondylitis.

PubMed

Dagfinrud, H; Kvien, T K; Hagen, K B

2008-01-23

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. Physiotherapy is considered an important part of the overall management of AS. To summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL and PEDro up to January 2007 for all relevant publications, without any language restrictions. We checked the reference lists of relevant articles and contacted the authors of included articles. We included randomised and quasi-randomised studies with AS patients and where at least one of the comparison groups received physiotherapy. The main outcomes of interest were pain, stiffness, spinal mobility, physical function and patient global assessment. Two reviewers independently selected trials for inclusion, extracted data and assessed trial quality. Investigators were contacted to obtain missing information. Eleven trials with a total of 763 participants were included in this updated review. Four trials compared individualised home exercise programs or a supervised exercise program with no intervention and reported low quality evidence for effects in spinal mobility (Relative percentage differences (RPDs) from 5-50%) and physical function (four points on a 33-point scale). Three trials compared supervised group physiotherapy with an individualised home-exercise program and reported moderate quality evidence for small differences in spinal mobility (RPDs 7.5-18%) and patient global assessment (1.46 cm) in favour of supervised group exercises. In one study, a three-week inpatient spa-exercise therapy followed by 37 weeks of weekly outpatient group physiotherapy (without spa) was compared with weekly outpatient group physiotherapy alone; there was moderate quality evidence for effects in pain (18%), physical function (24%) and patient global assessment (27%) in favour of the combined spa-exercise therapy. One study compared daily outpatient balneotherapy and an exercise program with only exercise program, and another study compared balneotherapy with fresh water therapy. None of these studies showed significant between-group differences. One study compared an experimental exercise program with a conventional program; statistically significant change scores were reported on nearly all spinal mobility measures and physical function in favour of the experimental program. The results of this review suggest that an individual home-based or supervised exercise program is better than no intervention; that supervised group physiotherapy is better than home exercises; and that combined inpatient spa-exercise therapy followed by group physiotherapy is better than group physiotherapy alone.

Anhedonia Is Associated with Poorer Outcomes in Contingency Management for Cocaine Use Disorder

PubMed Central

Wardle, Margaret C.; Vincent, Jessica N.; Suchting, Robert; Green, Charles E.; Lane, Scott D.; Schmitz, Joy M.

2016-01-01

This study explored anhedonia (lack of interest or pleasure in non-drug rewards) as a potentially modifiable individual difference associated with the effectiveness of Contingency Management (CM). It also tested the hypothesis that a dopaminergic drug, levodopa (L-DOPA), would improve the effectiveness of CM, particularly in individuals high in anhedonia. The study was a single-site, randomized, double-blind, parallel group, 12-week trial comparing L-DOPA with placebo, with both medication groups receiving voucher-based CM targeting cocaine-negative urines. Participants were N = 85 treatment-seeking adults with CUD. Anhedonia was measured at baseline using a validated self-report measure and a progressive ratio behavioral measure. Treatment Effectiveness Score (TES) was defined as the total number of cocaine-negative urines submitted. Analyses based on Frequentist general linear models were not significant, but Bayesian analyses indicated a high probability (92.6%) that self-reported anhedonia was associated with poor treatment outcomes (lower TES). L-DOPA did not significantly improve outcomes, nor was the effect of L-DOPA moderated by anhedonia. While the study failed to replicate positive findings from previous studies of L-DOPA in combination with CM, it does provide preliminary evidence that anhedonia may be a modifiable individual difference associated with poorer CM outcomes. PMID:27646197

ePORT, NASA's Computer Database Program for System Safety Risk Management Oversight (Electronic Project Online Risk Tool)

NASA Technical Reports Server (NTRS)

Johnson, Paul W.

2008-01-01

ePORT (electronic Project Online Risk Tool) provides a systematic approach to using an electronic database program to manage a program/project risk management processes. This presentation will briefly cover the standard risk management procedures, then thoroughly cover NASA's Risk Management tool called ePORT. This electronic Project Online Risk Tool (ePORT) is a web-based risk management program that provides a common framework to capture and manage risks, independent of a programs/projects size and budget. It is used to thoroughly cover the risk management paradigm providing standardized evaluation criterion for common management reporting, ePORT improves Product Line, Center and Corporate Management insight, simplifies program/project manager reporting, and maintains an archive of data for historical reference.

5 CFR 10.3 - OPM authority to review personnel management programs and practices.

Code of Federal Regulations, 2010 CFR

2010-01-01

... management programs and practices. 10.3 Section 10.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... (RULE X) § 10.3 OPM authority to review personnel management programs and practices. The Office of Personnel Management may review the human resources management programs and practices of any agency and...

12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.

Code of Federal Regulations, 2011 CFR

2011-01-01

... management program. (1) An Enterprise shall establish and maintain a risk management program that is reasonably designed to manage the risks of the operations of the Enterprise. (2) The risk management program... executive officer of the Enterprise. The risk management officer shall report regularly to the board of...

CARVE-FTS observations of arctic CO2, CH4, and CO: overview of the instrument

NASA Astrophysics Data System (ADS)

Dupont, Fabien; Tanguay, François; Li, Manyuan; Perron, Gaetan; Miller, Charles E.; Dinardo, Steven J.; Kurosu, Thomas P.

2012-09-01

CARVE-FTS is a near-IR Fourier-Transform Spectrometer (FTS) used by the Jet Propulsion Laboratory (JPL) for the Carbon in Arctic Reservoirs Vulnerability Experiment (CARVE). CARVE is a 5-year mission of intensive aircraft campaigns in the Alaskan Arctic selected as part of NASA's Earth Ventures program (EV-1). The CARVE-FTS has been designed, manufactured and tested by ABB Inc. The objective of this instrument is to provide integrated column measurements of carbon dioxide (CO2), methane (CH4), and carbon monoxide (CO). The system is inspired from the TSUKUBA-FTS built by ABB for the Japanese Aerospace Exploration Agency (JAXA). JAXA uses the instrument for preparation, calibration and validation within the GOSAT program. The instrument is a Michelson based FTS with three spectral bands. The light modulator is a Michelson single pass type interferometer with large aperture and medium spectral resolution. It provides infrared spectra from 12,900 cm-1 to 13,200 cm-1, from 5,800 cm-1 to 6,400 cm-1, and from 4,200 cm-1 to 4,900 cm-1. This instrument is also able to measure the scene radiance with S and P polarization simultaneously using monopixel detectors. The instrument is mounted on a damping platform and is installed in an aircraft. It delivers continuous data for flight campaigns over the Alaskan Arctic. SNR higher than 100 is reached for each band and the measured ILS full width at half maximum is as low as 0.26 cm-1 at 6,566 cm-1. We present the instrument design, its specification and test results obtained at ABB.

Current status and future prospects of research and development operations in traditional and complementary and alternative medicine manufacturing small- and medium-sized enterprises: a 2014 company-based survey.

PubMed

Ahn, Miyoung; Park, Eun-Ji; Woo, Jong-Min

2017-12-01

Small- and medium-sized enterprises (SMEs) have played key roles in the economic growth and technical innovation of traditional and complementary and alternative medicine (T&CM). Research and development (R&D) are critical activities for industrial progress. This study aimed to characterize the current status of SME R&D activities and to explore manufacturers' perceptions of R&D expansion. Records of the distribution of T&CM SMEs and R&D resources detailed in the 2014 Statistics of Korea T&CM Industries survey, a previously conducted survey on the industrial status of the T&CM field, were reviewed. Data on the perceptions of R&D activities were investigated through a company-based survey covering 285 T&CM-manufacturing SMEs. Greater than 99% of the 13,636 T&CM manufacturers at the time of the study were SMEs employing less than 50 workers. Natural cosmetics manufacturing SMEs (NC SMEs) had the highest R&D expenditures. NC SMEs rely heavily on internal R&D operations, which may contribute to their strong need for R&D collaboration with public research institutions and expanded T&CM-promoted R&D programs. "Digestive system disorders" are the main target diseases for current herbal and dietary supplement manufacturing SMEs and herbal medicine manufacturing SMEs. These SMEs tend to view their own product-related business as a priority for future R&D investment. This study represents the first attempt to assess SME perceptions of R&D activities. The findings herein can inform the design of sustainable programs that support R&D by reducing the gaps between the perspectives of T&CM product makers and policymakers.

Development of a Fan-Filter Unit Test Standard, LaboratoryValidations, and its Applications across Industries

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

Xu, Tengfang

2006-10-20

Lawrence Berkeley National Laboratory (LBNL) is now finalizing the Phase 2 Research and Demonstration Project on characterizing 2-foot x 4-foot (61-cm x 122-cm) fan-filter units in the market using the first-ever standard laboratory test method developed at LBNL.[1][2][3] Fan-filter units deliver re-circulated air and provide particle filtration control for clean environments. Much of the energy in cleanrooms (and minienvironments) is consumed by 2-foot x 4-foot (61-cm x 122-cm) or 4-foot x 4-foot (122-cm x 122-cm) fan-filter units that are typically located in the ceiling (25-100% coverage) of cleanroom controlled environments. Thanks to funding support by the California Energy Commission's Industrialmore » Program of the Public Interest Energy Research (PIER) Program, and significant participation from manufacturers and users of fan-filter units from around the world, LBNL has developed and performed a series of standard laboratory tests and reporting on a variety of 2-foot x 4-foot (61-cm x 122-cm) fan-filter units (FFUs). Standard laboratory testing reports have been completed and reported back to anonymous individual participants in this project. To date, such reports on standard testing of FFU performance have provided rigorous and useful data for suppliers and end users to better understand, and more importantly, to quantitatively characterize performance of FFU products under a variety of operating conditions.[1] In the course of the project, the standard laboratory method previously developed at LBNL has been under continuous evaluation and update.[2][3] Based upon the updated standard, it becomes feasible for users and suppliers to characterize and evaluate energy performance of FFUs in a consistent way.« less

Predicting use of case management support services for adolescents and adults living in community following brain injury: A longitudinal Canadian database study with implications for life care planning

PubMed Central

Baptiste, B.; Dawson, D.R.; Streiner, D.

2015-01-01

Abstract OBJECTIVE: To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. DESIGN: A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. STUDY SAMPLE: Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. METHODOLOGY: Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. RESULTS: Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. CONCLUSIONS: This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions. PMID:26409333

Piloting the addition of contingency management to best practice counselling as an adjunct treatment for rural and remote disordered gamblers: study protocol

PubMed Central

Christensen, Darren R; Witcher, Chad S G; Leighton, Trent; Hudson-Breen, Rebecca; Ofori-Dei, Samuel

2018-01-01

Introduction Problematic gambling is a significant Canadian public health concern that causes harm to the gambler, their families, and society. However, a significant minority of gambling treatment seekers drop out prior to the issue being resolved; those with higher impulsivity scores have the highest drop-out rates. Consequently, retention is a major concern for treatment providers. The aim of this study is to investigate the efficacy of internet-delivered cognitive behavioural therapy (CBT) and internet-delivered CBT and contingency management (CM+) as treatments for gambling disorder in rural Albertan populations. Contingency management (CM) is a successful treatment approach for substance dependence that uses small incentives to reinforce abstinence. This approach may be suitable for the treatment of gambling disorder. Furthermore, internet-delivered CM may hold particular promise in rural contexts, as these communities typically struggle to access traditional clinic-based counselling opportunities. Methods and analysis 54 adults with gambling disorder will be randomised into one of two conditions: CM and CBT (CM+) or CBT alone (CBT). Gambling will be assessed at intake, every treatment session, post-treatment, and follow-up. The primary outcome measures are treatment attendance, gambling abstinence, gambling, gambling symptomatology, and gambling urge. In addition, qualitative interviews assessing study experiences will be conducted with the supervising counsellor, graduate student counsellors, study affiliates, and a subset of treatment seekers. This is the first study to use CM as a treatment for gambling disorder in rural and remote populations. Ethics and dissemination This study was approved by the University of Lethbridge’s Human Subject Research Committee (#2016–080). The investigators plan to publish the results from this study in academic peer-reviewed journals. Summary information will be provided to the funder. Trial registration number NCT02953899; Pre-results. PMID:29615445

Piloting the addition of contingency management to best practice counselling as an adjunct treatment for rural and remote disordered gamblers: study protocol.

PubMed

Christensen, Darren R; Witcher, Chad S G; Leighton, Trent; Hudson-Breen, Rebecca; Ofori-Dei, Samuel

2018-04-03

Problematic gambling is a significant Canadian public health concern that causes harm to the gambler, their families, and society. However, a significant minority of gambling treatment seekers drop out prior to the issue being resolved; those with higher impulsivity scores have the highest drop-out rates. Consequently, retention is a major concern for treatment providers. The aim of this study is to investigate the efficacy of internet-delivered cognitive behavioural therapy (CBT) and internet-delivered CBT and contingency management (CM+) as treatments for gambling disorder in rural Albertan populations. Contingency management (CM) is a successful treatment approach for substance dependence that uses small incentives to reinforce abstinence. This approach may be suitable for the treatment of gambling disorder. Furthermore, internet-delivered CM may hold particular promise in rural contexts, as these communities typically struggle to access traditional clinic-based counselling opportunities. 54 adults with gambling disorder will be randomised into one of two conditions: CM and CBT (CM+) or CBT alone (CBT). Gambling will be assessed at intake, every treatment session, post-treatment, and follow-up. The primary outcome measures are treatment attendance, gambling abstinence, gambling, gambling symptomatology, and gambling urge. In addition, qualitative interviews assessing study experiences will be conducted with the supervising counsellor, graduate student counsellors, study affiliates, and a subset of treatment seekers. This is the first study to use CM as a treatment for gambling disorder in rural and remote populations. This study was approved by the University of Lethbridge's Human Subject Research Committee (#2016-080). The investigators plan to publish the results from this study in academic peer-reviewed journals. Summary information will be provided to the funder. NCT02953899; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Medical Management of Small Abdominal Aortic Aneurysms

PubMed Central

Baxter, B. Timothy; Terrin, Michael C.; Dalman, Ronald L.

2013-01-01

Abdominal aortic aneurysm is a common condition that may be lethal when it is unrecognized. Current guidelines suggest repair as the aneurysm diameter reaches 5.0 to 5.5 cm. Most aortic aneurysms are detected incidentally when imaging is done for other purposes or through screening programs. Ninety percent of these aneurysms are below the threshold for intervention at the time of detection. A number of studies have sought to determine factors that lead to progression of aneurysmal disease that might be amenable to intervention during this period of observation. We review these studies and make recommendations for the medical management of small abdominal aortic aneurysms. On the basis of our current knowledge of the causes of aneurysm, a number of approaches have been proposed to prevent progression of aneurysmal disease. These include hemodynamic management, inhibition of inflammation, and protease inhibition. The American College of Cardiology/American Heart Association clinical practice guidelines rules of evidence have helped to define strength of evidence to support these approaches. Level A evidence (from large randomized trials) is available to indicate that observation of small aneurysms in men is safe up to a size of 5.5 cm and that propranolol does not inhibit aneurysm expansion. Level B evidence (from small randomized trials) suggests that roxithromycin or doxycycline will decrease the rate of aneurysm expansion. A number of studies agree that tobacco use is associated with an increased rate of aneurysm expansion. Level B and C evidence is available to suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may inhibit aneurysm expansion. There are animal data but no human data demonstrating that angiotensin-converting enzyme inhibitors or losartan, an angiotensin receptor blocker, will decrease the rate of AAA expansion. A pharmacological agent without important side effects that inhibited aneurysm expansion could change current approaches to aneurysm treatment. Additional studies are needed to clarify the potential role of doxycycline, roxithromycin, and statin therapy in the progression of aneurysmal disease. PMID:18391122

Sport Management Graduate Programs: Characteristics of Effectiveness.

ERIC Educational Resources Information Center

Li, Ming; And Others

1994-01-01

Reports a study that examined the characteristics that enable graduate sport management programs to achieve their objectives. Surveys of sport management educators found they agreed on 11 characteristics that indicated a sport management program's effectiveness. Respondents believed an effective program should produce sport managers, not…

KENNEDY SPACE CENTER, FLA. -- From left, NASA Deputy Program Manager of the Space Shuttle Program Michael Wetmore, United Space Alliance (USA) Vice President and Space Shuttle Program Manager Howard DeCastro, NASA Deputy Associate Administrator for Space Station and Shuttle Programs Michael Kostelnik, and a USA technician examine cold plates in Orbiter Processing Facility Bay 2. NASA and USA Space Shuttle program management are participating in a leadership workday. The day is intended to provide management with an in-depth, hands-on look at Shuttle processing activities at KSC.

NASA Image and Video Library

2003-12-19

KENNEDY SPACE CENTER, FLA. -- From left, NASA Deputy Program Manager of the Space Shuttle Program Michael Wetmore, United Space Alliance (USA) Vice President and Space Shuttle Program Manager Howard DeCastro, NASA Deputy Associate Administrator for Space Station and Shuttle Programs Michael Kostelnik, and a USA technician examine cold plates in Orbiter Processing Facility Bay 2. NASA and USA Space Shuttle program management are participating in a leadership workday. The day is intended to provide management with an in-depth, hands-on look at Shuttle processing activities at KSC.

Wireless Power Transfer for Autonomous Wearable Neurotransmitter Sensors.

PubMed

Nguyen, Cuong M; Kota, Pavan Kumar; Nguyen, Minh Q; Dubey, Souvik; Rao, Smitha; Mays, Jeffrey; Chiao, J-C

2015-09-23

In this paper, we report a power management system for autonomous and real-time monitoring of the neurotransmitter L-glutamate (L-Glu). A low-power, low-noise, and high-gain recording module was designed to acquire signal from an implantable flexible L-Glu sensor fabricated by micro-electro-mechanical system (MEMS)-based processes. The wearable recording module was wirelessly powered through inductive coupling transmitter antennas. Lateral and angular misalignments of the receiver antennas were resolved by using a multi-transmitter antenna configuration. The effective coverage, over which the recording module functioned properly, was improved with the use of in-phase transmitter antennas. Experimental results showed that the recording system was capable of operating continuously at distances of 4 cm, 7 cm and 10 cm. The wireless power management system reduced the weight of the recording module, eliminated human intervention and enabled animal experimentation for extended durations.

