Sample records for management practices influence
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Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J; Chin, Marshall H; Chiu, Michael; Schaefer, Cynthia T
2015-01-01
Evidence suggests that top managers' support influences middle managers' commitment to innovation implementation. What remains unclear is how top managers' support influences middle managers' commitment. Results may be used to improve dismal rates of innovation implementation. We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 U.S. health centers to assess whether top managers' support directly influences middle managers' commitment; by allocating implementation policies and practices; or by moderating the influence of implementation policies and practices on middle managers' commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. We found support for each hypothesized relationship: Results suggest that top managers increase middle managers' commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = .09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95% confidence interval [0.03, 0.17]); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Top managers can demonstrate their support directly by conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers' support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation.
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Site establishment practices influence loblolly pine mortality throughout the stand rotation
Felipe G. Sanchez; Robert J. Eaton
2010-01-01
During a rotation, land managers need to estimate yields, update inventories, and evaluate stand dynamics. All of these factors in land management are heavily influenced by tree mortality. Tree mortality can, in turn, be influenced by land management practices from the inception of the stand and throughout the rotation. We describe the impact of organic matter removal...
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Paediatric fever management: continuing education for clinical nurses.
Walsh, Anne M; Edwards, Helen E; Courtney, Mary D; Wilson, Jenny E; Monaghan, Sarah J
2006-01-01
This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management. Fifty-one nurses from medical wards in an Australian metropolitan paediatric hospital completed a self-report descriptive survey. Knowledge of fever management was mediocre (Mean 12.4, SD 2.18 on 20 items). Nurses practicing at a higher level and those with between one and four years paediatric or current experience were more knowledgeable than novices or more experienced nurses. Negative beliefs that would impact nursing practice were identified. Interestingly, beliefs about fever, antipyretic use in fever management and febrile seizures were similar; they were not influenced by nurses' knowledge, experience, education or level of practice. Paediatric nurses are not expert fever managers. Knowledge deficits and negative attitudes influence their practice irrespective of additional paediatric education, paediatric or current experience or level of practice. Continuing education is therefore needed for all paediatric nurses to ensure the latest clear evidence available in the literature for best practice in fever management is applied.
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Boet, Sylvain; Patey, Andrea M; Baron, Justine S; Mohamed, Karim; Pigford, Ashlee-Ann E; Bryson, Gregory L; Brehaut, Jamie C; Grimshaw, Jeremy M
2017-06-01
Inadvertent perioperative hypothermia (IPH) is associated with a range of adverse outcomes. Safe and effective warming techniques exist to prevent IPH; however, IPH remains common. This study aimed to identify factors that anesthesiologists perceive may influence temperature management during the perioperative period. After Research Ethics Board approval, semi-structured interviews were conducted with staff anesthesiologists at a Canadian academic hospital. An interview guide based on the Theoretical Domains Framework (TDF) was used to capture 14 theoretical domains that may influence temperature management. The interview transcripts were coded using direct content analysis to generate specific beliefs and to identify relevant TDF domains perceived to influence temperature management behaviour. Data saturation was achieved after 15 interviews. The following nine theoretical domains were identified as relevant to designing an intervention for practices in perioperative temperature management: knowledge, beliefs about capabilities, beliefs about consequences, reinforcement, memory/attention/decision-making, environmental context and resources, social/professional role/identity, social influences, and behavioural regulation. Potential target areas to improve temperature management practices include interventions that address information needs about individual temperature management behaviour as well as patient outcome (feedback), increasing awareness of possible temperature management strategies and guidelines, and a range of equipment and surgical team dynamics that influence temperature management. This study identified several potential target areas for future interventions from nine of the TDF behavioural domains that anesthesiologists perceive to drive their temperature management practices. Future interventions that aim to close the evidence-practice gap in perioperative temperature management may include these targets.
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Dansky, Kathryn H; Weech-Maldonado, Robert; De Souza, Gita; Dreachslin, Janice L
2003-01-01
Empirical studies on diversity suggest that health care organizations have been slow to embrace diversity management. We propose that sensitivity to diversity, at the corporate level, moderates strategic decision making, which influences human resource management practices such as diversity initiatives. This study of 203 hospitals explored the relationships among organizational strategy, organizational sensitivity to diversity, and diversity management practices.
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Lee, Shoou-Yih Daniel; Weiner, Bryan J.; Chin, Marshall H.; Chiu, Michael; Schaefer, Cynthia T.
2014-01-01
Background Evidence suggests that top managers’ support influences middle managers’ commitment to innovation implementation. What remains unclear is how top managers’ support influences middle managers’ commitment. Results may be used to improve dismal rates of innovation implementation. Methods We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 US health centers to assess whether top managers’ support influences middle managers’ commitment directly, by allocating implementation policies and practices, or by moderating the influence of implementation policies and practices on middle managers’ commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. Findings We found support for each hypothesized relationship: Results suggest that top managers increase middle managers’ commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = 0.09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95 percent CI: 0.03, 0.17); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Practice Implications Top managers can demonstrate their support by directly conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers’ support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation. PMID:24566252
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A Case Study of Classroom Management Practices and the Influence on Classroom Disruptions
ERIC Educational Resources Information Center
Rusk, Robert Brian
2016-01-01
This qualitative case study explored how the classroom management practices of sampled teachers in a private school in central Oregon influenced classroom disruptions. Through the study, the researcher was able to provide insight on the differences in specific classroom management processes between teachers who had a high number of Positive…
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Daire, Judith; Gilson, Lucy
2014-01-01
In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager’s job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. PMID:25274644
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NASA Astrophysics Data System (ADS)
Sánchez-Navarro, Virginia; Zornoza, Raúl; Faz, Ángel; Fernández, Juan A.
2017-04-01
In this study we assessed the effect of two different rotations based on winter (faba bean) or summer (cowpea) legumes on the direct emissions of CO2 and CH4. Faba bean was rotated with the summer melon crop (Cucumis melo) while cowpea was rotated with the winter broccoli crop (Brassica oleracea). We also assessed if different legume cultivars and management practices (conventional and organic) significantly influenced gas emissions. The study was randomly designed in blocks with four replications, in plots of 10 m2, during two complete cycles. Gas samples were taken in different times (0, 30 and 60 minutes) once a week using the static gas chamber technique for each crop. Results showed that cumulative CO2 emissions in broccoli decreased after the rotation with both cowpea cultivars under conventional management practices. Faba bean cultivars and management practices had no influence on cumulative CO2 emissions in melon crop. Cumulative CH4 emissions in broccoli crop were lowest after the rotation with Grey-eyed pea than Black-eyed pea cultivar, under both management practices. However, faba bean cultivars and management practices had no influence on cumulative CH4 emissions in melon crop. Cumulative CH4 emissions in melon crop were highest than in the rest of crops. Cowpea cultivar and management practice influenced cumulative CH4 and CO2 emissions of broccoli crop, respectively. Faba bean cultivar and management practice had no effect on cumulative CH4 and CO2 emissions of melon crop. Acknowledgements: This research was financed by the FP7 European Project Eurolegume (FP7-KBBE-613781).
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The Influence of Corporate Leadership and Management Practices on a Public School District
ERIC Educational Resources Information Center
Napier, Randall Paul, Jr.
2012-01-01
The purpose of this case study is to understand how management and leadership ideas that were present in Toyota Motor Manufacturing Kentucky influenced management and leadership practices adopted by Scott County Public Schools during 2002-2011. Data for the study were collected during the summer of 2011, using individual and focus group interviews…
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Counseling women with early pregnancy failure: utilizing evidence, preserving preference.
Wallace, Robin R; Goodman, Suzan; Freedman, Lori R; Dalton, Vanessa K; Harris, Lisa H
2010-12-01
To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management. Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient priorities for EPF management; and the clinical factors, resources, and provider bias that may influence current practice. Women have strong and diverse preferences for EPF management and report higher satisfaction when treated according to these preferences. However, estimates of actual treatment patterns suggest that current practice does not reflect the evidence for safety and acceptability of all options, or patient preferences. Multiple practice barriers and biases exist that may be influencing provider counseling about options for EPF management. Choosing management for EPF is a preference-sensitive decision. A patient-centered approach to EPF management should incorporate counseling about all treatment options. Providers can integrate a counseling model into EPF management practice that utilizes principles of shared decision-making and an organized method for eliciting patient preferences, priorities, and concerns about treatment options. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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Daire, Judith; Gilson, Lucy
2014-09-01
In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager's job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.
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Hotel housekeeping work influences on hypertension management.
Sanon, Marie-Anne
2013-12-01
Characteristics of hotel housekeeping work increase the risk for hypertension development. Little is known about the influences of such work on hypertension management. For this qualitative study, 27 Haitian immigrant hotel housekeepers from Miami-Dade County, FL were interviewed. Interview transcripts were analyzed with the assistance of the Atlas.ti software for code and theme identification. Influences of hotel housekeeping work on hypertension management arose both at the individual and system levels. Factors at the individual level included co-worker dynamics and maintenance of transmigrant life. Factors at the system level included supervisory support, workload, work pace, and work hiring practices. No positive influences were reported for workload and hiring practices. Workplace interventions may be beneficial for effective hypertension management among hotel housekeepers. These work influences must be considered when determining effective methods for hypertension management among hotel housekeepers. © 2013 Wiley Periodicals, Inc.
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Lalleman, P C B; Smid, G A C; Lagerwey, M D; Shortridge-Baggett, L M; Schuurmans, M J
2016-11-01
Nurse managers play an important role in implementing patient safety practices in hospitals. However, the influence of their professional background on their clinical leadership behaviour remains unclear. Research has demonstrated that concepts of Bourdieu (dispositions of habitus, capital and field) help to describe this influence. It revealed various configurations of dispositions of the habitus in which a caring disposition plays a crucial role. We explore how the caring disposition of nurse middle managers' habitus influences their clinical leadership behaviour in patient safety practices. Our paper reports the findings of a Bourdieusian, multi-site, ethnographic case study. Two Dutch and two American acute care, mid-sized, non-profit hospitals. A total of 16 nurse middle managers of adult care units. Observations were made over 560h of shadowing nurse middle managers, semi-structured interviews and member check meetings with the participants. We observed three distinct configurations of dispositions of the habitus which influenced the clinical leadership of nurse middle managers in patient safety practices; they all include a caring disposition: (1) a configuration with a dominant caring disposition that was helpful (via solving urgent matters) and hindering (via ad hoc and reactive actions, leading to quick fixes and 'compensatory modes'); (2) a configuration with an interaction of caring and collegial dispositions that led to an absence of clinical involvement and discouraged patient safety practices; and (3) a configuration with a dominant scientific disposition showing an investigative, non-judging, analytic stance, a focus on evidence-based practice that curbs the ad hoc repertoire of the caring disposition. The dispositions of the nurse middle managers' habitus influenced their clinical leadership in patient safety practices. A dominance of the caring disposition, which meant 'always' answering calls for help and reactive and ad hoc reactions, did not support the clinical leadership role of nurse middle managers. By perceiving the team of staff nurses as pseudo-patients, patient safety practice was jeopardized because of erosion of the clinical disposition. The nurse middle managers' clinical leadership was enhanced by leadership behaviour based on the clinical and scientific dispositions that was manifested through an investigative, non-judging, analytic stance, a focus on evidence-based practice and a curbed caring disposition. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Reverse quality management: developing evidence-based best practices in health emergency management.
Lynch, Tim; Cox, Paul
2006-01-01
The British Columbia Ministry of Health's Framework for Core Functions in Public Health was the catalyst that inspired this review of best practices in health emergency management. The fieldwork was conducted in the fall of 2005 between hurricane Katrina and the South Asia earthquake. These tragedies, shown on 24/7 television news channels, provided an eyewitness account of disaster management, or lack of it, in our global village world. It is not enough to just have best practices in place. There has to be a governance structure that can be held accountable. This review of best practices lists actions in support of an emergency preparedness culture at the management, executive, and corporate/governance levels of the organization. The methodology adopted a future quality management approach of the emergency management process to identify the corresponding performance indictors that correlated with practices or sets of practices. Identifying best practice performance indictors needed to conduct a future quality management audit is described as reverse quality management. Best practices cannot be assessed as stand-alone criteria; they are influenced by organizational culture. The defining of best practices was influenced by doubt about defining a practice it is hoped will never be performed, medical staff involvement, leadership, and an appreciation of the resources required and how they need to be managed. Best practice benchmarks are seen as being related more to "measures" of performance defined locally and agreed on by 2 or more parties rather than to achieving industrial standards. Relating practices to performance indicators and then to benchmarks resulted in the development of a Health Emergency Management Best Practices Matrix that lists specific practice in the different phases of emergency management.
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The influence of the structure and culture of medical group practices on prescription drug errors.