Organizational Factors Associated with the Use of Contingency Management in Publicly Funded Substance Abuse Treatment Centers

PubMed Central

Bride, Brian E.; Abraham, Amanda J.; Roman, Paul M.

2010-01-01

A promising area within technology transfer studies is the identification of organizational factors that influence the adoption of treatment innovations. While studies have identified organizational factors associated with the adoption of pharmacological innovations, few studies have examined organizational factors in the adoption of psychosocial innovations, among which contingency management (CM) is a significant practice. Using data from a sample (n = 318) drawn from the population of publicly funded treatment centers in the U.S., this study modeled organizational factors falling in the domains of structural characteristics, workforce variables, values and norms, and patient characteristics associated with the use of CM. Organizations were more likely to use CM if they: embrace a supportive therapeutic approach, are research-friendly, offer only outpatient levels of care, or serve drug-court patients. Implications for studying the diffusion and implementation of evidence-based psychosocial interventions are discussed. PMID:20850259

Wireless Power Transfer for Autonomous Wearable Neurotransmitter Sensors

PubMed Central

Nguyen, Cuong M.; Kota, Pavan Kumar; Nguyen, Minh Q.; Dubey, Souvik; Rao, Smitha; Mays, Jeffrey; Chiao, J.-C.

2015-01-01

In this paper, we report a power management system for autonomous and real-time monitoring of the neurotransmitter L-glutamate (L-Glu). A low-power, low-noise, and high-gain recording module was designed to acquire signal from an implantable flexible L-Glu sensor fabricated by micro-electro-mechanical system (MEMS)-based processes. The wearable recording module was wirelessly powered through inductive coupling transmitter antennas. Lateral and angular misalignments of the receiver antennas were resolved by using a multi-transmitter antenna configuration. The effective coverage, over which the recording module functioned properly, was improved with the use of in-phase transmitter antennas. Experimental results showed that the recording system was capable of operating continuously at distances of 4 cm, 7 cm and 10 cm. The wireless power management system reduced the weight of the recording module, eliminated human intervention and enabled animal experimentation for extended durations. PMID:26404311

Emergency management training program: Guide to good practice

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

Not Available

1991-07-01

The Emergency Management Training Program Guide to Good Practice is a project of the Training Resources and Data Exchange (TRADE) Emergency Management Issues Special Interest Group (EMI SIG). EMI SIG members expressed interest in a resource to assist in development of a comprehensive emergency management training program. This publication provides guidelines, methods, and materials for EMI SIG members to use, assisting in complete and effective emergency management programs. The purposes of the Emergency Management Training Program Guide to Good Practice are: Provide guidance in the development and management of Emergency Management (EM) training programs; Assist EM trainers to incorporate componentsmore » of the DOE Emergency Management System philosophy of planning, preparedness, readiness assurance, and response into EM training programs; Help EM training managers meet EM training requirements and conditions established by current regulations and policies; Supplement other TRADE EMI SIG documents and complement individual facility training documents. This program is designed for emergency management personnel who are responsible for providing or overseeing EM training but who do not necessarily possess expertise in developing training. It provides good practices from the manager`s point of view on how to produce, administer, and document facility EM training programs in the spirit of the DOE EM system philosophy. Basic guidance is also included for personnel who design, develop, deliver, and/or evaluate EM training programs or parts. This guidance includes key points of EM training programs and identifies other documents that contain useful and/or more detailed training information.« less

Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children.

PubMed

Oxford, Lance E; McClay, John

2006-11-01

To evaluate the presentations and outcomes of pediatric subperiosteal orbital abscesses (SPOA) secondary to acute sinusitis. Case series Tertiary children's hospital. Forty-three admissions diagnosed with SPOA by clinical presentation and contrast enhanced computed tomography (CECT) were retrospectively reviewed. Clinical presentations, CECT dimensions, treatment, outcomes, and microbiology. Eighteen/43 (42%) patients resolved their infection with medical management only, including five children older than nine. Twenty-five/43 (58%) children underwent surgical drainage. Purulence was identified in 22 of 25 surgical patients, and the most common organism was Streptococcus milleri (7 patients). Compared to 22 patients with drained purulence, the 18 patients with abscesses managed medically had significant differences for: chemosis in 2/18 (11.1%) versus 14/22 (63.6%, p=0.001), proptosis in 10/18 (55.6%) versus 20/22 (90.9%, p=0.025), elevated intraocular pressure (IOP) in 0/18 (0%) versus 11/22 (50%, p<0.001), severe restriction of extraocular movements in 1/18 (5.6%) versus 12/22 (54.5%, p=0.002), and length of stay (4.3 versus 5.8 days, p=0.038). The dimensions of medial SPOA managed medically were significantly smaller on CECT compared to surgically drained purulent SPOA: width (0.25 versus 1.46cm, p<0.001), height (0.73 versus 1.35cm, p=0.002), and length (1.1 versus 1.86cm, p=0.004). Persistent morbidities occurred in no patients managed medically and in 2/25 (8%) managed surgically. Children with small medial SPOA without significant ocular signs may be managed medically with favorable outcomes. Proposed criteria for medical management of medial SPOA include: (1) normal vision, pupil, and retina; (2) no ophthalmoplegia; (3) IOP<20mmHg; (4) proptosis of 5mm or less; and (5) abscess width of 4mm or less. In contrast to prior series, older children with SPOA were managed successfully with medical therapy.

The Efficacy of Contingency Management on Cocaine Craving, using Prize-based Reinforcement of Abstinence in Cocaine Users.

PubMed

Pirnia, Bijan; Tabatabaei, Seyed Kazem Rasoulzadeh; Tavallaii, Abbas; Soleimani, Ali Akbar; Pirnia, Kambiz

2016-11-01

Contingency management (CM) is one of the most common therapies in the domain of drug addiction. This study has been carried out with the purpose of evaluating the efficacy of contingency management intervention. In an experimental design, between December 15, 2014 and November 20, 2015, fifty men (between 18 and 31 with an average age of 24.6) with a history of cocaine use, were selected voluntarily and were randomly assigned into two groups of CM and control group. The CM group were awarded coupons for negative urine tests, over a period of twelve weeks. The urine tests were taken from the participants twice per week, with cutoff concentrations for positive set at 300 ng/ml and self-reporting index of cocaine craving (response rate = 96%) were evaluated in two phase, through pretest and posttest measures. The data were analyzed by parametric covariance test. Additionally, the qualitative data, resulted from demographic measures, were coded and were analyzed with the help of an analysis instrument of qualitative data i.e. ATLAS.ti-5.2. The primary outcome was the number of negative urine tests and the secondary outcome included the cocaine usage craving index over twelve weeks. The mean of (95% of confidence) number of negative cocaine urine tests was 15.4 (13.1-17.8) in the CM group and 19.7 (17.7-21.6) in the control group (P = 0.049). Also, results showed that CM has a significant effect on reducing craving (p<0.01). The findings of this study, while having practical aspects in this domain, can be valuable in planning remedial procedures.

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.

Prognostic factors for survival in patients with Ewing's sarcoma using the surveillance, epidemiology, and end results (SEER) program database.

PubMed

Duchman, Kyle R; Gao, Yubo; Miller, Benjamin J

2015-04-01

The current study aims to determine cause-specific survival in patients with Ewing's sarcoma while reporting clinical risk factors for survival. The Surveillance, Epidemiology, and End Results (SEER) Program database was used to identify patients with osseous Ewing's sarcoma from 1991 to 2010. Patient, tumor, and socioeconomic variables were analyzed to determine prognostic factors for survival. There were 1163 patients with Ewing's sarcoma identified in the SEER Program database. The 10-year cause-specific survival for patients with non-metastatic disease at diagnosis was 66.8% and 28.1% for patients with metastatic disease. Black patients demonstrated reduced survival at 10 years with an increased frequency of metastatic disease at diagnosis as compared to patients of other race, while Hispanic patients more frequently presented with tumor size>10cm. Univariate analysis revealed that metastatic disease at presentation, tumor size>10cm, axial tumor location, patient age≥20 years, black race, and male sex were associated with decreased cause-specific survival at 10 years. Metastatic disease at presentation, axial tumor location, tumor size>10cm, and age≥20 years remained significant in the multivariate analysis. Patients with Ewing's sarcoma have decreased cause-specific survival at 10 years when metastatic at presentation, axial tumor location, tumor size>10cm, and patient age≥20 years. Copyright © 2015 Elsevier Ltd. All rights reserved.

Visualization and Tracking of Parallel CFD Simulations

NASA Technical Reports Server (NTRS)

Vaziri, Arsi; Kremenetsky, Mark

1995-01-01

We describe a system for interactive visualization and tracking of a 3-D unsteady computational fluid dynamics (CFD) simulation on a parallel computer. CM/AVS, a distributed, parallel implementation of a visualization environment (AVS) runs on the CM-5 parallel supercomputer. A CFD solver is run as a CM/AVS module on the CM-5. Data communication between the solver, other parallel visualization modules, and a graphics workstation, which is running AVS, are handled by CM/AVS. Partitioning of the visualization task, between CM-5 and the workstation, can be done interactively in the visual programming environment provided by AVS. Flow solver parameters can also be altered by programmable interactive widgets. This system partially removes the requirement of storing large solution files at frequent time steps, a characteristic of the traditional 'simulate (yields) store (yields) visualize' post-processing approach.

Lightning Mapper Sensor Lens Assembly S.O. 5459: Project Management Plan

NASA Technical Reports Server (NTRS)

Zeidler, Janet

1999-01-01

Kaiser Electro-Optics, Inc. (KEO) has developed this Project Management Plan for the Lightning Mapper Sensor (LMS) program. KEO has integrated a team of experts in a structured program management organization to meet the needs of the LMS program. The project plan discusses KEO's approach to critical program elements including Program Management, Quality Assurance, Configuration Management, and Schedule.

KENNEDY SPACE CENTER, FLA. -- From left, United Space Alliance (USA) Deputy Space Shuttle Program Manager of Operations Loren Shriver, USA Associate Program Manager of Ground Operations Andy Allen, NASA Deputy Associate Administrator for Space Station and Shuttle Programs Michael Kostelnik, and USA Vice President and Space Shuttle Program Manager Howard DeCastro examine a tile used in the Shuttle's Thermal Protection System (TPS) in KSC's TPS Facility. NASA and USA Space Shuttle program management are participating in a leadership workday. The day is intended to provide management with an in-depth, hands-on look at Shuttle processing activities at KSC.

NASA Image and Video Library

2003-12-19

KENNEDY SPACE CENTER, FLA. -- From left, United Space Alliance (USA) Deputy Space Shuttle Program Manager of Operations Loren Shriver, USA Associate Program Manager of Ground Operations Andy Allen, NASA Deputy Associate Administrator for Space Station and Shuttle Programs Michael Kostelnik, and USA Vice President and Space Shuttle Program Manager Howard DeCastro examine a tile used in the Shuttle's Thermal Protection System (TPS) in KSC's TPS Facility. NASA and USA Space Shuttle program management are participating in a leadership workday. The day is intended to provide management with an in-depth, hands-on look at Shuttle processing activities at KSC.

75 FR 41798 - Solicitation of Letters of Interest to Participate in Biotechnology Quality Management System...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

...] Solicitation of Letters of Interest to Participate in Biotechnology Quality Management System Program AGENCY... participate in the APHIS Biotechnology Quality Management System Program. The Biotechnology Quality Management..., audit-based compliance assistance program known as the Biotechnology Quality Management System Program...

14 CFR 91.1019 - Conducting tests and inspections.

Code of Federal Regulations, 2010 CFR

2010-01-01

... program manager under this subpart is complying with title 49 of the United States Code, applicable regulations, and the program manager's management specifications. (b) The program manager must— (1) Make available to the Administrator at the program manager's principal base of operations, or at a place approved...

32 CFR Appendix A to Part 806 - References

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Information Security Program Management AFI 31-501, Personnel Security Program Management AFI 31-601, Industrial Security Program Management AFI 33-129, Transmission of Information Via the Internet AFI 35-205... Management (will convert to AFPD 33-3) AFI 37-124, The Information Collections and Reports Management Program...

32 CFR Appendix A to Part 806 - References

Code of Federal Regulations, 2014 CFR

2014-07-01

..., Information Security Program Management AFI 31-501, Personnel Security Program Management AFI 31-601, Industrial Security Program Management AFI 33-129, Transmission of Information Via the Internet AFI 35-205... Management (will convert to AFPD 33-3) AFI 37-124, The Information Collections and Reports Management Program...

32 CFR Appendix A to Part 806 - References

Code of Federal Regulations, 2012 CFR

2012-07-01

..., Information Security Program Management AFI 31-501, Personnel Security Program Management AFI 31-601, Industrial Security Program Management AFI 33-129, Transmission of Information Via the Internet AFI 35-205... Management (will convert to AFPD 33-3) AFI 37-124, The Information Collections and Reports Management Program...

Clear cell sarcoma: the Roswell Park experience.

PubMed

Finley, J W; Hanypsiak, B; McGrath, B; Kraybill, W; Gibbs, J F

2001-05-01

Clear cell sarcoma of the tendons and aponeuroses (CCSTA) is an aggressive, rare soft-tissue tumor with approximately 300 reported cases. Although it appears to be histogenetically related to melanoma, its clinical behavior resembles soft tissue sarcoma with a propensity for lymph node metastases. We report our experience at a tertiary cancer center. Eight cases of CCSTA evaluated at Roswell Park Cancer Institute between 1970 and 1998 were reviewed retrospectively. Patient data analyzed included patient age, gender, anatomic location, size of tumor, development of local, regional and distant recurrence, and patient status at last follow up. Six of eight patients were alive at 2 years, while three of seven patients were alive at 5 years. Of the patients alive with no evidence of recurrence, two had tumors of less than 2 cm, and the remaining patient had incomplete information regarding tumor size. Five patients recurred within 2 years of definitive surgical management. Four had tumors > 5 cm. All five patients progressed to metastatic disease at a median follow up of 20 months (range 1-108 months) following definitive surgical management and all eventually died of their disease at a median of 3 months (range 0-24 months) from presentation with metastatic disease. Four of five patients with lesions > 5 cm received adjuvant chemotherapy with intent to cure, but all eventually died of disease at 4, 22, 34, and 41 months from initial presentation. CCSTA is an aggressive tumor of the soft tissues. Early recognition and management are associated with an excellent long-term prognosis. Tumors greater than 5 cm warrant aggressive surgical management and treatment, and are at high risk of the development of distant disease. Aggressive multiagent chemotherapy appeared to have no impact on outcome. Other adjuvant therapeutic options including immunotherapy should be investigated. Copyright 2001 Wiley-Liss, Inc.

Management considerations to minimize environmental impacts of arsenic following monosodium methylarsenate (MSMA) applications to turfgrass.

PubMed

Mahoney, Denis J; Gannon, Travis W; Jeffries, Matthew D; Matteson, Audrey R; Polizzotto, Matthew L

2015-03-01

Monosodium methylarsenate (MSMA) is an organic arsenical herbicide currently utilized in turfgrass and cotton systems. In recent years, concerns over adverse impacts of arsenic (As) from MSMA applications have emerged; however, little research has been conducted in controlled field experiments using typical management practices. To address this knowledge gap, a field lysimeter experiment was conducted during 2012-2013 to determine the fate of As following MSMA applications to a bareground and an established turfgrass system. Arsenic concentrations in soil, porewater, and aboveground vegetation, were measured through one yr after treatment. Aboveground vegetation As concentration was increased compared to nontreated through 120 d after initial treatment (DAIT). In both systems, increased soil As concentrations were observed at 0-4 cm at 30 and 120 DAIT and 0-8 cm at 60 and 365 DAIT, suggesting that As was bound in shallow soil depths. Porewater As concentrations in MSMA-treated lysimeters from a 30-cm depth (22.0-83.8 μg L(-1)) were greater than those at 76-cm depth (0.4-5.1 μg L(-1)). These results were combined with previous research to devise management considerations in systems where MSMA is utilized. MSMA should not be applied if rainfall is forecasted within 7 DAIT and/or in areas with shallow water tables. Further, disposing of MSMA-treated turfgrass aboveground vegetation in a confined area - a common management practice for turfgrass clippings - may be of concern due to As release to surface water or groundwater as the vegetation decomposes. Finally, long-term MSMA use may cause soil As accumulation and thus downward migration of As over time; therefore, MSMA should be used in rotation with other herbicides. Copyright © 2014 Elsevier Ltd. All rights reserved.

Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review.

PubMed

Scotland, Kymora B; Rudnick, Benjamin; Healy, Kelly A; Hubosky, Scott G; Bagley, Demetrius H

2018-06-06

Advances in flexible ureteroscope design and accessory instrumentation have allowed for more challenging cases to be treated ureteroscopically. Here, we evaluate our experience with ureteroscopy (URS) for the management of large renal calculi (≥2 cm) and provide a concise review of recent reports. A retrospective review was undertaken of all URS cases between 2004 and 2014 performed by the endourologic team at a single academic tertiary care institution. We identified patients with at least one stone ≥2 cm managed with retrograde URS. Stone size was defined as the largest linear diameter of the index stone. Small diameter flexible ureteroscopes were used primarily with holmium laser. Patient demographics, intraoperative data, and postoperative outcomes were evaluated. We evaluated 167 consecutive patients who underwent URS for large renal stones ≥2 cm. The initial reason for choosing URS included patient preference (29.5%), failure of other therapies (8.2%), anatomic considerations/body habitus (30.3%), and comorbidities (28.8%). Mean patient age was 55.5 years (22-84). The mean stone size was 2.75 cm with mean number of procedures per patient of 1.65 (1-6). The single session stone-free rate was 57.1%, two-stage procedure stone-free rate was 90.2% and three-stage stone-free rate was 94.0%. Access sheaths were used in 47% of patients. An association was identified between stone size and patient outcomes; smaller stones correlated with decreased number of procedures. Postoperative complications were minor. Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate.