Kralewski, John E; Dowd, Bryan E; Heaton, Alan; Kaissi, Amer
2005-08-01
This project was designed to identify the magnitude of prescription drug errors in medical group practices and to explore the influence of the practice structure and culture on those error rates. Seventy-eight practices serving an upper Midwest managed care (Care Plus) plan during 2001 were included in the study. Using Care Plus claims data, prescription drug error rates were calculated at the enrollee level and then were aggregated to the group practice that each enrollee selected to provide and manage their care. Practice structure and culture data were obtained from surveys of the practices. Data were analyzed using multivariate regression. Both the culture and the structure of these group practices appear to influence prescription drug error rates. Seeing more patients per clinic hour, more prescriptions per patient, and being cared for in a rural clinic were all strongly associated with more errors. Conversely, having a case manager program is strongly related to fewer errors in all of our analyses. The culture of the practices clearly influences error rates, but the findings are mixed. Practices with cohesive cultures have lower error rates but, contrary to our hypothesis, cultures that value physician autonomy and individuality also have lower error rates than those with a more organizational orientation. Our study supports the contention that there are a substantial number of prescription drug errors in the ambulatory care sector. Even by the strictest definition, there were about 13 errors per 100 prescriptions for Care Plus patients in these group practices during 2001. Our study demonstrates that the structure of medical group practices influences prescription drug error rates. In some cases, this appears to be a direct relationship, such as the effects of having a case manager program on fewer drug errors, but in other cases the effect appears to be indirect through the improvement of drug prescribing practices. An important aspect of this study is that it provides insights into the relationships of the structure and culture of medical group practices and prescription drug errors and provides direction for future research. Research focused on the factors influencing the high error rates in rural areas and how the interaction of practice structural and cultural attributes influence error rates would add important insights into our findings. For medical practice directors, our data show that they should focus on patient care coordination to reduce errors.
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Hotel Housekeeping Work Influences on Hypertension Management
Sanon, Marie-Anne
2013-01-01
Background Characteristics of hotel housekeeping work increase the risk for hypertension development. Little is known about the influences of such work on hypertension management. Methods For this qualitative study, 27 Haitian immigrant hotel housekeepers from Miami-Dade County, FL were interviewed. Interview transcripts were analyzed with the assistance of the Atlas. ti software for code and theme identification. Results Influences of hotel housekeeping work on hypertension management arose both at the individual and system levels. Factors at the individual level included co-worker dynamics and maintenance of transmigrant life. Factors at the system level included supervisory support, workload, work pace, and work hiring practices. No positive influences were reported for workload and hiring practices. Conclusions Workplace interventions may be beneficial for effective hypertension management among hotel housekeepers. These work influences must be considered when determining effective methods for hypertension management among hotel housekeepers. PMID:23775918
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Case management: developing practice through action research.
Smith, Annetta; Mackay, Seonaid; McCulloch, Kathleen
2013-09-01
This article is a report of an action research study carried out with community nurses to help develop case management within their practice. Using action research principles, nurses reviewed and analysed their current practice and developed recommendations for further embedding case management as a means of supporting patients with complex care needs in their own homes. Findings indicate that a number of factors can influence the community nurse's ability to implement case management. These factors include approaches to case finding, availability of resources and interprofessional working. Important considerations for nurses were the influence of the context of care, the geographical location and the health needs of the local patient population, which meant that case management may need to be adapted to meet local circumstances.
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76 FR 56145 - Clearwater National Forest; ID; Upper Lochsa Land Exchange EIS
Federal Register 2010, 2011, 2012, 2013, 2014
2011-09-12
... for timber production. For the most part these lands currently meet State Best Management Practices... River drainage to provide more efficient and effective resource management. This purpose can be achieved... years, differing management practices on the private lands has influenced resource management decision...
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Agi, Maher A N; Nishant, Rohit
2017-03-01
In this study, we establish a set of 19 influential factors on the implementation of Green Supply Chain Management (GSCM) practices and analyse the interaction between these factors and their effect on the implementation of GSCM practices using the Interpretive Structural Modelling (ISM) method and the "Matrice d'Impacts Croisés Multiplication Appliquée à un Classement" (MICMAC) analysis on data compiled from interviews with supply chain (SC) executives based in the Gulf countries (Middle East region). The study reveals a strong influence and driving power of the nature of the relationships between SC partners on the implementation of GSCM practices. We especially found that dependence, trust, and durability of the relationship with SC partners have a very high influence. In addition, the size of the company, the top management commitment, the implementation of quality management and the employees training and education exert a critical influence on the implementation of GSCM practices. Contextual elements such as the industry sector and region and their effect on the prominence of specific factors are also highlighted through our study. Finally, implications for research and practice are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.
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The influence of leadership practices and empowerment on Canadian nurse manager outcomes.
Spence Laschinger, Heather K; Wong, Carol A; Grau, Ashley L; Read, Emily A; Pineau Stam, Lisa M
2012-10-01
To examine the influence of senior nurse leadership practices on middle and first-line nurse managers' experiences of empowerment and organizational support and ultimately on their perceptions of patient care quality and turnover intentions. Empowering leadership has played an important role in staff nurse retention but there is limited research to explain the mechanisms by which leadership influences nurse managers' turnover intentions. This study was a secondary analysis of data collected using non-experimental, predictive mailed survey design. Data from 231 middle and 788 first-line Canadian acute care managers was used to test the hypothesized model using path analysis in each group. The results showed an adequate fit of the hypothesized model in both groups but with an added path between leadership practices and support in the middle line group. Transformational leadership practices of senior nurses empower middle- and first-line nurse managers, leading to increased perceptions of organizational support, quality care and decreased intent to leave. Empowered nurse managers at all levels who feel supported by their organizations are more likely to stay in their roles, remain committed to achieving quality patient care and act as influential role models for potential future leaders. © 2011 Blackwell Publishing Ltd.
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ERIC Educational Resources Information Center
Dillon, E. J.; Hennessy, T.; Cullinan, J.
2016-01-01
Purpose: To examine the role of agricultural education and extension in influencing the adoption of best practice with regard to herd-level mastitis management. Design/Methodology/Approach: Somatic cell count (SCC) is an indicator of herd health with regard to mastitis and is negatively related to productivity and profitability. Panel data…
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ERIC Educational Resources Information Center
April, Daniel; Bouchamma, Yamina
2017-01-01
In the province of Québec, Canada, school principals are obligated by law to ensure pedagogical supervision. This law, the Public Education Act (Government of Québec, 2017), also advocates a contractual Results-Based Management approach (RBM). We examined how the practices and perceptions of these supervisors influence the implementation of this…
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ERIC Educational Resources Information Center
Bennion, Paul
2013-01-01
This study focused on the perspectives of senior enrollment management administrators in relation to institutional strategic planning documents in order to gain insight into the extent to which "neoliberalism" is influencing the values and practices of private, nonprofit liberal arts institutions. The researcher focused on senior…
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Tavender, Emma J; Bosch, Marije; Gruen, Russell L; Green, Sally E; Knott, Jonathan; Francis, Jill J; Michie, Susan; O'Connor, Denise A
2014-01-13
Mild traumatic brain injury is a frequent cause of presentation to emergency departments. Despite the availability of clinical practice guidelines in this area, there is variation in practice. One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted, theory- and evidence-informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments. This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence-based recommended practices for managing mild traumatic brain injury. Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria. The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. A total of 42 participants (9 Directors, 20 doctors and 13 nurses) were interviewed over a seven-month period. The results suggested that (i) the prospective assessment of post-traumatic amnesia was influenced by: knowledge; beliefs about consequences; environmental context and resources; skills; social/professional role and identity; and beliefs about capabilities; (ii) the use of guideline-developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by: knowledge; beliefs about consequences; environmental context and resources; memory, attention and decision processes; beliefs about capabilities; social influences; skills and behavioral regulation; (iii) providing verbal and written patient information on discharge was influenced by: beliefs about consequences; environmental context and resources; memory, attention and decision processes; social/professional role and identity; and knowledge; (iv) the practice of providing brief, routine follow-up on discharge was influenced by: environmental context and resources; social/professional role and identity; knowledge; beliefs about consequences; and motivation and goals. Using the Theoretical Domains Framework, factors thought to influence the management of mild traumatic brain injury in the emergency department were identified. These factors present theoretically based targets for a future intervention.