Diversity of arbuscular mycorrhiza in the rhizosphere of Cajeput in agroforestry system with different fertilizer management of maize

NASA Astrophysics Data System (ADS)

Parwi; Pudjiasmanto, B.; Purnomo, D.; Cahyani, VR

2017-11-01

This study investigated the diversity of arbuscular mycorrhiza in rhizosphere of cajeput with different fertilizer management of maize. This research was conducted by observation on cajeput agroforestry system in Ponorogo that have different fertilizer management of maize: conventional management (CM), universal management (UM) and alternative management (AM1, AM2, and AM3). The result showed that the highest infection of arbuscular mycorrhiza was observed in the plot of AM3, while the lowest colonization was observed in the plot of CM. Infection of arbuscular mycorrhiza in roots cajeput from five fertilizer management, ranging from 32.64% - 63.33%. In all fertilizer management, there were eight species of arbuscular mycorrhiza which five species were Glomus genus, one species was Acaulospora genus and two species were Gigaspora genus. Glomus constrictum was the dominant species in all fertilizer management. Acaulospora favoeta was found only in the plot of AM3. Spore density varies between 150-594 / 100g of soil. The highest spore density was observed in the plot of AM3, while the lowest spore density was observed in the plot of AM1. The highest diversity index value of arbuscular mycorrhiza (Species richness and Shannon-Wiener) was observed in the plot of AM3.

Initial abstinence status and contingency management treatment outcomes: does race matter?

PubMed

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

2015-06-01

Limited research has evaluated African American substance users' response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed. (c) 2015 APA, all rights reserved).

Income received during treatment does not affect response to contingency management treatments in cocaine-dependent outpatients

PubMed Central

Andrade, Leonardo F.; Petry, Nancy M.

2013-01-01

Background Prior studies find no effect of baseline income on response to contingency management (CM) interventions. However, income among substance disordered patients is variable, particularly at treatment entry. This study investigated the impact of during-treatment income, a more proximal estimate of economic resources at the time that CM is in effect, on response to standard treatment or the standard treatment plus CM. Method These secondary analyses included 418 cocaine dependent participants initiating community intensive outpatient treatment. We examined whether differences were present in pretreatment and during-treatment overall income, as well as specific income sources. We then conducted a series of regression models to investigate the impact of during-treatment income on treatment outcome. Results Participants’ during-treatment income was significantly lower compared to pretreatment income, and this difference was largely attributable to decreases in earned income, illegal income, and support from friends and family. Neither the main effect of income, nor the interaction of income and treatment condition, was significantly associated with treatment outcome. CM, however, was a significant predictor of improved treatment outcome relative to standard treatment. Income sources and some demographic characteristics were also significant predictors of outcomes; public assistance income was associated with improved outcomes and illegal income was associated with poorer outcomes. Conclusions These results suggest that substance abusers benefit from CM regardless of their income level, and these data add to the growing literature supporting the generalizability of CM across a variety of patient characteristics. PMID:23631869

Management of refractory esophageal stenosis in the pediatric age.

PubMed

Alberca de Las Parras, Fernando; Navalón Rubio, María; Egea Valenzuela, Juan

2016-10-01

Refractory esophageal stenosis (RES) is a major health problem in the pediatric population. Several techniques such as stent placement or C-mitomycin (CM) have been described as alternative treatments. We present our experience with both techniques, in our case with biodegradable stents (BS) and sometimes the association with stents and CM. Six patients have been included: 2 post-operative fistulas in patients with type I esophageal atresia; 1 operated atresia without fistula; and 3 caustic strictures. 5 BS were placed in 4 children: 3 of them in cases of atresia (2 prosthesis in one case) and the other one in a case of stricture. CM was used in 5 cases: in 2 of them from the beginning, and in the other 3 cases after failure of the stent. When placed in fistulas, BS were fully covered. One of them successfully treated the fistula, but the other one was not effective. One stenosis was successfully treated with SB (in the case of persistent fistula), but recurrence was observed in the other 2 cases. One of these was solved with CM, and the other one needed a second stent. In the remaining 2 cases (one atresia and one caustic stricture) CM was effective after 1 and 2 sessions respectively. Overall, 5 out of 6 stenosis have been successfully treated (83.3%), and 1 out of 2 fistulas (50%). Association of BS and CM has been effective in the management of RES in children.

High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management.

PubMed

Good, Elin; Länne, Toste; Wilhelm, Elisabeth; Perk, Joep; Jaarsma, Tiny; de Muinck, Ebo

2016-09-01

Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown. Cross-sectional retrospective study. Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA). A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke. The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects. © The European Society of Cardiology 2016.

76 FR 10070 - Division of Coal Mine Workers' Compensation; Proposed Extension of Existing Collection; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-23

... DEPARTMENT OF LABOR Office of Workers' Compensation Programs Division of Coal Mine Workers... Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report... interpretation of x-rays. When a miner applies for benefits, the Division of Coal Mine Workers' Compensation...

Collaborative Concept Mapping Activities in a Classroom Scenario

ERIC Educational Resources Information Center

Elorriaga, J. A.; Arruarte, A.; Calvo, I.; Larrañaga, M.; Rueda, U.; Herrán, E.

2013-01-01

The aim of this study is to test collaborative concept mapping activities using computers in a classroom scenario and to evaluate the possibilities that Elkar-CM offers for collaboratively learning non-technical topics. Elkar-CM is a multi-lingual and multi-media software program designed for drawing concept maps (CMs) collaboratively. Concept…

The Design of Artificial Intelligence Robot Based on Fuzzy Logic Controller Algorithm

NASA Astrophysics Data System (ADS)

Zuhrie, M. S.; Munoto; Hariadi, E.; Muslim, S.

2018-04-01

Artificial Intelligence Robot is a wheeled robot driven by a DC motor that moves along the wall using an ultrasonic sensor as a detector of obstacles. This study uses ultrasonic sensors HC-SR04 to measure the distance between the robot with the wall based ultrasonic wave. This robot uses Fuzzy Logic Controller to adjust the speed of DC motor. When the ultrasonic sensor detects a certain distance, sensor data is processed on ATmega8 then the data goes to ATmega16. From ATmega16, sensor data is calculated based on Fuzzy rules to drive DC motor speed. The program used to adjust the speed of a DC motor is CVAVR program (Code Vision AVR). The readable distance of ultrasonic sensor is 3 cm to 250 cm with response time 0.5 s. Testing of robots on walls with a setpoint value of 9 cm to 10 cm produce an average error value of -12% on the wall of L, -8% on T walls, -8% on U wall, and -1% in square wall.

45 CFR 1304.51 - Management systems and procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... control program quality, maintain program accountability, and advise governing bodies, policy groups, and... DELEGATE AGENCIES Program Design and Management § 1304.51 Management systems and procedures. (a) Program... program planning that includes consultation with the program's governing body, policy groups, and program...

Free-Space Optical Communications Program at JPL

NASA Technical Reports Server (NTRS)

Hemmati, H.

1999-01-01

Conceptual design of a multi-functional optical instrument is underway for the X2000-Second Delivery Program. The transceiver will perform both free-space optical-communication and science imaging by sharing a common 10-cm aperture telescope.

22 CFR 518.20 - Purpose of financial and program management.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Purpose of financial and program management. 518... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 518.20 Purpose of financial and program management. Sections 518.21 through 518.28 prescribe standards for financial management systems, methods for...

34 CFR 74.20 - Purpose of financial and program management.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Purpose of financial and program management. 74.20... Requirements Financial and Program Management § 74.20 Purpose of financial and program management. Sections 74.21 through 74.28 prescribe standards for financial management systems, methods for making payments...

22 CFR 145.20 - Purpose of financial and program management.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Purpose of financial and program management... Financial and Program Management § 145.20 Purpose of financial and program management. Sections 145.21 through 145.28 prescribe standards for financial management systems, methods for making payments and rules...

76 FR 16000 - Voluntary Protection Programs Information; Extension of the Office of Management and Budget's...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-22

... management programs including how the programs successfully address management leadership and employee...] Voluntary Protection Programs Information; Extension of the Office of Management and Budget's (OMB's... concerning its proposal to extend the Office of Management and Budget's (OMB's) approval of the information...

76 FR 39857 - Alaska Coastal Management Program Withdrawal From the National Coastal Management Program Under...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-07

.... SUMMARY: By operation of Alaska State law, the federally approved Alaska Coastal Management Program... partner in the National Coastal Management Program. The ACMP expired by operation of Alaska Statutes 44.66... DEPARTMENT OF COMMERCE National Oceanic Atmospheric Administration Alaska Coastal Management...

2 CFR 215.20 - Purpose of financial and program management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Purpose of financial and program management... Financial and Program Management § 215.20 Purpose of financial and program management. Sections 215.21 through 215.28 prescribe standards for financial management systems, methods for making payments and rules...

Developing an Information and Records Management Program.

ERIC Educational Resources Information Center

Rutledge, Juli G.; Kartis, Alexia M.

1984-01-01

The need for information controls for college records management programs and the elements of program organization, planning, and management are discussed. Conditions at institutions that indicate a flaw in information control are identified, along with the benefits of a sound records management program. The management of an information and…

5 CFR 10.3 - OPM authority to review personnel management programs and practices.

Code of Federal Regulations, 2011 CFR

2011-01-01

... management programs and practices. 10.3 Section 10.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES AGENCY ACCOUNTABILITY SYSTEMS; OPM AUTHORITY TO REVIEW PERSONNEL MANAGEMENT PROGRAMS (RULE X) § 10.3 OPM authority to review personnel management programs and practices. The Office of...

30 CFR 256.20 - Consideration of coastal zone management program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 2 2011-07-01 2011-07-01 false Consideration of coastal zone management... SHELF Oil and Gas Leasing Program § 256.20 Consideration of coastal zone management program. In the development of the leasing program, consideration shall be given to the coastal zone management program being...

Management of information in a research and development agency

NASA Technical Reports Server (NTRS)

Keene, Wallace O.

1990-01-01

The NASA program for managing scientific and technical information (STI) is examined, noting the technological, managerial, educational, and legal aspects of transferring and disseminating information. A definition of STI is introduced and NASA's STI-related management programs are outlined. Consideration is given to the role of STI management in NASA mission programs, research efforts supporting the management and use of STI, STI program interfaces, and the Automated Information Management Program to eliminate redundant automation efforts in common administrative functions. The infrastructure needed to manage the broad base of NASA information and the interfaces between NASA's STI management and external organizations are described.

[Book Review] Building Models for Conservation and Wildlife Management, by A. M. Starfield and A. L. Bleloch

USGS Publications Warehouse

Johnson, D.H.

1988-01-01

Review of: Building Models for Conservation and Wildlife Management. By Anthony Starfield and A. L. Bleloch. New York: Macmillan; London: Collier Macmillan, 1986. ISBN: 002948040X. xi, 253 p.: ill.; 25 cm.

IT Workforce: Key Practices Help Ensure Strong Integrated Program Teams; Selected Departments Need to Assess Skill Gaps

DTIC Science & Technology

2016-11-01

personnel, career paths for program managers, plans to strengthen program management, and use of special hiring authorities) Monitor and report...agencies with direct hiring authority for program managers and directed OPM to create a specialized career path. OMB also tasked agencies with...guidance for developing career paths for IT program managers.14 OPM’s career path guide was to build upon its IT Program Management Competency Model

Gamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter.

PubMed

Huang, Cheng-Wei; Tu, Hsien-Tang; Chuang, Chun-Yi; Chang, Cheng-Siu; Chou, Hsi-Hsien; Lee, Ming-Tsung; Huang, Chuan-Fu

2018-05-01

OBJECTIVE Stereotactic radiosurgery (SRS) is an important alternative management option for patients with small- and medium-sized vestibular schwannomas (VSs). Its use in the treatment of large tumors, however, is still being debated. The authors reviewed their recent experience to assess the potential role of SRS in larger-sized VSs. METHODS Between 2000 and 2014, 35 patients with large VSs, defined as having both a single dimension > 3 cm and a volume > 10 cm 3 , underwent Gamma Knife radiosurgery (GKRS). Nine patients (25.7%) had previously undergone resection. The median total volume covered in this group of patients was 14.8 cm 3 (range 10.3-24.5 cm 3 ). The median tumor margin dose was 11 Gy (range 10-12 Gy). RESULTS The median follow-up duration was 48 months (range 6-156 months). All 35 patients had regular MRI follow-up examinations. Twenty tumors (57.1%) had a volume reduction of greater than 50%, 5 (14.3%) had a volume reduction of 15%-50%, 5 (14.3%) were stable in size (volume change < 15%), and 5 (14.3%) had larger volumes (all of these lesions were eventually resected). Four patients (11.4%) underwent resection within 9 months to 6 years because of progressive symptoms. One patient (2.9%) had open surgery for new-onset intractable trigeminal neuralgia at 48 months after GKRS. Two patients (5.7%) who developed a symptomatic cyst underwent placement of a cystoperitoneal shunt. Eight (66%) of 12 patients with pre-GKRS trigeminal sensory dysfunction had hypoesthesia relief. One hemifacial spasm completely resolved 3 years after treatment. Seven patients with facial weakness experienced no deterioration after GKRS. Two of 3 patients with serviceable hearing before GKRS deteriorated while 1 patient retained the same level of hearing. Two patients improved from severe hearing loss to pure tone audiometry less than 50 dB. The authors found borderline statistical significance for post-GKRS tumor enlargement for later resection (p = 0.05, HR 9.97, CI 0.99-100.00). A tumor volume ≥ 15 cm 3 was a significant factor predictive of GKRS failure (p = 0.005). No difference in outcome was observed based on indication for GKRS (p = 0.0761). CONCLUSIONS Although microsurgical resection remains the primary management choice in patients with VSs, most VSs that are defined as having both a single dimension > 3 cm and a volume > 10 cm 3 and tolerable mass effect can be managed satisfactorily with GKRS. Tumor volume ≥ 15 cm 3 is a significant factor predicting poor tumor control following GKRS.

Emergency management training program: Guide to good practice

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

Not Available

1991-07-01

The Emergency Management Training Program Guide to Good Practice is a project of the Training Resources and Data Exchange (TRADE) Emergency Management Issues Special Interest Group (EMI SIG). EMI SIG members expressed interest in a resource to assist in development of a comprehensive emergency management training program. This publication provides guidelines, methods, and materials for EMI SIG members to use, assisting in complete and effective emergency management programs. The purposes of the Emergency Management Training Program Guide to Good Practice are: Provide guidance in the development and management of Emergency Management (EM) training programs; Assist EM trainers to incorporate componentsmore » of the DOE Emergency Management System philosophy of planning, preparedness, readiness assurance, and response into EM training programs; Help EM training managers meet EM training requirements and conditions established by current regulations and policies; Supplement other TRADE EMI SIG documents and complement individual facility training documents. This program is designed for emergency management personnel who are responsible for providing or overseeing EM training but who do not necessarily possess expertise in developing training. It provides good practices from the manager's point of view on how to produce, administer, and document facility EM training programs in the spirit of the DOE EM system philosophy. Basic guidance is also included for personnel who design, develop, deliver, and/or evaluate EM training programs or parts. This guidance includes key points of EM training programs and identifies other documents that contain useful and/or more detailed training information.« less

Green campus management based on conservation program in Universitas Negeri Semarang

NASA Astrophysics Data System (ADS)

Prihanto, Teguh

2018-03-01

Universitas Negeri Semarang (UNNES) has a great commitment in the development of higher education programs in line with its vision as a conservation - minded and internationally reputable university. Implementation of conservation programs with respect to the rules or conservation aspects of sustainable use, preservation, provisioning, protection, restoration and conservation of nature. In order to support the implementation of UNNES conservation program more focused, development strategies and development programs for each conservation scope are covered: (1) Biodiversity management; (2) Internal transportation management; (3) energy management; (4) Green building management; (5) Waste and water management; (6) Cultural conservation management. All related to conservation development strategies and programs are managed in the form of green campus management aimed at realizing UNNES as a green campus, characterized and reputable at the regional and global level.

KENNEDY SPACE CENTER, FLA. -- From left, a United Space Alliance (USA) technician briefs NASA Deputy Program Manager of the Space Shuttle Program Michael Wetmore, USA Vice President and Space Shuttle Program Manager Howard DeCastro, and NASA Deputy Associate Administrator for Space Station and Shuttle Programs Michael Kostelnik on the use of cold plates in Orbiter Processing Facility Bay 2. NASA and USA Space Shuttle program management are participating in a leadership workday. The day is intended to provide management with an in-depth, hands-on look at Shuttle processing activities at KSC.

NASA Image and Video Library

2003-12-19

KENNEDY SPACE CENTER, FLA. -- From left, a United Space Alliance (USA) technician briefs NASA Deputy Program Manager of the Space Shuttle Program Michael Wetmore, USA Vice President and Space Shuttle Program Manager Howard DeCastro, and NASA Deputy Associate Administrator for Space Station and Shuttle Programs Michael Kostelnik on the use of cold plates in Orbiter Processing Facility Bay 2. NASA and USA Space Shuttle program management are participating in a leadership workday. The day is intended to provide management with an in-depth, hands-on look at Shuttle processing activities at KSC.

14 CFR 1214.1706 - Program management.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Program management. 1214.1706 Section 1214... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson. ...

14 CFR 1214.1706 - Program management.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Program management. 1214.1706 Section 1214... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson. ...

14 CFR 1214.1706 - Program management.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Program management. 1214.1706 Section 1214... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson. ...

6 CFR 29.5 - Requirements for protection.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROTECTED CRITICAL... PCII Program Manager or the PCII Program Manager's designee; (2) The information is submitted for... information initially provided received by the PCII Program Manager or the PCII Program Manager's designee...

6 CFR 29.5 - Requirements for protection.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROTECTED CRITICAL... PCII Program Manager or the PCII Program Manager's designee; (2) The information is submitted for... information initially provided received by the PCII Program Manager or the PCII Program Manager's designee...

14 CFR 1214.1706 - Program management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Program management. 1214.1706 Section 1214... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson. ...

Impact of managed MediCal on California family practice programs.

PubMed

Zweifler, J A

2001-05-01

An important source of patients for California's family practice program is MediCal. During the past 5 years, MediCal has established a variety of capitated managed care plans. To assess the impact of California's managed MediCal program on the state's 38 family practice training programs. A cross-sectional, retrospective descriptive survey. A 3-page, 11-question survey was developed by family practice residency directors and staff from the California Academy of Family Physicians, San Francisco. The 38 family practice programs in existence in California in September 1997 were stratified by type of managed MediCal in their county and by type of sponsoring institution--university, county, community based, staff-model health maintenance organization, or managed care system. Of the 38 family practice programs, 27 responded; 19 of 27 programs participated in managed MediCal. The total number of family health center patients, and the percentage of MediCal patients (48%-60%) at family practice programs was similar when stratified by programs with and without managed MediCal and by type of sponsorship. Most programs reported that they were able to compete effectively, although most also reported increased administrative, nursing, and front office costs. Managed MediCal patients were directly assigned to residents in only 3 of 19 programs. The introduction of managed MediCal has not adversely affected the number of patients cared for in California's family practice programs. Continued vigilance regarding California family practice programs' involvement in managed MediCal, including collection of accurate data on the number of MediCal patients and the financial and educational implications for California's family practice programs, is warranted.

QTLs associated with agronomic traits in the Attila × CDC Go spring wheat population evaluated under conventional management

PubMed Central

Zou, Jun; Iqbal, Muhammad; Chen, Hua; Asif, Mohammad; N’Diaye, Amidou; Navabi, Alireza; Perez-Lara, Enid; Pozniak, Curtis; Yang, Rong-Cai; Randhawa, Harpinder; Spaner, Dean

2017-01-01

Recently, we investigated the effect of the wheat 90K single nucleotide polymorphic (SNP) array and three gene-specific (Ppd-D1, Vrn-A1 and Rht-B1) markers on quantitative trait loci (QTL) detection in a recombinant inbred lines (RILs) population derived from a cross between two spring wheat (Triticum aestivum L.) cultivars, ‘Attila’ and ‘CDC Go’, and evaluated for eight agronomic traits at three environments under organic management. The objectives of the present study were to investigate the effect of conventional management on QTL detection in the same mapping population using the same set of markers as the organic management and compare the results with organic management. Here, we evaluated 167 RILs for number of tillers (tillering), flowering time, maturity, plant height, test weight (grain volume weight), 1000 kernel weight, grain yield, and grain protein content at seven conventionally managed environments from 2008 to 2014. Using inclusive composite interval mapping (ICIM) on phenotypic data averaged across seven environments and a subset of 1203 informative markers (1200 SNPs and 3 gene specific markers), we identified a total of 14 QTLs associated with flowering time (1), maturity (2), plant height (1), grain yield (1), test weight (2), kernel weight (4), tillering (1) and grain protein content (2). Each QTL individually explained from 6.1 to 18.4% of the phenotypic variance. Overall, the QTLs associated with each trait explained from 9.7 to 35.4% of the phenotypic and from 22.1 to 90.8% of the genetic variance. Three chromosomal regions on chromosomes 2D (61–66 cM), 4B (80–82 cM) and 5A (296–297 cM) harbored clusters of QTLs associated with two to three traits. The coincidental region on chromosome 5A harbored QTL clusters for both flowering and maturity time, and mapped about 2 cM proximal to the Vrn-A1 gene, which was in high linkage disequilibrium (0.70 ≤ r2 ≤ 0.75) with SNP markers that mapped within the QTL confidence interval. Six of the 14 QTLs (one for flowering time and plant height each, and two for maturity and kernel weight each) were common between the conventional and organic management systems, which suggests issues in directly utilizing gene discovery results based on conventional management to make in detail selection (decision) for organic management. PMID:28158253

Earth Observing System (EOS)/Advanced Microwave Sounding Unit A (AMSU-A) configuration management plan

NASA Technical Reports Server (NTRS)

Cavanaugh, J.

1994-01-01

This plan describes methods and procedures Aerojet will follow in the implementation of configuration control for each established baseline. The plan is written in response to the GSFC EOS CM Plan 420-02-02, dated January 1990, and also meets he requirements specified in DOD-STD-480, DOD-D 1000B, MIL-STD-483A, and MIL-STD-490B. The plan establishes the configuration management process to be used for the deliverable hardware, software, and firmware of the EOS/AMSU-A during development, design, fabrication, test, and delivery. This revision includes minor updates to reflect Aerojet's CM policies.

Care manager to control cardiovascular risk factors in primary care: the Raffaello cluster randomized trial.

PubMed

Deales, A; Fratini, M; Romano, S; Rappelli, A; Penco, M; Perna, G Piero; Beccaceci, G; Borgia, R; Palumbo, W; Magi, M; Vespasiani, G; Bronzini, M; Musilli, A; Nocciolini, M; Mezzetti, A; Manzoli, L

2014-05-01

This cluster randomized trial evaluated the efficacy of a disease and care management (D&CM) model in cardiovascular (CVD) prevention in primary care. Eligible subjects had ≥ 1 among: blood pressure ≥ 140/90 mmHg; glycated hemoglobin ≥ 7%; LDL-cholesterol ≥ 160 or ≥ 100 mg/dL (primary or secondary prevention, respectively); BMI ≥ 30; current smoking. The D&CM intervention included a teamwork including nurses as care managers for the implementation of tailored care plans. Control group was allocated to usual-care. The main outcome was the proportion of subjects achieving recommended clinical targets for ≥ 1 of uncontrolled CVD risk factors at 12-month. During 2008-2009 we enrolled 920 subjects in the Abruzzo/Marche regions, Italy. Following the exclusion of L'Aquila due to 2009 earthquake, final analyses included 762 subjects. The primary outcome was achieved by 39.1% (95%CI: 34.2-44.2) and 25.2% (95%CI: 20.9-29.9) of subjects in the intervention and usual-care group, respectively (p < 0.001). The D&CM intervention significantly increased the proportion of subjects who achieved clinical targets for both diabetes and hypertension, with no differences in hypercholesterolemia, smoking status and obesity. The D&CM intervention was effective in controlling cardiovascular risk factors, in particular hypertension and diabetes. Numbers needed to treat were small. Such intervention may deserve further consideration in clinical practice. ACTRN12611000813987. Copyright © 2013 Elsevier B.V. All rights reserved.

Conservative management of cesarean scar pregnancies: a prospective randomized controlled trial at a single center.

PubMed

Wang, Mingyi; Yang, Zhiling; Li, Yunming; Chen, Biliang; Wang, Jian; Ma, Xiangdong; Wang, Yu

2015-01-01

To assess clinical outcomes related to conservative management of women with cesarean scar pregnancies (CSPs), specifically through uterine artery embolization (UAE) with local and systemic methotrexate (MTX) treatment (UAE-MTX), or ultrasound-guided local and systemic MTX treatment (USG-MTX). Forty-five patients with CSP were randomly allocated to receive UAE-MTX (n = 24) or USG-MTX (n = 21). Participants' clinical outcomes were compared, and clinical characteristics of failed cases were evaluated relative to successful cases. The 2 groups were similar in clinical characteristics, success rate (83.3% cf. 80.9%), time to normalization of serum beta (β) human chorionic gonadotropin (β-hCG), and percentage of patients receiving multiple doses of systemic MTX. However, within the failed cases, the percentages of patients with gestational sac > 5 cm (87.5%), or type II CSP (75.0%) was significantly higher than in the successful cases (13.5% and 18.9%, respectively; P < 0.001, both), without regard to treatment group. According to the logistic regression model, a gestational sac diameter > 5 cm or type II CSP were independent risk factors for failed CSP management (gestational sac > 5 cm: OR 51.87, 95% CI 3.48-775.91, P < 0.01; type II CSP: OR 15.54, 95% CI 1.25-193.36, P < 0.05). The conservative treatments UAE-MTX and USG-MTX were similarly effective in treating CSP patients. Either treatment was likely to fail for CSP patients with gestational sac > 5 cm or type II CSP.

Effects of Contingency Management and Bupropion on Cigarette Smoking in Smokers with Schizophrenia

PubMed Central

Tidey, Jennifer W.; Rohsenow, Damaris J.; Kaplan, Gary B.; Swift, Robert M; Reid, Netesha

2013-01-01

Rationale Individuals with schizophrenia have high smoking-related morbidity and mortality rates and need powerful and innovative smoking cessation interventions. Objectives This proof-of-concept study investigated the feasibility and initial efficacy of combining a contingency management intervention with bupropion to reduce smoking in people with schizophrenia. Methods Using a double-blind, placebo-controlled, between-groups design, 57 non-treatment seeking participants were randomized to receive 300 mg/day bupropion or placebo. One week later, participants were randomized to a contingency management (CM) intervention in which reductions in urinary cotinine levels were reinforced, or a non-contingent reinforcement (NR) condition in which session attendance was reinforced, regardless of cotinine level. Over the 22-day study period, participants visited the laboratory approximately three times per week to provide urine samples for analysis of cotinine levels, to give breath samples for analysis of carbon monoxide (CO) levels, and to report number of cigarettes smoked per day, nicotine withdrawal symptoms, cigarette craving and psychiatric symptoms. Results Cotinine and CO levels significantly decreased during the study period in participants randomized to the CM condition, but not the NR condition. Bupropion did not reduce cotinine levels or increase the efficacy of CM. Cigarette craving and psychiatric symptom levels significantly decreased during the study in all groups. Conclusions The results of this study indicate the efficacy and feasibility of this CM intervention for reducing smoking in individuals with schizophrenia. PMID:21475970

Using causal maps to support ex-post assessment of social impacts of dams

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

Aledo, Antonio, E-mail: Antonio.Aledo@ua.es; García-Andreu, Hugo, E-mail: Hugo.Andreu@ua.es; Pinese, José, E-mail: pinese@uel.br

- Highlights: • We defend the usefulness of causal maps (CM) for ex-post impact assessment of dams. • Political decisions are presented as unavoidable technical measures. • CM enable the identification of multiple causes involved in the dam impacts. • An alternative management of the dams is shown from the precise tracking of the causes. • Participatory CM better the quality of information and the governance of the research. This paper presents the results of an ex-post assessment of two important dams in Brazil. The study follows the principles of Social Impact Management, which offer a suitable framework for analyzingmore » the complex social transformations triggered by hydroelectric dams. In the implementation of this approach, participative causal maps were used to identify the ex-post social impacts of the Porto Primavera and Rosana dams on the community of Porto Rico, located along the High Paraná River. We found that in the operation of dams there are intermediate causes of a political nature, stemming from decisions based on values and interests not determined by neutral, exclusively technical reasons; and this insight opens up an area of action for managing the negative impacts of dams.« less

Woody debris in north Iberian streams: influence of geomorphology, vegetation, and management.

PubMed

Diez, J R; Elosegi, A; Pozo, J

2001-11-01

The effect of stream geomorphology, maturity, and management of riparian forests on abundance, role, and mobility of wood was evaluated in 20 contrasting reaches in the Agüera stream catchment (northern Iberian Peninsula). During 1 year the volume of woody debris exceeding 1 cm in diameter was measured in all reaches. All large woody debris (phi > 5 cm) pieces were tagged, their positions mapped, and their subsequent changes noted. Volume of woody debris was in general low and ranged from 40 to 22,000 cm3 m-2; the abundance of debris dams ranged from 0 to 5.5 per 100 m of channel. Wood was especially rare and unstable in downstream reaches, or under harvested forests (both natural or plantations). Results stress that woody debris in north Iberian streams has been severely reduced by forestry and log removal. Because of the important influence of woody debris on structure and function of stream systems, this reduction has likely impacted stream communities. Therefore, efforts to restore north Iberian streams should include in-channel and riparian management practices that promote greater abundance and stability of large woody debris whenever possible.

A meta-analysis of the effect of hospital-based case management on hospital length-of-stay and readmission.

PubMed

Kim, Young-Ju; Soeken, Karen L

2005-01-01

Although many hospital-based case management (CM) interventions have been studied, there is little work summarizing the effectiveness of these studies. The purpose of this study was to investigate the effect of hospital-based CM compared with usual care on length of hospital stay and readmission rate. A meta-analytic method was employed to analyze the effect sizes of CM intervention on outcomes. Eligible studies were retrieved using computerized database searches, footnote chasing, and contact with content experts. The authors reviewed the final 12 studies, and the effect size, 95% confidence interval (CI), sensitivity, homogeneity, and publication bias were analyzed. The overall average weighted effect size on length of stay (LOS) was 0.094 with a 95% CI of -0.032 to 0.220. The overall odds ratio for readmission was 0.87 with a 95% CI of 0.69 to 1.04. Overall, hospital-based CM interventions were not significantly effective in reducing LOS and readmissions. However, CM for patients with heart failure (effect size of 0.241 with a 95% CI of 0.012 to 0.470) was significantly effective in reducing LOS, although it was not effective for stroke patients (effect size of -0.226 with a 95% CI of -0.542 to 0.089) and frail elders (effect size of 0.126 with a 95% CI of -0.073 to 0.324). Analysis indicated that in this meta-analysis publication bias was unlikely. The findings of this meta-analysis demonstrate a 6% decrease in readmission rate for patients who received hospital-based CM interventions. Further meta-analytic studies are needed to investigate the effectiveness of CM on other outcomes.

A Developmental Perspective on Neuroeconomic Mechanisms of Contingency Management

PubMed Central

Stanger, Catherine; Budney, Alan J.; Bickel, Warren K.

2012-01-01

This paper provides a developmental overview of relevant theory and research on delay discounting and neuroeconomics, and their implications for CM approaches to treatment. Recent advances in neuroscience, and in particular the neuroscience of decision making, have the potential to inform treatment development for adolescent substance use in general, and contingency management (CM) treatments in particular. CM utilizes abstinence-based reinforcement to enhance motivation to engage in treatment and engender abstinence. CM interventions may be informed by research on delay discounting, a type of decision making that reflects how individuals value immediate vs. delayed rewards. Delay discounting reliably distinguishes substance abusers from non abusers and is a significant predictor of individual differences in response to substance use treatments. Delay discounting is also of high potential importance in the development of substance use problems in adolescence. Discounting may also be important in predicting response to CM, as CM attempts to directly influence this decision making process, shifting the preference from the immediate rewards of use to delayed rewards for choosing not to use. Multiple neural processes underlie decision making, and those processes have implications for adolescent substance abuse. There are significant neurodevelopmental processes that differentiate adolescents from adults. These processes are implicated in delay discounting, suggesting that adolescence may reflect a period of plasticity in temporal decision making. Understanding the neural mechanisms of delay discounting has led to promising working memory interventions directly targeting the executive functions that underlie individual choices. These interventions may be particularly helpful in combination with CM interventions that offer immediate rewards for brief periods of abstinence, and may show particular benefit in adolescence due to the heightened neural plasticity of systems that underlie temporal discounting in adolescence. PMID:22663343

Performance-Based Contingency Management in Cognitive Remediation Training: A Pilot Study.

PubMed

Kiluk, Brian D; Buck, Matthew B; Devore, Kathleen A; Babuscio, Theresa A; Nich, Charla; Carroll, Kathleen M

2017-01-01

Impairments in attention, working memory, and executive function are common among substance users and may adversely affect SUD treatment outcomes. The ability of cognitive remediation (CR) interventions to improve these deficits is hindered in part because levels of engagement in CR training may be inadequate to achieve benefit. This pilot study aimed to increase CR engagement and improve outcome by implementing contingency management (CM) procedures that reinforce performance improvements on CR tasks. Participants were forty individuals (50% male; 65% African American) in an outpatient substance use treatment facility with mild cognitive impairment who had ≥30-days of abstinence from alcohol and drugs. They were randomized to standard (CR-S; n=21) or CM-enhanced (CR-CM; n=19) cognitive remediation training. CR consisted of 1-hour sessions, three times per week for four weeks (12 sessions). A neuropsychological assessment battery was administered prior to and after the four-week intervention. Both groups had high rates of CR session attendance (mean CR-S=11.7, CR-CM=10.9 sessions). Performance on 8 of the 9 CR tasks significantly improved over time for both conditions, with the CR-CM condition demonstrating greater improvement on a CR Sequenced Recall task [F(1,37)=5.81, p<.05]. Significant improvement was also evident on 4 of 9 neuropsychological assessment measures, with the CR-CM condition showing differential improvement on the Trail Making Test - Part B [F (1,37)=5.34, p<.05]. These findings support the feasibility of using CM procedures to enhance substance users' engagement with CR training and suggest the potential value of more research in this area. Copyright © 2016 Elsevier Inc. All rights reserved.

A randomized trial of assertive continuing care and contingency management for adolescents with substance use disorders.