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Influence of farm management upon arbuscular mycorrhizal fungi
USDA-ARS?s Scientific Manuscript database
Good farming practices are conducted for a variety of reasons. Farmers now include management practices such as over wintering cover crops, reduced tillage, and crop rotation with the goals of reducing soil erosion, managing nutrient availability, building soil organic matter, controlling weeds, an...
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Bonenberger, Marc; Aikins, Moses; Akweongo, Patricia; Wyss, Kaspar
2016-01-14
There is increasing evidence that good district management practices can improve health system performance and conversely, that poor and inefficient management practices have detrimental effects. The aim of the present study was to identify factors contributing to inefficient management practices of district health managers and ways to improve their overall efficiency. Nineteen semi-structured interviews were conducted with district health managers in three districts of the Eastern Region in Ghana. The 19 interviews conducted comprised 90% of the managerial workforce in these districts in 2013. A thematic analysis was carried out using the WHO's leadership and management strengthening framework to structure the results. Key factors for inefficient district health management practices were identified to be: human resource shortages, inadequate planning and communication skills, financial constraints, and a narrow decision space that constrains the authority of district health managers and their ability to influence decision-making. Strategies that may improve managerial efficiency at both an individual and organizational level included improvements to planning, communication, and time management skills, and ensuring the timely release of district funds. Filling District Health Management Team vacancies, developing leadership and management skills of district health managers, ensuring a better flow of district funds, and delegating more authority to the districts seems to be a promising intervention package, which may result in better and more efficient management practices and stronger health system performance.
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ERIC Educational Resources Information Center
Reimer, Adam P.; Weinkauf, Denise Klotthor; Prokopy, Linda Stalker
2012-01-01
Agricultural best management practices (BMPs), or conservation practices, can help reduce nonpoint source pollution from agricultural lands, as well as provide valuable wildlife habitat. There is a large literature exploring factors that lead to a producer's voluntary adoption of BMPs, but there have been inconsistent findings. Generally, this…
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Hamilton-Webb, A; Naylor, R; Little, R; Maye, D
2016-11-19
Relatively little is known about the perceived influence of different compensation systems on animal keepers' management of exotic livestock disease. This paper aims to address this research gap by drawing on interviews with 61 animal keepers and 21 veterinarians, as well as a series of nine animal keeper focus groups across five different livestock sectors in England. The perceived influence of current compensation systems on disease control behaviour was explored and alternative compensation systems that respectively reward positive practices and penalise poor practices were presented in the form of scenarios, alongside a third system that considered the option of a cost-sharing levy system between industry and government. The results indicate that animal keepers consider themselves to be influenced by a range of non-financial factors, for example, feelings of responsibility, reputation and animal welfare concerns, in the context of their exotic disease management practices. The majority of animal keepers were unaware of the current compensation systems in place for exotic diseases, and were therefore not consciously influenced by financial recompense. Concerns were raised about linking compensation to disease management behaviour due to auditing difficulties. A cost-sharing levy system would likely raise awareness of exotic disease and compensation among animal keepers, but differentiation of payments based upon individual farm-level risk assessments was called for by participants as a strategy to promote positive disease management practices. British Veterinary Association.
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Teachers' Professional Learning: The Role of Knowledge Management Practices
ERIC Educational Resources Information Center
Niehoff, Karissa
2010-01-01
This qualitative study explored the degree to which knowledge management strategies addressed teacher professional learning at the high school level. In the setting of a Connecticut public high school, interviews were conducted which explored teacher perceptions of knowledge sharing practices in the school and how those practices influenced their…
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Strange, David M
2014-01-01
Behavior guidance in pediatric dentistry is a composite of influences including expert opinion, historical precedent, scientific studies, and social factors including the law and the media. The early icons of pediatric dentistry injected their personal views on child management, and those often reflected the child-rearing norms of the times. The business of pediatric dentistry with its efficiency and quality orientations also shaped approaches to behavior management. Scientific studies contributed minimally. A major influence on behavior guidelines in recent years has been external scrutiny of techniques prompted by media and other exposure of both private practice and corporate management of children. Changing parenting and reaction of society to authority have also had significant impact on behavior. This paper describes in more detail the evolution of behavior guidance and the subsequent codification of practices into professionally derived guidelines.
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Managing Self-Access Language Learning: Principles and Practice
ERIC Educational Resources Information Center
Gardner, David; Miller, Lindsay
2011-01-01
This paper is based on a research project looking at the management of self-access language learning (SALL) from the perspective of the managers of self-access centres. It looks at the factors which influence the practice of seven managers of self-access language learning in tertiary institutions in Hong Kong. The discussion centres around five…
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An Examination of Assistant Professors' Project Management Practices
ERIC Educational Resources Information Center
Alpert, Shannon Atkinson; Hartshorne, Richard
2013-01-01
Purpose: The purpose of this research was to identify factors that influence the use of project management in higher education research projects by investigating the project management practices of assistant professors. Design/methodology/approach: Using a grounded theory approach that included in-depth, semi-structured interviews with 22…
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Leadership practices and staff nurses' intent to stay: a systematic review.