PubMed

Godley, Mark D; Godley, Susan H; Dennis, Michael L; Funk, Rodney R; Passetti, Lora L; Petry, Nancy M

2014-02-01

Most adolescents relapse within 90 days of discharge from residential substance use treatment. We hypothesized that contingency management (CM), assertive continuing care (ACC), and their combination (CM + ACC) would each be more effective than usual continuing care (UCC). Following residential treatment, 337 adolescents were randomized to 4 continuing care conditions: UCC alone, CM, ACC, or CM + ACC. UCC was available across all conditions. Outcome measures over 12 months included percentage of days abstinent from alcohol, heavy alcohol, marijuana, and any alcohol or other drugs (AOD) using self-reports and toxicology testing and remission status at 12 months. CM had significantly higher rates of abstinence than UCC for heavy alcohol use, t(297) = 2.50, p < .01, d = 0.34; any alcohol use, t(297) = 2.58, p < .01, d = 0.36; or any AOD use, t(297) = 2.12, p = .01, d = 0.41; and had a higher rate in remission, odds ratio (OR) = 2.45, 90% confidence interval (CI) [1.18, 5.08], p = .02. ACC had significantly higher rates of abstinence than UCC from heavy alcohol use, t(297) = 2.66, p < .01, d = 0.31; any alcohol use, t(297) = 2.63, p < .01, d = 0.30; any marijuana use, t(297) = 1.95, p = .02, d = 0.28; or any AOD use, t(297) = 1.88, p = .02, d = 0.30; and had higher rates in remission, OR = 2.31, 90% CI [1.10, 4.85], p = .03. The ACC + CM condition was not significantly different from UCC on any outcomes. CM and ACC are promising continuing care approaches after residential treatment. Future research should seek to further improve their effectiveness. PsycINFO Database Record (c) 2014 APA, all rights reserved.

IPM: Integrated Pest Management Kit for Building Managers. How To Implement an Integrated Pest Management Program in Your Building(s).

ERIC Educational Resources Information Center

Mitchell, Brad

This management kit introduces building managers to the concept of Integrated Pest Management (IPM), and provides the knowledge and tools needed to implement an IPM program in their buildings. It discusses the barriers to implementing an IPM program, why such a program should be used, and the general guidelines for its implementation. Managerial…

Disease Management, Case Management, Care Management, and Care Coordination: A Framework and a Brief Manual for Care Programs and Staff.

PubMed

Ahmed, Osman I

2016-01-01

With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.

Fire Management/Suppression Systems/Concepts Relating to Aircraft Cabin Fire Safety.

DTIC Science & Technology

1982-07-01

polyamide- cm; cell size, cm; paper honeycomb; paper honeycomb; density, kg/cm 3 ; filler 2.413;0.31; 48.06; 2.413;0.31; 48.06; no core filler no core...0 4’ 14 ~ 1 4 44 N4 El4 (36M -11 - 0 0 N4 8A 0o N. 0 04 0n 0m C,0 0 44 . . 000040 -t 0 0 880 -8 ,0 04 0 C, 0 C4 4-0 OD -CD0C, m. g G - C4 A - 40 a

Optimization of Soft Tissue Management, Spacer Design, and Grafting Strategies for Large Segmental Bone Defects using the Chronic Caprine Tibial Defect Model

DTIC Science & Technology

2016-12-01

gastrocnemius muscles. 4. Place an interlocking intramedullary nail using a custom spacer to maintain 5-cm defect length. 5. Place a pre-molded 5 cm long x...2 cm diameter PMMA spacer around the nail in the defect. 6. Irrigate the wound with normal (0.9 %) saline and close the wound. The Treatment...PMMA spacer using a “bomb bay door opening”. 4. Remove the spacer without damaging the membrane or nail . 5. Collect appropriate IM samples as

Effects of organic and conventional management of sugar cane crop on soil physicochemical characteristics and phosphomonoesterase activity.

PubMed

Purcena, Luiza L A; Di Medeiros, Maria Carolina B; Leandro, Wilson M; Fernandes, Kátia F

2014-02-19

Soil enzymes play an important role in agriculture and particularly in nutrient cycling. They are also involved in the degradation, transformation, and mineralization of organic matter and availability of nutrients in soil. It is believed that organic agriculture causes fewer losses to soil quality and is less aggressive to the environment than conventional management. In this study, the effects of conventional (CM) and organic management (OM) on phosphomonoesterases, an important enzyme for soil fertility, were evaluated and compared to those results from native Cerrado (Brazilian Savanna) soil (NS), because they are the most common phosphatases in soils. The results showed that there were both acid (AcP) and alkaline (AkP) phosphatases in all soils tested and that AcP activity was higher than that of AkP. In contrast to AkP, AcP had its activity affected by land use. In the cultivated areas there was a reduction of almost 50% of AcP activity respect to native unexploited soils and there was no significant difference between organic and CM, demonstrating that independent of the management chosen, there was an impact of land use on AcP activity. Principal component analysis indicated that characteristics related to pH such as alkali saturation (V%), aluminum saturation (M%), Al(3+), soil total acidity (H+Al), and Ca(2+) are the main factors that permit distinguishing NS from OM and CM.

OECD 2-D Core Concrete Interaction (CCI) tests : CCI-2 test plan, Rev. 0 January 31, 2004.

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

Farmer, M. T.; Kilsdonk, D. J.; Lomperski, S.

The Melt Attack and Coolability Experiments (MACE) program addressed the issue of the ability of water to cool and thermally stabilize a molten core-concrete interaction when the reactants are flooded from above. These tests provided data regarding the nature of corium interactions with concrete, the heat transfer rates from the melt to the overlying water pool, and the role of noncondensable gases in the mixing processes that contribute to melt quenching. As a follow-on program to MACE, The Melt Coolability and Concrete Interaction Experiments (MCCI) project is conducting reactor material experiments and associated analysis to achieve the following objectives: (1)more » resolve the ex-vessel debris coolability issue through a program that focuses on providing both confirmatory evidence and test data for the coolability mechanisms identified in MACE integral effects tests, and (2) address remaining uncertainties related to long-term two-dimensional molten core-concrete interactions under both wet and dry cavity conditions. Achievement of these two program objectives will demonstrate the efficacy of severe accident management guidelines for existing plants, and provide the technical basis for better containment designs for future plants. In terms of satisfying these objectives, the Management Board (MB) approved the conduct of two long-term 2-D Core-Concrete Interaction (CCI) experiments designed to provide information in several areas, including: (i) lateral vs. axial power split during dry core-concrete interaction, (ii) integral debris coolability data following late phase flooding, and (iii) data regarding the nature and extent of the cooling transient following breach of the crust formed at the melt-water interface. The first of these two tests, CCI-1, was conducted on December 19, 2003. This test investigated the interaction of a fully oxidized 400 kg PWR core melt, initially containing 8 wt % calcined siliceous concrete, with a specially designed two-dimensional siliceous concrete test section with an initial cross-sectional area of 50 cm x 50 cm. The second of these two planned tests, CCI-2, will be conducted with a nearly identical test facility and experiment boundary conditions, but with a Limestone/Common Sand (LCS) concrete test section to investigate the effect of concrete type on the two-dimensional core-concrete interaction and debris cooling behavior. The objective of this report is to provide the overall test plan for CCI-2 to enable pretest calculations to be carried out. The report begins by providing a summary description of the CCI-2 test apparatus, followed by a description of the planned test operating procedure. Overall specifications for CCI-2 are provided in Table 1-1.« less

Hamstring injury prevention in soccer: Before or after training?

PubMed

Lovell, R; Knox, M; Weston, M; Siegler, J C; Brennan, S; Marshall, P W M

2018-02-01

We examined the effects of a 12-week program of Nordic hamstring exercises (NHE), administered before or after football training, upon eccentric hamstring strength, muscle activity, and architectural adaptations. Amateur soccer players were randomized into three groups. The control group (CON; n=11) undertook core stability exercises, whereas a periodized NHE program was delivered either before (NHE BEF ; n=10) or after (NHE AFT ; n=14) biweekly training sessions. Outcome measures included peak torque and concomitant normalized peak surface electromyography signals (sEMG) of the biceps femoris (BF) and medial hamstring (MH) muscles during knee flexor maximal eccentric contractions, performed at 30°·s -1 . Ultrasonography was used to determine BF muscle thickness, muscle fiber pennation angle, and fascicle length. Performing the NHE derived likely moderate peak torque increases in both NHE BEF (+11.9%; 90% confidence interval: 3.6%-20.9%) and NHE AFT (+11.6%; 2.6%-21.5%) vs CON. Maximum sEMG increases were moderately greater in the BF of both NHE training groups vs CON. There were likely moderate increases in BF muscle thickness (+0.17 cm; 0.05-0.29 cm) and likely small pennation angle increases (+1.03°; -0.08° to 2.14°) in NHE AFT vs CON and NHE BEF . BF fascicle length increases were likely greater in NHE BEF (+1.58 cm; 0.48-2.68 cm; small effect) vs CON and NHE AFT . A 12-week eccentric hamstring strengthening program increased strength and sEMG to a similar magnitude irrespective of its scheduling relative to the football training session. However, architectural adaptations to support the strength gains differed according to the timing of the injury prevention program. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

75 FR 68418 - Real-Time System Management Information Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-08

...-Time System Management Information Program AGENCY: Federal Highway Administration (FHWA), DOT. ACTION...) to establish a Real-Time System Management Information Program that provides, in all States, the... traveler information. The purposes of the Real-Time System Management Information Program are to: (1...

76 FR 42536 - Real-Time System Management Information Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

...-Time System Management Information Program AGENCY: Federal Highway Administration (FHWA), DOT. ACTION... Real-Time System Management Information Program and general information about current and planned... establishing requirements for the Real-Time System Management Information Program on November 8, 2010, at 75 FR...

78 FR 72747 - Meeting: RTCA Program Management Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-03

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Meeting: RTCA Program Management...: Notice of RTCA Program Management Committee Meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of RTCA Program Management Committee. DATES: The meeting will be held December...

76 FR 74842 - RTCA Program Management Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-01

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration RTCA Program Management Committee... RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of RTCA Program Management Committee DATES: The meeting will be held December 13, 2011...

77 FR 12905 - Meeting: RTCA Program Management Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-02

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Meeting: RTCA Program Management...: Notice of RTCA Program Management Committee Meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES: The meeting will be held...

78 FR 43962 - Meeting: RTCA Program Management Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-22

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Meeting: RTCA Program Management...: Notice of RTCA Program Management Committee Meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of RTCA Program Management Committee. DATES: The meeting will be held August...

78 FR 57673 - RTCA Program Management Committee; Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-19

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration RTCA Program Management Committee...: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of RTCA Program Management Committee. DATES: The meeting will be held October...

Counselor attitudes toward contingency management for substance use disorder: effectiveness, acceptability, and endorsement of incentives for treatment attendance and abstinence☆

PubMed Central

Aletraris, Lydia; Shelton, Jeff S.; Roman, Paul M.

2015-01-01

Despite research demonstrating its effectiveness, use of contingency management (CM) in substance use disorder treatment has been limited. Given the vital role that counselors play as arbiters in the use of therapies, examination of their attitudes can provide insight into how further use of CM might be effectively promoted. In this paper, we examine 731 counselors' attitudes toward the effectiveness and acceptability of CM in treatment, as well as their specific attitudes toward both unspecified and tangible incentives for treatment attendance and abstinence. Compared to cognitive behavioral therapy, motivational interviewing, and community reinforcement approach, counselors rated CM as the least effective and least acceptable psychosocial intervention. Exposure through the use of CM in a counselor's employing organization was positively associated with perceptions of acceptability, agreement that incentives have a positive effect on the client–counselor relationship, and endorsement of tangible incentives for abstinence. Endorsement of tangible incentives for treatment attendance was significantly greater among counselors with more years in the treatment field, and counselors who held at least a master's degree. Counselors' adaptability or openness to innovations was also positively associated with attitudes toward CM. Further, female counselors and counsellors with a greater 12-step philosophy were less likely to endorse the use of incentives. A highlight of our study is that it offers the first specific assessment of the impact of “Promoting Awareness of Motivational Incentives” (PAMI), a Web-based tool based on findings of CM protocols tested within the Clinical Trials Network (CTN), on counselors employed outside the CTN. We found that 10% of counselors had accessed PAMI, and those who had accessed PAMI were more likely to report a higher degree of perceived effectiveness of CM than those who had not. This study lays the groundwork for vital research on the impact of multiple Web-based educational strategies. Given the barriers to CM adoption, identifying predictors of positive attitudes among counselors can help diffuse CM into routine clinical practice. PMID:26001821

Children/Youth Physical Fitness Program Management System.

ERIC Educational Resources Information Center

Mozzini, Lou; And Others

Intended for physical fitness program managers, this book presents a system through which these professionals can justify, evaluate, develop, supervise, and promote a sound physical fitness program. Sections address the management stages of: (1) program assessment; (2) program commitment; (3) physical fitness program planning; (4) program…

41 CFR 102-192.150 - What are your general responsibilities as a program level mail manager?

Code of Federal Regulations, 2010 CFR

2010-07-01

... responsibilities as a program level mail manager? 102-192.150 Section 102-192.150 Public Contracts and Property... general responsibilities as a program level mail manager? Your responsibilities at the program level include— (a) Working closely with the agency mail manager and mail center managers who handle significant...

41 CFR 102-194.5 - What is the Standard and Optional Forms Management Program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is the Standard and Optional Forms Management Program? 102-194.5 Section 102-194.5 Public Contracts and Property Management... PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.5 What is the Standard and Optional...

NONINVASIVE FOLLICULAR TUMOR WITH PAPILLARY-LIKE NUCLEAR FEATURES: NOT A TEMPEST IN A TEAPOT.

PubMed

Agrawal, Nidhi; Abbott, Collette E; Liu, Cheng; Kang, Stella; Tipton, Laura; Patel, Kepal; Persky, Mark; King, Lizabeth; Deng, Fang-Ming; Bannan, Michael; Ogilvie, Jennifer B; Heller, Keith; Hodak, Steven P

2017-04-02

Encapsulated non-invasive follicular variant papillary thyroid cancer (ENIFVPTC) has recently been retermed noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This designation specifically omits the word "cancer" to encourage conservative treatment since patients with NIFTP tumors have been shown to derive no benefit from completion thyroidectomy or adjuvant radio-active iodine (RAI) therapy. This was a retrospective study of consecutive cases of tumors from 2007 to 2015 that met pathologic criteria for NIFTP. The conservative management (CM) group included patients managed with lobectomy alone or appropriately indicated total thyroidectomy. Those included in the aggressive management (AM) group received either completion thyroidectomy or RAI or both. From 100 consecutive cases of ENIFVPTC reviewed, 40 NIFTP were included for the final analysis. Of these, 10 (27%) patients treated with initial lobectomy received completion thyroidectomy and 6 of 40 (16%) also received postsurgical adjuvant RAI. The mean per-patient cost of care in the AM group was $17,629 ± 2,865, nearly twice the $8,637 ± 309 costs in the CM group, and was largely driven by the cost of completion thyroidectomy and RAI. The term NIFTP has been recently promulgated to identify a type of thyroid neoplasm, formerly identified as a low-grade cancer, for which initial surgery represents adequate treatment. We believe that since the new NIFTP nomenclature intentionally omits the word "cancer," the clinical indolence of these tumors will be better appreciated, and cost savings will result from more conservative and appropriate clinical management. AM = aggressive management CM = conservative management ENIFVPTC = encapsulated noninvasive form of FVPTC FVPTC = follicular variant of papillary thyroid carcinoma NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features PTC = papillary thyroid carcinoma PTMC = papillary thyroid microcarcinoma RAI = radio-active iodine US = ultrasound.

Project management in the Apollo program: An interdisciplinary study

NASA Technical Reports Server (NTRS)

Drucker, E. E.; Pooler, W. S.; Wilemon, D. L.; Wood, B. D.

1972-01-01

Findings concerning project management in the NASA Apollo program are presented. The Apollo program in the context of the total NASA organization is examined along with the nature of project management and the manner in which project managers functioned in the Apollo program. The utilization of the in-house technical competence in the support of the Apollo program, and the formal and informal relationships between Apollo managers and the contractors are discussed.

The analysis of the program to develop the Nuclear Waste Management System: Allocated requirements for the Office of Civilian Radioactive Waste Management Program

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

Woods, T.W.

1991-09-01

This report is volume 3, part B, of the program to satisfy the allocated requirements of the Office of Civilian Radioactive Waste Management Program, in the development of the nuclear waste management system. The report is divided into the following sections: regulatory compliance; external relations; international programs; strategic and contingency planning; contract business management; and administrative services. (CS)

[Characteristics of case management programs and their potential for patient empowerment].

PubMed

Grün, Oskar; Maier, Manfred

2008-01-01

Different types of case management programs have been increasingly developed for health care systems. This study, therefore, aimed to identify similarities and differences of case management programs, to estimate their shaping with special emphasis on patient empowerment, and to develop an instrument for their differentiation. During an interdisciplinary seminar for students, eight different case management programs were selected and analyzed. Five characteristics of case management programs were identified: type of case, extent of functions, players involved, limits of availability and need for resources. The programs were categorized into information-, provider-, disease- or patient centred. With these characteristics the selected programs could be exactly described and their potential for patient empowerment could be assessed. This newly developed tool for describing case management programs allows for their sufficient differentiation. The potential for patient empowerment apparently is most prominent in patient centred programs.

Disease management programs for CKD patients: the potential and pitfalls.

PubMed

Rocco, Michael V

2009-03-01

Disease management describes the use of a number of approaches to identify and treat patients with chronic health conditions, especially those that are expensive to treat. Disease management programs have grown rapidly in the United States in the past several years. These programs have been established for patients with chronic kidney disease (CKD), but some have been discontinued because of the high cost of the program. Disease management programs for CKD face unique challenges. Identification of patients with CKD is hampered by incomplete use of the International Classification of Diseases, Ninth Revision (ICD-9) codes for CKD by physicians and the less than universal use of estimated glomerular filtration rate from serum creatinine measurements to identify patients with an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2). CKD affects multiple organ systems. Thus, a comprehensive disease management program will need to manage each of these aspects of CKD. These multiple interventions likely will make a CKD disease management program more costly than similar disease management programs designed for patients with diabetes mellitus, congestive heart failure, or other chronic diseases. The lack of data that can be used to develop effective disease management programs in CKD makes it difficult to determine goals for the management of each organ system affected by CKD. Finally, long periods of observation will be needed to determine whether a particular disease management program is effective in not only improving patient outcomes, but also decreasing both resource use and health care dollars. This long-term observation period is contrary to how most disease management contracts are written, which usually are based on meeting goals during a 1- to 3-year period. Until these challenges are resolved, it likely will be difficult to maintain effective disease management programs for CKD.