Cowden, Tracy; Cummings, Greta; Profetto-McGrath, Joanne
2011-05-01
The aim of the present study was to describe the findings of a systematic review of the literature that examined the relationship between managers' leadership practices and staff nurses' intent to stay in their current position. The nursing shortage demands that managers focus on the retention of staff nurses. Understanding the relationship between leadership practices and nurses' intent to stay is fundamental to retaining nurses in the workforce. Published English language articles on leadership practices and staff nurses' intent to stay were retrieved from computerized databases and a manual search. Data extraction and quality assessments were completed for the final 23 research articles. Relational leadership practices influence staff nurses' intentions to remain in their current position. This study supports a positive relationship between transformational leadership, supportive work environments and staff nurses' intentions to remain in their current positions. Incorporating relational leadership theory into management practices will influence nurse retention. Advancing current conceptual models will increase knowledge of intent to stay. Clarifying the distinction between the concepts intent to stay and intent to leave is needed to establish a clear theoretical foundation for further intent to stay research. Nurse managers and leaders who practice relational leadership and ensure quality workplace environments are more likely to retain their staff. The findings of the present study support the claim that leadership practices influence staff nurse retention and builds on intent to stay knowledge. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.
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Hua, Bin; Yan, Wengui; Yang, John
2013-01-01
Arsenic (As) uptake by rice plants and the straighthead disease induced by As-based herbicide are of environmental concerns. Bioavailability or mobility of inorganic As in soil has been reported to be significantly influenced by soil minerals such as iron (hydr) oxide; however, the interactions of organic As such as monosodium methanearsonate (MSMA) with soil minerals are little studied, thus largely unknown. In an effort to minimize the As uptake by rice and determine rice cultivar response to soil MSMA level, a field experiment was conducted on three rice cultivars grown in both MSMA-treated and -untreated soils under continuous or intermittent flood water management practices. Results indicated that the grain yield and the occurrence of straighthead disease were cultivar-dependent and influenced by soil As level and water management practices. Straighthead-resistant cultivars yielded more and had lower grain As than the susceptible ones. Elevated soil As with continuous flood management significantly reduced the grain yield of susceptible cultivars by >89% due to substantially increased straighthead, which were induced by increased As content in grains. Yield reduction by MSMA treatment could be partially mitigated with intermittent flood water practice. The As accumulation was found to be associated with soil iron redox transformation influenced by the water management. This study demonstrates that the selection of less As-susceptible cultivars and intermittent flood water practice could be effective means to lower the As accumulation in grains and minimize the occurrence of the As-induced straighthead symptom and yield reduction. Copyright © 2012 Elsevier B.V. All rights reserved.
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Influences of health literacy, judgment skills, and empowerment on asthma self-management practices.
Londoño, Ana Maria Moreno; Schulz, Peter J
2015-07-01
Asthma self-management has been recognized as an essential factor for the improvement of asthma outcomes and patients' quality of life (WHO, 2013). Likewise, empowerment and health literacy have been noted as important elements for the management of chronic diseases. To study the influence of health literacy and empowerment on asthma self-management. This cross-sectional study used a self-reported questionnaire assessing health literacy, judgment skills, empowerment, and asthma self-management; 236 patients were recruited from medical offices in Switzerland and Italy. Judgment skills (B=2.28, p<0.001) and empowerment (B=0.19, p<0.05) have a significant and positive influence on several asthma self-management practices such as use of medicines, timely medical consultation, and asthma triggers control whereas health literacy (B=-0.15, p<0.175) appeared to have a negative effect on self-management practices. However, this was not significant. These findings suggest that empowered patients with adequate judgment skills carry out key self-management tasks more appropriately, which in turn will potentially result in better asthma control. This study recommends that both empowerment and judgment skills should be addressed in patient education as they serve as essential motivators to engage patients in these behaviors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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USDA-ARS?s Scientific Manuscript database
Here, we demonstrate how vineyard management practices influence shifts in soil resources, which in turn affects shifts in soil-borne bacterial communities. The objective is to determine the hierarchical effects of management practices, soil attributes and location factors on the structure of soil-b...
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NASA Astrophysics Data System (ADS)
Schachtschneider, Klaudia
Namibia's aridity is forcing its water sector to resort to new water resource management approaches, including water demand management (WDM). Such a change in management approach is facilitated through the country's opportunity at independence to rewrite and adapt its old policies, including those for water and tourism. Legal support for WDM through the Water Act and other sector-specific Acts is crucial to plan the practical implementation of WDM throughout the different water use sectors of Namibia. In order to be able to put the policy into practice, it is imperative to understand which factors motivate people to adopt WDM initiatives. Within the Namibian tourism industry three main factors have been identified which influence the water-management approaches at tourist facilities. This paper discusses how the water and tourism decision makers can consider these factors when developing new regulations to introduce WDM in the tourism sector.
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Exploring Cultural Influences of Self-Management of Diabetes in Coastal Kenya
Abdulrehman, Munib Said; Woith, Wendy; Jenkins, Sheryl; Kossman, Susan; Hunter, Gina Louise
2016-01-01
In spite of increasing prevalence of diabetes among Kenyans and evidence suggesting Kenyans with diabetes maintain poor glycemic control, no one has examined the role of cultural attitudes, beliefs, and practices in their self-management of diabetes. The purpose of this ethnographic study was to describe diabetes self-management among the Swahili of coastal Kenya, and explore factors that affect diabetes self-management within the context of Swahili culture. Thirty men and women with type 2 diabetes from Lamu town, Kenya, participated in this study. Diabetes self-management was insufficiently practiced, and participants had limited understanding of diabetes. Economic factors such as poverty and the high cost of biomedical care appear to have more influence in self-management behavior than socio-cultural and educational factors do. Economic and socio-cultural influences on diabetes self-management should not be underestimated, especially in a limited resource environment like coastal Kenya, where biomedical care is not accessible or affordable to all. PMID:28462335
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Rice management interventions to mitigate greenhouse gas emissions: a review.
Hussain, Saddam; Peng, Shaobing; Fahad, Shah; Khaliq, Abdul; Huang, Jianliang; Cui, Kehui; Nie, Lixiao
2015-03-01
Global warming is one of the gravest threats to crop production and environmental sustainability. Rice, the staple food of more than half of the world's population, is the most prominent cause of greenhouse gas (GHG) emissions in agriculture and gives way to global warming. The increasing demand for rice in the future has deployed tremendous concerns to reduce GHG emissions for minimizing the negative environmental impacts of rice cultivation. In this review, we presented a contemporary synthesis of existing data on how crop management practices influence emissions of GHGs in rice fields. We realized that modifications in traditional crop management regimes possess a huge potential to overcome GHG emissions. We examined and evaluated the different possible options and found that modifying tillage permutations and irrigation patterns, managing organic and fertilizer inputs, selecting suitable cultivar, and cropping regime can mitigate GHG emissions. Previously, many authors have discussed the feasibility principle and the influence of these practices on a single gas or, in particular, in the whole agricultural sector. Nonetheless, changes in management practices may influence more than one gas at the same time by different mechanisms or sometimes their effects may be antagonistic. Therefore, in the present attempt, we estimated the overall global warming potential of each approach to consider the magnitude of its effects on all gases and provided a comprehensive assessment of suitable crop management practices for reducing GHG emissions in rice culture.
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Garman, Andrew N; McAlearney, Ann Scheck; Harrison, Michael I; Song, Paula H; McHugh, Megan
2011-01-01
: Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. : Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. : Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. : The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. : Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.
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Effects of forest management practices and environment on occurrence of Armillaria species
Mee-Sook Kim; Ned B. Klopfenstein; Geral I. McDonald
2010-01-01
Influences of environment (indicated by plant associations) and forest management practices on the distribution of Armillaria spp. and genets (vegetative clones) were investigated. A total of 142 isolates of Armillaria was collected from various host trees on pristine and managed sites (thinned and/or fertilized) growing in relatively wet and dry environments in...
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ERIC Educational Resources Information Center
Lambert, Misty D.; Torres, Robert M.; Tummons, John D.
2012-01-01
Monitoring the stress of teachers continues to be important--particularly stress levels of beginning agriculture teachers. The study sought to describe the relationship between beginning teachers' perceived ability to manage their time and their level of stress. The Time Management Practices Inventory and the Job Stress Survey were used to measure…
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Attitudes, norms and controls influencing lifestyle risk factor management in general practice.
Ampt, Amanda J; Amoroso, Cheryl; Harris, Mark F; McKenzie, Suzanne H; Rose, Vanessa K; Taggart, Jane R
2009-08-26
With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of services to patients. General practitioner attitudes, normative influences from both patients and the profession, and perceived external control factors (time, cost, availability and practice capacity) all influence management of behavioural risk factors. Provider education, community awareness raising, support and capacity building may improve the uptake of lifestyle modification interventions.
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Influences of management of Southern forests on water quantity and quality
Ge Sun; Mark Riedel; Rhett Jackson; Randy Kolka; Devendra Amatya; Jim Shepard
2004-01-01
Water is a key output of southern forests and is critical to other processes, functions, and values of forest ecosystems. This chapter synthesizes published literature about the effects of forest management practices on water quantity and water quality across the Southern United States region. We evaluate the influences of forest management at different temporal and...
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Factors Influencing Farmers’ Adoption of Best Management Practices: A Review and Synthesis
Best management practices (BMPs) for reducing agricultural non-point source pollution are widely available. However, agriculture remains a major global contributor to degradation of waters because farmers often do not adopt BMPs. To improve water quality, it is necessary to under...
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The impact of broiler production system practices on consumer perceptions of animal welfare.
de Jonge, Janneke; van Trijp, Hans C M
2013-12-01
This research explores the extent to which different farm management practices influence the perceived animal friendliness of broiler production systems, and how this differs between individuals. Using a conjoint design with paired comparisons, respondents evaluated broiler production systems that were described on the basis of 7 animal welfare-related practices. It was found that practices in the area of outdoor access, stocking density, and day-night rhythm were overall perceived to have a larger impact on perceptions of animal friendliness than other practices, such as transport duration or the type of breed used. However, individuals differed regarding the extent to which they believed the different farm management practices influenced the animal friendliness of the production system. Differences between individuals regarding their knowledge about and familiarity with livestock farming, degree of anthropomorphism, and their moral beliefs regarding animal welfare partly explained the relative importance individuals attached to farm management practices. The obtained insight into which welfare-related farm management practices, in consumers' minds, most strongly contribute to animal welfare, and the existence of differences between consumers, can be helpful in the development of animal welfare-based certification schemes that are appealing to consumers, as well as the positioning of welfare concepts in the market.
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Nurse managers describe their practice environments.
Warshawsky, Nora E; Lake, Sharon W; Brandford, Arica
2013-01-01
Hospital work environments that support the professional practice of nurses are critical to patient safety. Nurse managers are responsible for creating these professional practice environments for staff nurses, yet little is known about the environments needed to support nurse managers. Domains of nurse managers' practice environment have recently been defined. This is a secondary analysis of 2 cross-sectional studies of organizational characteristics that influence nurse manager practice. Content analysis of the free text comments from 127 nurse managers was used to illustrate the 8 domains of nurse managers' practice environments. Nurse managers valued time spent with their staff; therefore, workloads must permit meaningful interaction. Directors demonstrated trust when they empowered nurse managers to make decisions. Administrative leaders should build patient safety cultures on the basis of shared accountability and mutual respect among the health care team. The expectations of nurse managers have greatly expanded in the volume and complexity of direct reports, patient care areas, and job functions. The nurse managers in this analysis reported characteristics of their practice environments that limit their role effectiveness and may negatively impact organizational performance. Further research is needed to understand the effects of nurse managers' practice environments on staff and patient outcomes.
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NASA Astrophysics Data System (ADS)
Shahlan, M. Z.; Sidek, A. A.; Suffian, S. A.; Hazza, M. H. F. A.; Daud, M. R. C.
2018-01-01
In this paper, climate change and global warming are the biggest current issues in the industrial sectors. The green supply chain managements (GSCM) is one of the crucial input to these issues. Effective GSCM can potentially secure the organization’s competitive advantage and improve the environmental performance of the network activities. In this study, the aim is to investigate and examine how a small and medium enterprises (SMEs) stakeholder pressure and top management influence green supply chain management practices. The study is further advance green supply chain management research in Malaysia focusing on SMEs manufacturing sector using structural equation modelling. Structural equation modelling is a multivariate statistical analysis technique used to examine structural relationship. It is the combination of factor analysis and multi regression analysis and used to analyse structural relationship between measure variable and latent factor. This research found that top management support and stakeholder pressure is the major influence for SMEs to adopt green supply chain management. The research also found that top management is fully mediate with the relationship between stakeholder pressure and monitoring supplier environmental performance.
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MONTANO, Diego
2016-01-01
The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach. PMID:26860787
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Montano, Diego
2016-08-05
The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach.
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Sources of influence on medical practice
Fernandez, L. A.; Martin, J. M.; del Castillo, J. d. D. L.; Gaspar, O. S.; Millan, J. I.; Lozano, M. J.; Keenoy, E. D.