Assessing the quality of cost management

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

Fayne, V.; McAllister, A.; Weiner, S.B.

1995-12-31

Managing environmental programs can be effective only when good cost and cost-related management practices are developed and implemented. The Department of Energy`s Office of Environmental Management (EM), recognizing this key role of cost management, initiated several cost and cost-related management activities including the Cost Quality Management (CQM) Program. The CQM Program includes an assessment activity, Cost Quality Management Assessments (CQMAs), and a technical assistance effort to improve program/project cost effectiveness. CQMAs provide a tool for establishing a baseline of cost-management practices and for measuring improvement in those practices. The result of the CQMA program is an organization that has anmore » increasing cost-consciousness, improved cost-management skills and abilities, and a commitment to respond to the public`s concerns for both a safe environment and prudent budget outlays. The CQMA program is part of the foundation of quality management practices in DOE. The CQMA process has contributed to better cost and cost-related management practices by providing measurements and feedback; defining the components of a quality cost-management system; and helping sites develop/improve specific cost-management techniques and methods.« less

High Resolution Airborne Digital Imagery for Precision Agriculture

NASA Technical Reports Server (NTRS)

Herwitz, Stanley R.

1998-01-01

The Environmental Research Aircraft and Sensor Technology (ERAST) program is a NASA initiative that seeks to demonstrate the application of cost-effective aircraft and sensor technology to private commercial ventures. In 1997-98, a series of flight-demonstrations and image acquisition efforts were conducted over the Hawaiian Islands using a remotely-piloted solar- powered platform (Pathfinder) and a fixed-wing piloted aircraft (Navajo) equipped with a Kodak DCS450 CIR (color infrared) digital camera. As an ERAST Science Team Member, I defined a set of flight lines over the largest coffee plantation in Hawaii: the Kauai Coffee Company's 4,000 acre Koloa Estate. Past studies have demonstrated the applications of airborne digital imaging to agricultural management. Few studies have examined the usefulness of high resolution airborne multispectral imagery with 10 cm pixel sizes. The Kodak digital camera integrated with ERAST's Airborne Real Time Imaging System (ARTIS) which generated multiband CCD images consisting of 6 x 106 pixel elements. At the designated flight altitude of 1,000 feet over the coffee plantation, pixel size was 10 cm. The study involved the analysis of imagery acquired on 5 March 1998 for the detection of anomalous reflectance values and for the definition of spectral signatures as indicators of tree vigor and treatment effectiveness (e.g., drip irrigation; fertilizer application).

Rising out-of-pocket costs in disease management programs.

PubMed

Chernew, Michael E; Rosen, Allison B; Fendrick, A Mark

2006-03-01

To document the rise in copayments for patients in disease management programs and to call attention to the inherent conflicts that exist between these 2 approaches to benefit design. Data from 2 large health plans were used to compare cost sharing in disease management programs with cost sharing outside of disease management programs. The copayments charged to participants in disease management programs usually do not differ substantially from those charged to other beneficiaries. Cost sharing and disease management result in conflicting approaches to benefit design. Increasing copayments may lead to underuse of recommended services, thereby decreasing the clinical effectiveness and increasing the overall costs of disease management programs. Policymakers and private purchasers should consider the use of targeted benefit designs when implementing disease management programs or redesigning cost-sharing provisions. Current information systems and health services research are sufficiently advanced to permit these benefit designs.

44 CFR 16.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Program accessibility: Existing facilities. 16.150 Section 16.150 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY § 16.150 Program...

14 CFR § 1214.1706 - Program management.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Program management. § 1214.1706 Section Â... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson. ...

10 CFR 800.002 - Program management.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility for...

10 CFR 800.002 - Program management.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility for...

10 CFR 800.002 - Program management.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility for...

10 CFR 800.002 - Program management.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility for...

30 CFR 401.12 - Program management.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal year's...

30 CFR 401.12 - Program management.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 2 2012-07-01 2012-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal year's...

30 CFR 401.12 - Program management.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 2 2013-07-01 2013-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal year's...

30 CFR 401.12 - Program management.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 2 2011-07-01 2011-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal year's...

30 CFR 401.12 - Program management.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 2 2014-07-01 2014-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal year's...

78 FR 14151 - Meeting: RTCA Program Management Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-04

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Meeting: RTCA Program Management...: Notice of RTCA Program Management Committee Meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of RTCA Program Management Committee. DATES: The meeting will be held March 20...

10 CFR 800.002 - Program management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility for...

77 FR 31421 - Meeting: RTCA Program Management Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-25

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Meeting: RTCA Program Management...: Notice of RTCA Program Management Committee Meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES: The meeting will be held June...

Sublethal Exposure to Clove and Cinnamon Essential Oils Induces Hormetic-Like Responses and Disturbs Behavioral and Respiratory Responses in Sitophilus zeamais (Coleoptera: Curculionidae).

PubMed

Haddi, Khalid; Oliveira, Eugênio E; Faroni, Lêda R A; Guedes, Daniela C; Miranda, Natalie N S

2015-12-01

Essential oils have been suggested as suitable alternatives for controlling insect pests. However, the potential adaptive responses elicited in insects for mitigating the actions of these compounds have not received adequate attention. Furthermore, as is widely reported with traditional insecticides, sublethal exposure to essential oils might induce stimulatory responses or contribute to the development of resistance strategies that can compromise the management of insect pests. The current study evaluated the locomotory and respiratory responses as well as the number of larvae per grain produced by the maize weevil, Sitophilus zeamais Motschulsky, after being sublethally exposed to the essential oils of clove, Syzygium aromaticum L., and cinnamon, Cinnamomum zeylanicum L. The essential oils showed similar insecticidal toxicity (exposure route: contact with dried residues; Clove LC95 = 3.96 [2.78-6.75] µl/cm(2); Cinnamon LC95 = 3.47 [2.75-4.73] µl/cm(2)). A stimulatory effect on the median survival time (TL50) was observed when insects were exposed to low concentrations of each oil. Moreover, a higher number of larvae per grain was produced under sublethal exposure to clove essential oil. S. zeamais avoided the treated areas (in free-choice experiments) and altered their mobility when sublethally exposed to both essential oils. The respiratory rates of S. zeamais (i.e., CO2 production) were significantly reduced under low concentrations of the essential oils. We recommend the consideration of the potential sublethal effects elicited by botanical pesticides during the development of integrated pest management programs aiming to control S. zeamais. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Minimally Invasive Sacroiliac Joint Fusion, Radiofrequency Denervation, and Conservative Management for Sacroiliac Joint Pain: 6-Year Comparative Case Series.

PubMed

Vanaclocha, Vicente; Herrera, Juan Manuel; Sáiz-Sapena, Nieves; Rivera-Paz, Marlon; Verdú-López, Francisco

2018-01-01

Sacroiliac joint (SIJ) pain is an under-recognized condition. Substantial information supports the safety and effectiveness of SIJ fusion (SIJF). Long-term follow-up after SIJF has not been reported. To determine responses to conservative management (CM), SIJ denervation, and SIJF in patients with SIJ pain unresponsive to CM. Retrospective study with long-term (up to 6 yr) follow-up of 137 patients with SIJ pain seen in an outpatient neurosurgery clinic who received either CM (n = 63), sacroiliac denervation (n = 47), or minimally invasive SIJF (n = 27). At each routine clinic visit, patients completed pain scores and Oswestry Disability Index. Additional data were extracted from medical charts. Patients treated with continued CM had no long-term improvement in pain (mean worsening of 1 point) or disability (mean Oswestry Disability Index worsened by 4-6 points), increased their use of opioids, and had poor long-term work status. SIJF patients had large improvements in SIJ pain (mean 6 points), large improvements in disability (mean 25 points), a decrease in opioid use, and good final work status. Sacroiliac denervation patients had intermediate responses (0-1 and 1-2 points, respectively). In patients with SIJ pain unresponsive to CM, SIJF resulted in excellent long-term clinical responses, with low opioid use and better work status compared to other treatments. Copyright © 2017 by the Congress of Neurological Surgeons

Proceedings of the Strategy Meeting for the Development of an International Consortium for Chinese Medicine and Cancer

PubMed Central

White, Jeffrey D.; Lin, Hongsheng; Wu, Roy S.; Lam, Stephen; Li, Jie; Dou, Jinhui; Kumar, Nagi; Lin, Lizhu; Lao, Lixing

2017-01-01

On November 3, 2014, in Bethesda, MD, the Office of Cancer Complementary and Alternative Medicine of the National Cancer Institute held a meeting to examine the potential utility and feasibility of establishing an international consortium for Chinese medicine and cancer. There is significant interest in the West in using components of Chinese medicine (CM) —such as botanicals and herbal medicines, acupuncture and acupressure, and qigong—in the field of oncology, as potential anticancer agents, for symptom management, and to improve quality of life. The proposal for a consortium on CM came from the Chinese Academy of Chinese Medical Sciences, with the aims of improving scientific communications and collaborations and modernizing the studies of CM for cancer. The US National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine agreed to work with Chinese Academy of Chinese Medical Sciences to explore the feasibility of establishing an international consortium for Chinese medicine and cancer. At the meeting, participants from the United States, China, Canada, Australia, and Korea discussed issues in CM and cancer research, treatment, and management, including potential mechanisms of action, proof of efficacy, adverse effects, regulatory issues, and the need for improving the quality of randomized clinical trials of CM treatments and supportive care interventions. Presented in these proceedings are some of the main issues and opportunities discussed by workshop participants. PMID:29244995

Dissolved organic C and N pools in soils amended with composted and thermally-dried sludge as affected by soil tillage systems and sampling depth

NASA Astrophysics Data System (ADS)

García-Gil, Juan Carlos; Soler-Rovira, Pedro Angel; García López de Sa, Esther; Polo, Alfredo

2013-04-01

Soil tillage practices exert a significant influence on the dynamic of soluble organic C and N pools, affecting nutrient cycling in agricultural systems by enhancing its mineralization through microbial activities or stabilization in soil microaggregates, which contribute to mitigate greenhouse gases emissions. The objective of the present research was to determine the influence of three different soil management systems (moldboard plowing, chisel and no-tillage) and the application of composted sludge (CS) and thermally-dried sewage sludge (TSS) obtained from wastewater treatment processes on dissolved organic C (water-soluble organic C -WSOC-, carbohydrates, phenolic compounds) and soluble N (total-N, NH4+, NO3-) pools in a long-term field experiment (27 years) conducted on a sandy-loam soil at the experimental station "La Higueruela" (40° 03'N, 4° 24'W) under semi-arid conditions. Both organic amendments were applied at a rate of 30 tonnes per hectare prior to tillage practices. Unamended soils were used as control for each tillage system. Soil sampling was performed two months after tillage practices at the following depths for each treatment: 0-10 cm, 10-20 cm and 20-30 cm. Results obtained for unamended soils showed that no-tillage management increased total-N, NH4+ and NO3- contents at the 0-10 cm depth samples, meanwhile WSC and carbohydrates contents were larger at 20-30 cm depth samples in both moldboard and no-tillage plots. CS and TSS-amended soils presented a general increase in soluble C and N compounds, being significantly higher in TSS-amended soils, as TSS contains a great amount of labile organic C and N substrates due to the lack of stabilization treatment. TSS-amended soils under no-tillage and chisel plowing showed larger N, NH4+ and NO3- content at the 0-10 cm samples, meanwhile moldboard management exhibited larger NH4+ and NO3- content at 10-20 and 20-30 cm samples, possibly due to the incorporation of TSS at deeper depths (20-40 cm). CS and TSS-amended soils in no-tillage system showed the largest content of organic C pools at 0-10 cm depth samples due to less soil disturbance and the input of organic substrates with CS and TSS on soil surface. CS and TSS-amended soils under chisel plowing exhibited similar contents of soluble organic C pools at 10-20 and 20-30 cm depth samples and only TSS-amended soils increased significantly WSOC content at 0-10 cm samples. Similarly, contents of WSOC and carbohydrates in moldboard plowing were distributed more uniformly throughout the soil profile due to the turnover of soil and CS and TSS amendments into the plow layer. Acknowledgements: this research was supported by the Spanish CICYT, Project no. CTM2011-25557.

Diurnal roosts of male evening bats (Nycticeius humeralis) in diversely managed pine-hardwood forests

Treesearch

Roger W. Perry; Ronald E. Thill

2008-01-01

We examined attributes of 45 roost sites used by 17 adult male evening bats (Nycticeius humeralis) in a diverse forested landscape within the Ouachita Mountains, Arkansas. Bats roosted in a diverse array of substrates, including live or dead Pinus echinata $15 cm diam at breast height (29% of roosts) and small (,10 cm) understory or midstory...

Randomized Trial of Continuing Care Enhancements for Cocaine-Dependent Patients following Initial Engagement

ERIC Educational Resources Information Center

McKay, James R.; Lynch, Kevin G.; Coviello, Donna; Morrison, Rebecca; Cary, Mark S.; Skalina, Lauren; Plebani, Jennifer

2010-01-01

Objective: The effects of cognitive-behavioral relapse prevention (RP), contingency management (CM), and their combination (CM + RP) were evaluated in a randomized trial with 100 cocaine-dependent patients (58% female, 89% African American) who were engaged in treatment for at least 2 weeks and had an average of 44 days of abstinence at baseline.…

Software Process Automation: Experiences from the Trenches.

DTIC Science & Technology

1996-07-01

Integration of problem database Weaver tions) J Process WordPerfect, All-in-One, Oracle, CM Integration of tools Weaver System K Process Framemaker , CM...handle change requests and problem reports. * Autoplan, a project management tool * Framemaker , a document processing system * Worldview, a document...Cadre, Team Work, FrameMaker , some- thing for requirements traceability, their own homegrown scheduling tool, and their own homegrown tool integrator

Chiari Type I Malformations in Young Adults: Implications for the College Health Practitioner

ERIC Educational Resources Information Center

Elam, Mary Jane; Vaughn, John A.

2011-01-01

In this article, the authors describe 2 cases of Chiari type I malformation (CM-I) in students presenting to a college health center within a 6-month period. A review of CM-I, including epidemiology, typical presentation, evaluation, and management, is followed by a discussion of the clinical and functional implications of the disorder in an…

Urethral calculi in young-adult Nigerian males: a case series.

PubMed

Gali, B M; Ali, N; Agbese, G O; Garba, I I; Musa, K

2011-01-01

Urethral calculi are rare and usually encountered in males with urethral pathology. To present our experience managing urethral calculi in a resource limited centre and review the literature. We did a chart review of management of patients with urethral calculi between January and April 2009, at Federal Medical Centre (FMC) Azare, Nigeria. We also reviewed the literature on this rare condition. Four young adult male Nigerians between the ages of 17 and 27 years presented with varying degrees of urethral pain and palpable calculi in the anterior urethra. Two presented with acute retention of urine, but none had haematuria. The calculi were radio-opaque, located in the anterior urethra with no associated urethral pathology. Three were solitary and one multiple. The composition of the urethral calculi was a mixture of calcium oxalate calcium carbonate, magnesium phosphate, one has additional cystine but none had struvite or uric acid. Their sizes ranged between 1cm ×1.5cm and 1.5cm × 5.5cm. External urethrotomy was the method of treatment. Urethral calculi are rare in our setting, with no clear identifiable aetiological factors which suggests urinary schistosomiasisbeing associsted. The occurrence of urethral calculi appears to have a relationship with childhood urinary schistosomasis.

Computer-assisted Behavioral Therapy and Contingency Management for Cannabis Use Disorder

PubMed Central

Budney, Alan J.; Stanger, Catherine; Tilford, J. Mick; Scherer, Emily; Brown, Pamela C.; Li, Zhongze; Li, Zhigang; Walker, Denise

2015-01-01

Computer-assisted behavioral treatments hold promise for enhancing access to and reducing costs of treatments for substance use disorders. This study assessed the efficacy of a computer-assisted version of an efficacious, multicomponent treatment for cannabis use disorders (CUD), i.e., motivational enhancement therapy, cognitive-behavioral therapy, and abstinence-based contingency-management (MET/CBT/CM). An initial cost comparison was also performed. Seventy-five adult participants, 59% African Americans, seeking treatment for CUD received either, MET only (BRIEF), therapist-delivered MET/CBT/CM (THERAPIST), or computer-delivered MET/CBT/CM (COMPUTER). During treatment, the THERAPIST and COMPUTER conditions engendered longer durations of continuous cannabis abstinence than BRIEF (p < .05), but did not differ from each other. Abstinence rates and reduction in days of use over time were maintained in COMPUTER at least as well as in THERAPIST. COMPUTER averaged approximately $130 (p < .05) less per case than THERAPIST in therapist costs, which offset most of the costs of CM. Results add to promising findings that illustrate potential for computer-assisted delivery methods to enhance access to evidence-based care, reduce costs, and possibly improve outcomes. The observed maintenance effects and the cost findings require replication in larger clinical trials. PMID:25938629

Issues in NASA Program and Project Management. Special Edition: A Collection of Papers on NASA Procedures and Guidance 7120.5A. Volume 14

NASA Technical Reports Server (NTRS)

Hoffman, Edward J. (Editor); Lawbaugh, William M. (Editor)

1998-01-01

A key aspect of NASA's new Strategic Management System is improving the way we plan, approve, execute and evaluate our programs and projects. To this end, NASA has developed the NASA Program and Project Management processes and Requirements-NASA Procedures and Guidelines (NPG) 7120.5A, which formally documents the "Provide Aerospace Products and Capabilities" crosscutting process, and defines the processes and requirements that are responsive to the Program/Project Management-NPD 7120.4A. The Program/Project Management-NPD 7120.4A, issued November 14, 1996, provides the policy for managing programs and projects in a new way that is aligned with the new NASA environment. An Agencywide team has spent thousands of hours developing the NASA Program and Project Management Processes and Requirements-NPG 7120.5A. We have created significant flexibility, authority and discretion for the program and project managers to exercise and carry out their duties, and have delegated the responsibility and the accountability for their programs and projects.

Variations of deep soil moisture under different vegetation types and influencing factors in a watershed of the Loess Plateau, China

NASA Astrophysics Data System (ADS)

Fang, Xuening; Zhao, Wenwu; Wang, Lixin; Feng, Qiang; Ding, Jingyi; Liu, Yuanxin; Zhang, Xiao

2016-08-01

Soil moisture in deep soil layers is a relatively stable water resource for vegetation growth in the semi-arid Loess Plateau of China. Characterizing the variations in deep soil moisture and its influencing factors at a moderate watershed scale is important to ensure the sustainability of vegetation restoration efforts. In this study, we focus on analyzing the variations and factors that influence the deep soil moisture (DSM) in 80-500 cm soil layers based on a soil moisture survey of the Ansai watershed in Yan'an in Shanxi Province. Our results can be divided into four main findings. (1) At the watershed scale, higher variations in the DSM occurred at 120-140 and 480-500 cm in the vertical direction. At the comparable depths, the variation in the DSM under native vegetation was much lower than that in human-managed vegetation and introduced vegetation. (2) The DSM in native vegetation and human-managed vegetation was significantly higher than that in introduced vegetation, and different degrees of soil desiccation occurred under all the introduced vegetation types. Caragana korshinskii and black locust caused the most serious desiccation. (3) Taking the DSM conditions of native vegetation as a reference, the DSM in this watershed could be divided into three layers: (i) a rainfall transpiration layer (80-220 cm); (ii) a transition layer (220-400 cm); and (iii) a stable layer (400-500 cm). (4) The factors influencing DSM at the watershed scale varied with vegetation types. The main local controls of the DSM variations were the soil particle composition and mean annual rainfall; human agricultural management measures can alter the soil bulk density, which contributes to higher DSM in farmland and apple orchards. The plant growth conditions, planting density, and litter water holding capacity of introduced vegetation showed significant relationships with the DSM. The results of this study are of practical significance for vegetation restoration strategies, especially for the choice of vegetation types, planting zones, and proper human management measures.

The effectiveness and barriers of implementing a workplace health promotion program to improve metabolic disorders in older workers in Taiwan.

PubMed

Chen, Meei-Maan; Tsai, Alan C; Wang, Jiun-Yi

2016-06-01

To determine the effectiveness of a pragmatic health promotion program to improve the metabolic disorders in older workers in Taiwan, we conducted a 24-week quasi-experiment in three worksites in southern Taiwan in 2010. Among 1,245 workers, 108 met the inclusion criteria (full-time workers aged over 50 years) and agreed to participate in the study. They were assigned to either the intervention (n = 58) or the reference group (n = 50) according to their availability to participate in health-promoting activities. The intervention group received training in behavioral modifications to improve diet, time-use, stress management and physical activity. Motivational lectures, group activities, and team competitions were used to improve participants' knowledge and skills in managing own health. Subjects in the reference group received no intervention. Lifestyle, anthropometric and biochemical indicators were measured at baseline and end-point. Mixed effects linear models were used to determine the intervention effects. The intervention significantly lowered body weight (intervention vs. reference = -1.22 vs. -0.30kg, p = 0.026), BMI (-0.46 vs. -0.02kg/m2, p = 0.006), and waist circumference (-2.68 vs. +0.79cm, p <0.001), but had no effect on biochemical parameters. These findings suggest the workplace-based health promotion can be effective and useful in reducing the risk of metabolic disorders in older workers in Taiwan. © The Author(s) 2014.

49 CFR 237.33 - Content of bridge management programs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Content of bridge management programs. 237.33... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Railroad Bridge Safety Assurance § 237.33 Content of bridge management programs. Each bridge management program adopted in compliance with this part...

20 CFR 638.800 - Program management.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 3 2012-04-01 2012-04-01 false Program management. 638.800 Section 638.800... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Administrative Provisions § 638.800 Program management. (a) The Job Corps Director shall establish and use internal program management procedures sufficient...

20 CFR 638.800 - Program management.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Program management. 638.800 Section 638.800... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Administrative Provisions § 638.800 Program management. (a) The Job Corps Director shall establish and use internal program management procedures sufficient...

77 FR 60919 - Tennessee: Final Authorization of State Hazardous Waste Management Program Revisions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-05

...: Final Authorization of State Hazardous Waste Management Program Revisions AGENCY: Environmental..., Division of Solid Waste Management, 5th Floor, L & C Tower, 401 Church Street, Nashville, Tennessee 37243... RCRA hazardous waste management program. We granted authorization for changes to Tennessee's program on...

14 CFR 91.1023 - Program operating manual requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... manager must prepare and keep current a program operating manual setting forth procedures and policies acceptable to the Administrator. The program manager's management, flight, ground, and maintenance personnel... personnel. (b) Each program manager must maintain at least one copy of the manual at its principal base of...

20 CFR 638.800 - Program management.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Program management. 638.800 Section 638.800... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Administrative Provisions § 638.800 Program management. (a) The Job Corps Director shall establish and use internal program management procedures sufficient...

49 CFR 237.33 - Content of bridge management programs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Content of bridge management programs. 237.33... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Railroad Bridge Safety Assurance § 237.33 Content of bridge management programs. Each bridge management program adopted in compliance with this part...

Management Training for Directors.

ERIC Educational Resources Information Center

Yaptinchay, Karen

1998-01-01

Describes a management program for Head Start directors called the Head Start-Johnson & Johnson Management Fellows program that focuses on issues and problems encountered by directors in implementing and operating programs at the local level. Notes that the management program represents a response to increasing need for cost-effective and…

More than a century of Grain for Green Program is expected to restore soil carbon stock on alpine grassland revealed by field (13)C pulse labeling.

PubMed

Li, Qi; Chen, Dongdong; Zhao, Liang; Yang, Xue; Xu, Shixiao; Zhao, Xinquan

2016-04-15

Anthropogenic changes in land use/cover have altered the vegetation, soil, and carbon (C) cycling on the Qinghai-Tibetan Plateau (QTP) over the last ~50years. As a result, the Grain for Green Program (GfGP) has been widely implemented over the last 10years to mitigate the impacts of cultivation. To quantify the effects of the GfGP on C partitioning and turnover rates at the ecosystem scale, an in situ (13)C pulse labeling experiment was conducted on natural and GfGP grasslands in an agro-pastoral ecotone in the Lake Qinghai region on the QTP. We found that there were significant differences in the C stocks of all the considered pools in both the natural and GfGP grasslands, with higher CO2 uptake rates in the GfGP grassland than that in the natural grassland. Partitioning of photoassimilate (% of recovered (13)C) in C pools of both grasslands was similar 25days after labeling, except in the roots of the 0-15 and 5-15cm soil layer. Soil organic C (SOC) sequestration rate in the GfGP grassland was 11.59±1.89gCm(-2)yr(-1) significantly greater than that in the natural grassland. The results confirmed that the GfGP is an efficient approach for grassland restoration and C sequestration. However, it will take more than a century (119.19±20.26yr) to restore the SOC stock from the current cropland baseline level to the approximate level of natural grassland. We suggest that additional measures are needed in the selection of suitable plant species for vegetation restoration, and in reasonable grazing management. Copyright © 2016 Elsevier B.V. All rights reserved.

Using concept mapping to explore why patients become lost to follow up from an antiretroviral therapy program in the Zomba District of Malawi

PubMed Central

2013-01-01

Background Retention in antiretroviral therapy (ART) programmes remains a challenge in many settings including Malawi, in part due to high numbers of losses to follow-up. Concept Mapping (CM), a mix-method participatory approach, was used to explore why patients on ART are lost to follow-up (LTFU) by identifying: 1) factors that influence patient losses to follow-up and 2) barriers to effective and efficient tracing in Zomba, Malawi. Methods CM sessions (brainstorming, sorting and rating, interpretation) were conducted in urban and rural settings in Zomba, Malawi. Participants included ART patients, ART providers, Health Surveillance Assistants, and health managers from the Zomba District Health Office. In brainstorming, participants generated statements in response to “A specific reason why an individual on ART becomes lost to follow-up is…” Participants then sorted and rated the consolidated list of brainstormed items. Analysis included inductive qualitative methods for grouping of data and quantitative cluster identification to produce visual maps which were then interpreted by participants. Results In total, 90 individuals brainstormed 371 statements, 64 consolidated statements were sorted (participant n = 46), and rated on importance and feasibility (participant n = 69). A nine-cluster concept map was generated and included both patient- and healthcare-related clusters such as: Stigma and Fears, Beliefs, Acceptance and Knowledge of ART, Access to ART, Poor Documentation, Social and Financial Support Issues, Health Worker Attitudes, Resources Needed for Effective Tracing, and Health Worker Issues Related to Tracing. Strategies to respond to the clusters were generated in Interpretation. Conclusions Multiple patient- and healthcare focused factors influence why patients become LTFU. Findings have implications particularly for programs with limited resources struggling with the retention of ART patients. PMID:23758879

Using concept mapping to explore why patients become lost to follow up from an antiretroviral therapy program in the Zomba District of Malawi.

PubMed

Rachlis, Beth; Ahmad, Farah; van Lettow, Monique; Muula, Adamson S; Semba, Medson; Cole, Donald C

2013-06-11

Retention in antiretroviral therapy (ART) programmes remains a challenge in many settings including Malawi, in part due to high numbers of losses to follow-up. Concept Mapping (CM), a mix-method participatory approach, was used to explore why patients on ART are lost to follow-up (LTFU) by identifying: 1) factors that influence patient losses to follow-up and 2) barriers to effective and efficient tracing in Zomba, Malawi. CM sessions (brainstorming, sorting and rating, interpretation) were conducted in urban and rural settings in Zomba, Malawi. Participants included ART patients, ART providers, Health Surveillance Assistants, and health managers from the Zomba District Health Office. In brainstorming, participants generated statements in response to "A specific reason why an individual on ART becomes lost to follow-up is…" Participants then sorted and rated the consolidated list of brainstormed items. Analysis included inductive qualitative methods for grouping of data and quantitative cluster identification to produce visual maps which were then interpreted by participants. In total, 90 individuals brainstormed 371 statements, 64 consolidated statements were sorted (participant n = 46), and rated on importance and feasibility (participant n = 69). A nine-cluster concept map was generated and included both patient- and healthcare-related clusters such as: Stigma and Fears, Beliefs, Acceptance and Knowledge of ART, Access to ART, Poor Documentation, Social and Financial Support Issues, Health Worker Attitudes, Resources Needed for Effective Tracing, and Health Worker Issues Related to Tracing. Strategies to respond to the clusters were generated in Interpretation. Multiple patient- and healthcare focused factors influence why patients become LTFU. Findings have implications particularly for programs with limited resources struggling with the retention of ART patients.

Importance of a Patient Dosimetry and Clinical Follow-up Program in the Detection of Radiodermatitis After Long Percutaneous Coronary Interventions

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

Vano, Eliseo, E-mail: eliseov@med.ucm.es; Escaned, Javier; Vano-Galvan, Sergio

Complex percutaneous interventions often require high radiation doses likely to produce skin radiation injuries. We assessed the methodology used to select patients with potential skin injuries in cardiac procedures and in need of clinical follow-up. We evaluated peak skin dose and clinical follow-up in a case of radiodermatitis produced during a total occlusion recanalization. This prospective study followed CIRSE and ACC/AHA/SCAI recommendations for patient radiation dose management in interventional procedures carried out in a university hospital with a workload of 4200 interventional cardiac procedures per year. Patient dose reports were automatically transferred to a central database. Patients exceeding trigger levelsmore » for air kerma area product (500 Gy cm{sup 2}) and cumulative skin dose (5 Gy) were counseled and underwent follow-up for early detection of skin injuries, with dermatologic support. The Ethical Committee and the Quality Assurance and Radiation Safety Committee approved the program. During 2010, a total of 13 patients (3.0/1,000 that year) received dose values exceeding trigger levels in the cardiovascular institute. Only one patient, who had undergone two consecutive procedures resulting in 970 Gy cm{sup 2} and 13.0 Gy as cumulative skin dose, showed signs of serious radiodermatitis that resolved in 3.7 months. The remaining patients did not manifest skin lesions during follow-up, and whenever patient examination was not feasible as part of the follow-up, neither patients nor families reported any skin injuries. Peak skin dose calculation and close clinical follow-up were feasible and appropriate, with a moderate additional workload for the staff and satisfaction for the patient.« less

Vapor feed direct methanol fuel cells with passive thermal-fluids management system

NASA Astrophysics Data System (ADS)

Guo, Zhen; Faghri, Amir

The present paper describes a novel technology that can be used to manage methanol and water in miniature direct methanol fuel cells (DMFCs) without the need for a complex micro-fluidics subsystem. At the core of this new technology is a unique passive fuel delivery system that allows for fuel delivery at an adjustable rate from a reservoir to the anode. Furthermore, the fuel cell is designed for both passive water management and effective carbon dioxide removal. The innovative thermal management mechanism is the key for effective operation of the fuel cell system. The vapor feed DMFC reached a power density of 16.5 mW cm -2 at current density of 60 mA cm -2. A series of fuel cell prototypes in the 0.5 W range have been successfully developed. The prototypes have demonstrated long-term stable operation, easy fuel delivery control and are scalable to larger power systems. A two-cell stack has successfully operated for 6 months with negligible degradation.

Critical analysis of procurement techniques in construction management sectors

NASA Astrophysics Data System (ADS)

Tiwari, Suman Tiwari Suresh; Chan, Shiau Wei; Faraz Mubarak, Muhammad

2018-04-01

Over the last three decades, numerous procurement techniques have been one of the highlights of the Construction Management (CM) for ventures, administration contracting, venture management as well as design and construct. Due to the development and utilization of those techniques, various researchers have explored the criteria for their choice and their execution in terms of time, cost and quality. Nevertheless, there is a lack of giving an account on the relationship between the procurement techniques and the progressed related issues, for example, supply chain, sustainability, innovation and technology development, lean construction, constructability, value management, Building Information Modelling (BIM) as well as e-procurement. Through chosen papers from the reputable CM-related academic journals, the specified scopes of these issues are methodically assessed with the objective to explore the status and trend in procurement related research. The result of this paper contributes theoretically as well as practically to the researchers and industrialist in order to be aware and appreciate the development of procurement techniques.

32 CFR 239.10 - Management Controls.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Systems. Headquarters, USACE has an existing information management system that manages all information related to the HAP program. (1) HAPMIS. The Homeowners Assistance Program Management Information System... to this program and the management in formation system to protect the privacy information of Expanded...

32 CFR 239.10 - Management controls.

Code of Federal Regulations, 2013 CFR

2013-07-01

... systems. Headquarters, USACE has an existing information management system that manages all information related to the HAP program. (1) HAPMIS. The Homeowners Assistance Program Management Information System... to this program and the management information system to protect the privacy of Expanded HAP...

32 CFR 239.10 - Management controls.

Code of Federal Regulations, 2012 CFR

2012-07-01

... systems. Headquarters, USACE has an existing information management system that manages all information related to the HAP program. (1) HAPMIS. The Homeowners Assistance Program Management Information System... to this program and the management information system to protect the privacy of Expanded HAP...

32 CFR 239.10 - Management controls.

Code of Federal Regulations, 2011 CFR

2011-07-01

... systems. Headquarters, USACE has an existing information management system that manages all information related to the HAP program. (1) HAPMIS. The Homeowners Assistance Program Management Information System... to this program and the management information system to protect the privacy of Expanded HAP...

Strategies in disability management. Corporate disability management programs implemented at the work site.

PubMed

Kalina, C M

1999-10-30

Managers are challenged to demonstrate all programs as economically essential to the business, generating an appreciable return on investment. Further challenge exists to blend and integrate clinical and business objectives in program development. Disability management programs must be viewed as economically essential to the financial success of the business to assure management support for clinical interventions and return-to-work strategies essential for a successful program. This paper discusses a disability management program integrating clinical and business goals and objectives in return-to-work strategies to effect positive clinical, social-cultural, and business results. Clinical, educational, social, and economic challenges in the development, implementation, and continued management of a disability program at a large corporation with multiple global work sites are defined. Continued discussion addresses the effective clinical interventions and educational strategies utilized successfully within the workplace environment in response to each defined challenge. A multiple disciplinary team approach, clinical and business outcome measures, and quality assurance indicators are discussed as major program components. This article discusses a successful program approach focusing on business process and methodology. These parameters are used to link resources to strategy, developing a product for implementing and managing a program demonstrating economic value added through effective clinical medical case management.

Issues in NASA program and project management

NASA Technical Reports Server (NTRS)

Hoban, Francis T. (Editor)

1989-01-01

This new collection of papers on aerospace management issues contains a history of NASA program and project management, some lessons learned in the areas of management and budget from the Space Shuttle Program, an analysis of tools needed to keep large multilayer programs organized and on track, and an update of resources for NASA managers. A wide variety of opinions and techniques are presented.

Nationwide access to an Internet-based contingency management intervention to promote smoking cessation: A randomized controlled trial

PubMed Central

Dallery, Jesse; Raiff, Bethany R.; Kim, Sunny Jung; Marsch, Lisa A.; Stitzer, Maxine; Grabinski, Michael J.