2000-01-01
OBJECTIVES—To explore the opinion of general practitioners on the importance and legitimacy of sources of influence on medical practice. METHODS—General practitioners (n=723) assigned to Primary Care Teams (PCTs) in two Spanish regions were randomly selected to participate in this study. A self administered questionnaire was sent by mail and collected by hand. The dependent variable collected the opinion on different sources that exert influence on medical practice. Importance was measured with a 9 item scale while legitimacy was evaluated with 16 items measured with a 1 to 7 point Likert scale. RESULTS—The most important and legitimate sources of influence according to general practitioners were: training courses and scientific articles, designing self developed protocols and discussing with colleagues. The worst evaluated were: financial incentives and the role played by the pharmaceutical industry. CONCLUSIONS—The development of medical practice is determined by many factors, grouped around three big areas: organisational setting, professional system and social setting. The medical professional system is the one considered as being the most important and legitimate by general practitioners. Other strategies of influence, considered to be very important by the predominant management culture (financial incentives), are not considered to be so by general practitioners. These results, however, are not completely reliable as regards the real network of influences existing in medical practice, which reflect instead different "value systems". Keywords: primary health care; physicians' practice patterns; medical practice management; physicians' incentive plans PMID:10890875
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Soil respiration and carbon responses to logging debris and competing vegetation
Robert A. Slesak; Stephen H. Schoenholtz; Timothy B. Harrington
2010-01-01
Management practices following forest harvesting that modify organic matter (OM) inputs and influence changes in the soil environment have the potential to alter soil C pools, but there is still much uncertainty regarding how these practices influence soil C flux. We examined the influence of varying amounts of logging-debris retention (0, 40, and 80% coverage) and...
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Jack, Corin; Hotchkiss, Emily; Sargison, Neil D; Toma, Luiza; Milne, Catherine; Bartley, David J
2017-04-01
Nematode control in sheep, by strategic use of anthelmintics, is threatened by the emergence of roundworms populations that are resistant to one or more of the currently available drugs. In response to growing concerns of Anthelmintic Resistance (AR) development in UK sheep flocks, the Sustainable Control of Parasites in Sheep (SCOPS) initiative was set up in 2003 in order to promote practical guidelines for producers and advisors. To facilitate the uptake of 'best practice' approaches to nematode management, a comprehensive understanding of the various factors influencing sheep farmers' adoption of the SCOPS principles is required. A telephone survey of 400 Scottish sheep farmers was conducted to elicit attitudes regarding roundworm control, AR and 'best practice' recommendations. A quantitative statistical analysis approach using structural equation modelling was chosen to test the relationships between both observed and latent variables relating to general roundworm control beliefs. A model framework was developed to test the influence of socio-psychological factors on the uptake of sustainable (SCOPS) and known unsustainable (AR selective) roundworm control practices. The analysis identified eleven factors with significant influences on the adoption of SCOPS recommended practices and AR selective practices. Two models established a good fit with the observed data with each model explaining 54% and 47% of the variance in SCOPS and AR selective behaviours, respectively. The key influences toward the adoption of best practice parasite management, as well as demonstrating negative influences on employing AR selective practices were farmer's base line understanding about roundworm control and confirmation about lack of anthelmintic efficacy in a flock. The findings suggest that improving farmers' acceptance and uptake of diagnostic testing and improving underlying knowledge and awareness about nematode control may influence adoption of best practice behaviour. Copyright © 2017 Elsevier B.V. All rights reserved.
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Long term management practices influenced soil aggregation and carbon dynamics
USDA-ARS?s Scientific Manuscript database
Soil aggregation protects soil organic C (SOC) against rapid decomposition, improves soil quality, and reduces soil erosion potential. The objectives of this study are to evaluate the effects of long-term (21 yrs.) management practices on SOC, water stable aggregate (WSA), and aggregate-associated ...
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Zhu, D Q; Norman, I J; While, A E
2011-06-01
It has been established that health professionals' smoking and physical activity influence their related health-promoting behaviours, but it is unclear whether health professionals' weight status also influences their related professional practices. A systematic review was conducted to understand the relationship between personal weight status and weight management practices. Nine eligible studies were identified from a search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and Chinese databases. All included studies were cross-sectional surveys employing self-reported questionnaires. Weight management practice variables studied were classified under six practice indicators, developed from weight management guidelines. Syntheses of the findings from the selected studies suggest that: normal weight doctors and nurses were more likely than those who were overweight to use strategies to prevent obesity in-patients, and, also, provide overweight or obese patients with general advice to achieve weight loss. Doctors' and nurses' own weight status was not found to be significantly related to their referral and assessment of overweight or obese patients, and associations with their relevant knowledge/skills and specific treatment behaviours were inconsistent. Additionally, in female, primary care providers, relevant knowledge and training, self-efficacy and a clear professional identity emerged as positive predictors of weight management practices. This review's findings will need to be confirmed by prospective theoretically driven studies, which employ objective measures of weight status and weight management practices and involve multivariate analyses to identify the relative contribution of weight status to weight management. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.
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de Cássia Ramos do Egypto Queiroga, Rita; Costa, Roberto Germano; Madruga, Marta Suely; de Medeiros, Ariosvaldo Nunes; Dos Santos Garruti, Deborah; Magnani, Marciane; de Souza, Evandro Leite
2016-04-01
This study evaluated the influence of lactation stage (early, middle, late) and management practices (milking hygiene and buck presence) on the sensory attributes of Saanen goat milk. Goats were randomly divided in four groups in respect of different milking sanitary procedures and the presence/absence of the buck in the barn. Milk samples were analyzed for sensory attributes including quantitative descriptive analysis (QDA) and acceptance. The milking hygiene practice caused no significant influence on microbiological parameters. Results of QDA revealed that the buck presence increased the characteristic odor of milk at the middle and late lactation stages. The off-odor and off-flavor descriptors showed a distinct response since a higher intensity of these sensory characteristics was noted in the samples obtained from goats maintained without the buck. Odor and flavor contributed most in characterizing the different samples regardless of the management practice and lactation stage. The acceptance of odor showed to be influenced only by the lactation stage, while the acceptance of flavor was only through the presence of the buck. Odor acceptance correlated negatively to off-odor and off-flavor, suggesting that these two sensory attributes impaired the preference for the aroma of the milk samples. © 2015 Japanese Society of Animal Science.
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Simulating soil organic carbon in a wheat–fallow system using the Daycent model
USDA-ARS?s Scientific Manuscript database
Crop management practices that contribute to soil organic carbon (SOC) sequestration can improve productivity and long-term sustainability. We present a modeling study on influence of (>80 years) various long-term crop residue and nutrient management practices on SOC dynamics under conventional and ...
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Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E
2002-12-01
Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.