2016-01-01

Background and aims Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of Internet-based CM relative to an Internet-based monitoring and goal setting control group in a nationwide sample of cigarette smokers. Design Randomized controlled trial with 3- and 6-month follow ups. Setting USA. Participants Smokers (n=94) from 26 states were enrolled (mean age 36, 56% female). Intervention and comparator Participants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video-verified abstinence using breath carbon monoxide (CO) output (n=48; Abstinent Contingent Group, AC), or based on submitting CO samples (n=46, Submission Contingent, SC). Both groups also received the same CO-based goals. A $50 deposit was required in both groups that could be recouped from initial earnings. Measures The primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3- and 6-month follow-ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0–100mm visual analog scale. Findings Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups (odds ratio=4.4, 95% CI=1.6–12.3), but not at the 3- (29.2% AC and 19.6% SC, odds ratio=1.7, 95% CI=.6–4.4), or 6- (22.9% AC and 13.0% SC, odds ratio=2.0, 95% CI=.7–5.9) month follow-ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, odds ratio = 3.5, 95% CI=3.1–4.0; 43.4% AC and 24.6% SC, odds ratio = 2.3, 95% CI=1.6–3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = −10.3%–23.8%, x2=.75, p = .39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money. Conclusions A contingency management/financial incentive program delivered via the Internet improved short-term abstinence rates compared with an internet program without the incentives. PMID:27923264

Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial.

PubMed

Dallery, Jesse; Raiff, Bethany R; Kim, Sunny Jung; Marsch, Lisa A; Stitzer, Maxine; Grabinski, Michael J

2017-05-01

Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of internet-based CM relative to an internet-based monitoring and goal-setting control group in a nationwide sample of cigarette smokers. Randomized controlled trial with 3- and 6-month follow-ups. United States. Smokers (n = 94) from 26 states were enrolled (mean age 36, 56% female). Participants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video-verified abstinence using breath carbon monoxide (CO) output (n = 48; abstinent contingent group, AC), or based on submitting CO samples (n = 46, submission contingent, SC). Both groups also received the same CO-based goals. A $50 deposit was required in both groups that could be recouped from initial earnings. The primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3- and 6-month follow-ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0-100-mm visual analog scale. Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups [odds ratio (OR) = 4.4, 95% confidence interval (CI) = 1.6-12.3], but not at the 3- (29.2% AC and 19.6% SC, OR = 1.7, 95% CI = 0.6-4.4) or 6- (22.9% AC and 13.0% SC, OR = 2.0, 95% CI = 0.7-5.9) month follow-ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, OR = 3.5, 95% CI = 3.1-4.0; 43.4% AC and 24.6% SC, OR = 2.3, 95% CI = 1.6-3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = -10.3 to 23.8 %, F < 1, P = 0.39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money. A contingency management/financial incentive program delivered via the internet improved short-term abstinence rates compared with an internet program without the incentives. © 2016 Society for the Study of Addiction.

A Review of the MLAS Parachute Systems

NASA Technical Reports Server (NTRS)

Taylor, Anthony P.; Kelley, Christopher; Magner, Eldred; Peterson, David; Hahn, Jeffrey; Yuchnovicz, Daniel E.

2009-01-01

The NASA Engineering and Safety Center (NESC) is developing the Max Launch Abort System (MLAS) as a risk-mitigation design should problems arise with the baseline Orion spacecraft launch abort design. The Max in MLAS is dedicated to Max Faget, the renowned NASA spacecraft designer. The MLAS flight test vehicle consists of boost skirt, coast skirt and the MLAS fairing which houses a full scale boilerplate Orion Crew Module (CM). The objective of the flight test is to prove that the CM can be released from the MLAS fairing during pad abort conditions without detrimental recontact between the CM and fairing, achieving performance similar to the Orion launch abort system. The boost and coast skirts provide the necessary thrust and stability to achieve the flight test conditions and are released prior to the test -- much like the Little Joe booster was used in the Apollo Launch Escape System tests. To achieve the test objective, two parachutes are deployed from the fairing to reorient the CM/fairing to a heatshield first orientation. The parachutes then provide the force necessary to reduce the total angle of attack and body angular rates required for safe release of the CM from the fairing. A secondary test objective after CM release from the fairing is to investigate the removal of the CM forward bay cover (FBC) with CM drogue parachutes for the purpose of attempting to synchronously deploying a set of CM main parachutes. Although multiple parachute deployments are used in the MLAS flight test vehicle to complete its objective, there are only two parachute types employed in the flight test. Five of the nine parachutes used for MLAS are 27.6 ft D(sub 0) ribbon parachutes, and the remaining four are standard G-12 cargo parachutes. This paper presents an overview of the 27.6 ft D(sub 0) ribbon parachute system employed on the MLAS flight test vehicle for coast skirt separation, fairing reorientation, and as drogue parachutes for the CM after separation from the fairing. Discussion will include: the process used to select this design, previously proven as a spin/stall recovery parachute; descriptions of all components of the parachute system; the minor modifications necessary to adapt the parachute to the MLAS program; the techniques used to analyze the parachute for the multiple roles it performs; a discussion of the rigging techniques used to interface the parachute system to the vehicle; and a brief description of how the evolution of the program affected parachute usage and analysis. An overview of the Objective system, rationale for the MLAS approach and the future of the program will also be presented. We hope to have flight test results to report at the time of the Conference Presentation.

14 CFR 91.1431 - CAMP: Continuing analysis and surveillance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... program manager who maintains program aircraft under a CAMP must establish and maintain a system for the... program manager or by another person. (b) Whenever the Administrator finds that the programs described in... program manager must, after notification by the Administrator, make changes in those programs requested by...

Major Management Challenges and Program Risks. Department of Education

DTIC Science & Technology

2001-01-01

GAO United States General Accounting Office Performance and Accountability SeriesJanuary 2001 Major Management Challenges and Program Risks ...34) Title and Subtitle Major Management Challenges and Program Risks Department of Education Contract or Grant Number Program Element Number Authors...Accountability Series: Major Management Challenges and Program Risks . In that series, GAO advised the Congress that it planned to reassess the

Counter-Chemical, Biological, Radiological, and Nuclear Operations

DTIC Science & Technology

2007-01-26

environment. (Page 10) Consequence management activities serve to reduce the effects of a CBRN attack or event, and assist in the restoration of...can be used quite effectively as attack agents. Toxic Industrial Chemicals (TICs), Toxic Industrial Materials (TIMs), and other potentially...CBRN pillars. Consequence Management Consequence management (CM) activities serve to reduce the effects of a CBRN attack or event, and assist in

Effect of inhaled glucocorticoids in childhood on adult height.

PubMed

Kelly, H William; Sternberg, Alice L; Lescher, Rachel; Fuhlbrigge, Anne L; Williams, Paul; Zeiger, Robert S; Raissy, Hengameh H; Van Natta, Mark L; Tonascia, James; Strunk, Robert C

2012-09-06

The use of inhaled glucocorticoids for persistent asthma causes a temporary reduction in growth velocity in prepubertal children. The resulting decrease in attained height 1 to 4 years after the initiation of inhaled glucocorticoids is thought not to decrease attained adult height. We measured adult height in 943 of 1041 participants (90.6%) in the Childhood Asthma Management Program; adult height was determined at a mean (±SD) age of 24.9±2.7 years. Starting at the age of 5 to 13 years, the participants had been randomly assigned to receive 400 μg of budesonide, 16 mg of nedocromil, or placebo daily for 4 to 6 years. We calculated differences in adult height for each active treatment group, as compared with placebo, using multiple linear regression with adjustment for demographic characteristics, asthma features, and height at trial entry. Mean adult height was 1.2 cm lower (95% confidence interval [CI], -1.9 to -0.5) in the budesonide group than in the placebo group (P=0.001) and was 0.2 cm lower (95% CI, -0.9 to 0.5) in the nedocromil group than in the placebo group (P=0.61). A larger daily dose of inhaled glucocorticoid in the first 2 years was associated with a lower adult height (-0.1 cm for each microgram per kilogram of body weight) (P=0.007). The reduction in adult height in the budesonide group as compared with the placebo group was similar to that seen after 2 years of treatment (-1.3 cm; 95% CI, -1.7 to -0.9). During the first 2 years, decreased growth velocity in the budesonide group occurred primarily in prepubertal participants. The initial decrease in attained height associated with the use of inhaled glucocorticoids in prepubertal children persisted as a reduction in adult height, although the decrease was not progressive or cumulative. (Funded by the National Heart, Lung, and Blood Institute and the National Center for Research Resources; CAMP ClinicalTrials.gov number, NCT00000575.).

SU-E-T-312: Dosimetric Consideration for the Agility MLC When Planning Rotational SRT/SBRT Treatments

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

Kong, X; Harris, J; Spitznagel, D

2015-06-15

Purpose: To analyze the radiation transmission of the Agility MLC and make recommendation based on the MLC dosimetric characteristics for SRT, SBRT and VMAT planning Method and Materials: Agility MLC is the newest model from Elekta and has no back up diaphragm behind leaves for this generation. Leaves are single focused with rounded end; composed of leafs each 0.5cm wide, 9cm thick, constructed from tungsten alloy and provide low transmission <0.5%. Total radiation transmission from leaves and diaphragm is <0.13%. A 360degree arc was generated using iCom tools; leaves were programmed closed while keeping the diaphragm fully open to maximizemore » the MLC transmission effect. Gafchromic EBT films were sandwiched between 4cm of solid water and situated at midplane to take dose measurement. 5000MU was delivered using 6MV VersaHD, various collimator angles, and a 5cm central axis offset was tested also. Films were scanned with Epson 10000XL scanner and analyzed using DoseLab Pro. Results: Due to the rounded leaf end and nature of rotation therapy, dose accumulation through the leaf gap is significant. By offsetting the leaf gap from central axis, this accumulation can be greatly reduced. There are dark bands showing accumulation of interleaf transmission which is improved by increasing collimator angle from 0 to 45dgree. However for 45 degree, in most cases, there are larger volumes sweeping under MLC alone, which needs considered planning. Conclusions: While inter-leaf leakage is minimized by using collimator angles greater than 0 degrees, the location of the leaf gap must also be managed. The leaf gap position becomes critically important when the treatment area is off axis such is the case when more than one PTV is being treated. With VMAT for SRT, SBRT becoming a more popular planning technique, special attention needs to be paid when initially setting up the field geometry.« less

High-order finite difference formulations for the incompressible Navier-Stokes equations on the CM-5

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

Tafti, D.

1995-12-01

The paper describes the features and implementation of a general purpose high-order accurate finite difference computer program for direct and large-eddy simulations of turbulence on the CM-5 in the data parallel mode. Benchmarking studies for a direct simulation of turbulent channel flow are discussed. Performance of up to 8.8 GFLOPS is obtained for the high-order formulations on 512 processing nodes of the CM-5. The execution time for a simulation with 24 million nodes in a domain with two periodic directions is in the range of 0.2 {mu}secs/time-step/degree of freedom on 512 processing nodes of the CM-5.

Follow-up treatment effects of contingency management and motivational interviewing on substance use: A meta-analysis.

PubMed

Sayegh, Caitlin S; Huey, Stanley J; Zara, Erica J; Jhaveri, Kinnari

2017-06-01

Motivation is an integral factor in substance use treatment and long-term recovery. However, it is unclear what role intrinsic and extrinsic motivation play across different treatment modalities. A meta-analysis (N = 84) was performed to estimate the pooled effect size of Motivational Interviewing (MI; primarily targeting intrinsic motivation) and contingency management (CM; primarily targeting extrinsic motivation) at different follow-up periods. Collapsed across all substance types, CM had a significant effect at 3-month follow-up, only. In contrast, MI had a significant effect at 6-month follow-up, only. CM had small and medium effects on multiple substances at 3-month follow-up (i.e., tobacco, marijuana, stimulants, polysubstances), but not at 6-month follow-up. MI had 1 significant medium effect at 3-month follow-up (i.e., marijuana), but several significant small effects at 6-month follow-up (i.e., alcohol, tobacco, polysubstances). This meta-analysis suggests that both CM and MI promote reductions in a range of substances, even several months after the intervention concludes. Further, these results provide some evidence that extrinsically focused CM may produce medium follow-up effects in the short run, but intrinsically focused MI may produce small but durable follow-up effects. However, this interpretation is complicated by the differences between the MI and CM studies that preclude statistical tests comparing effect sizes, and few studies assessed motivation itself. Future researchers should investigate how motivational dynamics impact lasting outcomes in substance use treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

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

Xu, H; Guerrero, M; Chen, S

Purpose: The TG-71 report was published in 2014 to present standardized methodologies for MU calculations and determination of dosimetric quantities. This work explores the clinical implementation of a TG71-based electron MU calculation algorithm and compares it with a recently released commercial secondary calculation program–Mobius3D (Mobius Medical System, LP). Methods: TG-71 electron dosimetry data were acquired, and MU calculations were performed based on the recently published TG-71 report. The formalism in the report for extended SSD using air-gap corrections was used. The dosimetric quantities, such PDD, output factor, and f-air factors were incorporated into an organized databook that facilitates data accessmore » and subsequent computation. The Mobius3D program utilizes a pencil beam redefinition algorithm. To verify the accuracy of calculations, five customized rectangular cutouts of different sizes–6×12, 4×12, 6×8, 4×8, 3×6 cm{sup 2}–were made. Calculations were compared to each other and to point dose measurements for electron beams of energy 6, 9, 12, 16, 20 MeV. Each calculation / measurement point was at the depth of maximum dose for each cutout in a 10×10 cm{sup 2} or 15×15cm{sup 2} applicator with SSDs 100cm and 110cm. Validation measurements were made with a CC04 ion chamber in a solid water phantom for electron beams of energy 9 and 16 MeV. Results: Differences between the TG-71 and the commercial system relative to measurements were within 3% for most combinations of electron energy, cutout size, and SSD. A 5.6% difference between the two calculation methods was found only for the 6MeV electron beam with 3×6 cm{sup 2}cutout in the 10×10{sup 2}cm applicator at 110cm SSD. Both the TG-71 and the commercial calculations show good consistency with chamber measurements: for 5 cutouts, <1% difference for 100cm SSD, and 0.5–2.7% for 110cm SSD. Conclusions: Based on comparisons with measurements, a TG71-based computation method and a Mobius3D program produce reasonably accurate MU calculations for electron-beam therapy.« less

49 CFR 237.31 - Adoption of bridge management programs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Adoption of bridge management programs. 237.31... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Railroad Bridge Safety Assurance § 237.31 Adoption of bridge management programs. Each track owner shall adopt a bridge safety management program to...

45 CFR 2543.20 - Purpose of financial and program management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Purpose of financial and program management. 2543... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Financial and Program Management § 2543.20 Purpose of financial and program management. Sections 2543.21 through 2543.25 prescribe standards for...

40 CFR 30.20 - Purpose of financial and program management.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Program Management § 30.20 Purpose of financial and program management. Sections 30.21 through 30.28 prescribe standards for financial management systems, methods for making payments and rules for: satisfying... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Purpose of financial and program...

30 CFR 256.20 - Consideration of coastal zone management program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Consideration of coastal zone management....20 Consideration of coastal zone management program. In the development of the leasing program, consideration shall be given to the coastal zone management program being developed or administered by an...

24 CFR 84.20 - Purpose of financial and program management.

Code of Federal Regulations, 2010 CFR

2010-04-01

... and Program Management § 84.20 Purpose of financial and program management. Sections 84.21 through 84.28 prescribe standards for financial management systems, methods for making payments and rules for... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Purpose of financial and program...

75 FR 76691 - Oregon; Correction of Federal Authorization of the State's Hazardous Waste Management Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-09

...; Correction of Federal Authorization of the State's Hazardous Waste Management Program AGENCY: Environmental... to the State of Oregon's federally authorized RCRA hazardous waste management program. On January 7... changes the State of Oregon made to its federally authorized RCRA Hazardous Waste Management Program...

75 FR 918 - Oregon: Final Authorization of State Hazardous Waste Management Program Revision

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-07

... Authorization of State Hazardous Waste Management Program Revision AGENCY: Environmental Protection Agency (EPA... hazardous waste management program under the Resource Conservation and Recovery Act, as amended (RCRA). On... has decided that the revisions to the Oregon hazardous waste management program satisfy all of the...

49 CFR 237.31 - Adoption of bridge management programs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Adoption of bridge management programs. 237.31... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Railroad Bridge Safety Assurance § 237.31 Adoption of bridge management programs. Each track owner shall adopt a bridge safety management program to...

Endurance testing of a 30-cm Kaufman thruster

NASA Technical Reports Server (NTRS)

Collett, C. R.

1973-01-01

Results of a program to demonstrate lifetime capability of a 30-cm Kaufman ion thruster with a 6000 hour endurance test are described. Included in the program are (1) thruster fabrication, (2) design and construction of a test console containing a transistorized high frequency power processor, and control circuits which provide unattended automatic operation of the thruster, and (3) modification of a vacuum facility to incorporate a frozen mercury collector and permit unattended operation. Four tests ranging in duration from 100 to 1100 hours have been completed. These tests and the resulting thruster modifications are described. The status of the endurance test is also presented.

20 CFR 632.76 - Program management systems.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Program management systems. 632.76 Section... management systems. (a) All Native American grantees shall establish management information systems to... for the overall management of all programs including: (1) Eligibility verification systems as...

[The German program for disease management guidelines--implementation with pathways and quality management].

PubMed

Ollenschläger, Günter; Lelgemann, Monika; Kopp, Ina

2007-07-15

In Germany, physicians enrolled in disease management programs are legally obliged to follow evidence-based clinical practice guidelines. That is why a Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 aiming at implementation of best-practice evidence-based recommendations for nationwide as well as regional disease management programs. Against this background the article reviews programs, methods and tools for implementing DM-CPGs via clinical pathways as well as regional guidelines for outpatient care. Special reference is given to the institutionalized program of adapting DM-CPGs for regional use by primary-care physicians in the State of Hesse.