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Patterson, James J; Smith, Carl; Bellamy, Jennifer
2013-10-15
Nonpoint source (NPS) water pollution in catchments is a 'wicked' problem that threatens water quality, water security, ecosystem health and biodiversity, and thus the provision of ecosystem services that support human livelihoods and wellbeing from local to global scales. However, it is a difficult problem to manage because water catchments are linked human and natural systems that are complex, dynamic, multi-actor, and multi-scalar in nature. This in turn raises questions about understanding and influencing change across multiple levels of planning, decision-making and action. A key challenge in practice is enabling implementation of local management action, which can be influenced by a range of factors across multiple levels. This paper reviews and synthesises important 'enabling' capacities that can influence implementation of local management action, and develops a conceptual framework for understanding and analysing these in practice. Important enabling capacities identified include: history and contingency; institutional arrangements; collaboration; engagement; vision and strategy; knowledge building and brokerage; resourcing; entrepreneurship and leadership; and reflection and adaptation. Furthermore, local action is embedded within multi-scalar contexts and therefore, is highly contextual. The findings highlight the need for: (1) a systemic and integrative perspective for understanding and influencing change for managing the wicked problem of NPS water pollution; and (2) 'enabling' social and institutional arenas that support emergent and adaptive management structures, processes and innovations for addressing NPS water pollution in practice. These findings also have wider relevance to other 'wicked' natural resource management issues facing similar implementation challenges. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Samuel, Susan M.; Flynn, Rachel; Zappitelli, Michael; Dart, Allison; Parekh, Rulan; Pinsk, Maury; Mammen, Cherry; Wade, Andrew; Scott, Shannon D.
2017-01-01
Background: Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. Methods: Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. Results: Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. Interpretation: Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes. PMID:28592406
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NASA Astrophysics Data System (ADS)
de Mar Alguacil, Maria; Torrecillas, Emma; Garcia-Orenes, Fuensanta; Torres, Maria Pilar; Roldan, Antonio
2013-04-01
The arbuscular mycorrhizal fungi (AMF) are a key, integral component of the stability, sustainability and functioning of ecosystems. In this study a field experiment was performed at the El Teularet-Sierra de Enguera Experimental Station (eastern Spain) to assess the influence during a 6-yr period of different agricultural practices on the diversity of arbuscular mycorrhizal fungi (AMF). The management practices included residual herbicide use, ploughing, ploughing + oats, addition of oat straw mulch and a control (land abandonment). Adjacent soil under natural vegetation was used as a reference for local, high-quality soil and as a control for comparison with the agricultural soils under different management practices. The AM fungal small-subunit (SSU) rRNA genes were subjected to PCR, cloning, sequencing and phylogenetic analyses. Thirty-six different phylotypes were identified, which were grouped in four families: Glomeraceae, Paraglomeraceae, Ambisporaceae and Claroideoglomeraceae. The first results showed significant differences in the distribution of the AMF phylotypes as consequence of the difference between agricultural management practices. Thus, the lowest diversity was observed for the plot that was treated with herbicide. The management practices including ploughing and ploughing + oats had similar AMF diversity. Oat straw mulching yielded the highest number of different AMF sequence types and showed the highest diversity index. Thus, this treatment could be more suitable in sustainable soil use and therefore protection of biodiversity.
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Ceci, Christine
2006-03-01
Home care is a health sector under increasing pressure. Demand is often said to be outstripping capacity, with constant change and retrenchment distinguishing features of the current context. This paper takes a reading of the current conditions of home care using data gathered during a field study of home care case management practices conducted in 2004. As economic discourses become increasingly influential in determining responses to client situations, case managers (and their managers) find themselves with limited capacity to exercise control over their practices. A growing gap between professionally influenced discourses--those presumably intended to guide practice--and organizational priorities creates a dissonance for case managers as the political-ethical dimensions of their practices are displaced by budget "realities." For front-line workers, such displacement cannot be sustained in their face-to-face encounters with clients, leading to a growing sense of frustration and powerlessness among these highly skilled practitioners.
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Influence of gender on office staff management in orthodontics.
Holmes, Patrick B; Shroff, Bhavna; Best, Al M; Lindauer, Steven J
2010-11-01
To examine the gender differences in managing practice and staff members in orthodontic practices. All orthodontists in Virginia and Maryland (n = 427) were surveyed and demographic information was collected. For the crude analyses of the data, a Fisher's exact test or chi(2) test was performed. For the adjusted analyses, genders were compared using a logistic regression or analysis of covariance. The covariates were adjusted for age, program length, years in practice, number of years since graduation, and practice state. The length of the residency program attended did not differ with gender. No gender differences in practice ownership or creating the practice were observed. There was a significant gender difference in implementation of performance reviews: female orthodontists were more likely to provide performance reviews and tended to accept more poor reviews before staff termination than male orthodontists. However, when provided, no gender difference was observed in the number of performance reviews. Gender has a significant impact on the implementation of performance reviews in practices. Practice ownership status was not influenced by providers' gender.
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Management practices effects on soil carbon dioxide emission and carbon storage
USDA-ARS?s Scientific Manuscript database
Management practices can influence soil CO2 emission and C content in cropland, which can effect global warming. We examined the effects of combinations of irrigation, tillage, cropping systems, and N fertilization on soil CO2 flux, temperature, water, and C content at the 0 to 20 cm depth from May ...
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USDA-ARS?s Scientific Manuscript database
Cropland is an important land cover influencing global carbon and water cycles. Variability of agricultural carbon and water fluxes depends on crop species, management practices, soil characteristics, and climatic conditions. In the context of climate change, it is critical to quantify the long-term...
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Mohammed, Siti Asma; Yusof, Maryati Mohd
2013-04-01
Poor information quality (IQ) must be understood as a business problem rather than systems problem. In health care organization, what is required is an effective quality management that continuously manages and reviews the factors influencing IQ in health information systems (HIS) so as to achieve the desired outcomes. Hence, in order to understand the issues of information quality management (IQM) practices in health care organizations, a more holistic evaluation study should be undertaken to investigate the IQM practices in health care organizations. It is the aim of this paper to identify the significant evaluation criteria that influence the production of good IQ in HIS. Six selected frameworks and best practices both from health informatics and information systems literature have been reviewed to identify the evaluation criteria from the perspective of human, organizational and technological factors. From the review, it was found that human and organization factors are of greater significance in influencing HIS IQ. Our review depicts that there is still shortage in finding a comprehensive IQM evaluation framework. Thus, the criteria from the frameworks reviewed can be used in combination for more comprehensive evaluation criteria. Integrated IQM evaluation criteria for HIS are then proposed in this study. Poor IQ is the result of complex interdependency within sociotechnical factors in health care organization and lack of formal and structured IQM practices. Thus, a feedback mechanism such as evaluation is needed to understand the issues in depth in the future. © 2012 Blackwell Publishing Ltd.
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Brodie, Katie E; Saltzman, Amanda F; Cost, Nicholas G
2018-04-01
Testicular microlithiasis (TM) is a condition characterized by calcium deposits within the testis, usually detected incidentally during ultrasonography of the scrotum. TM has been associated with the presence of, and possibly the development of, testicular malignancy. Our aim was to document international clinical management practices for TM and to analyze what factors and perception of risk influence conservative versus active management and follow-up. European Society for Paediatric Urology (ESPU) and Society for Pediatric Urology (SPU) members were invited to complete an online case-based survey of clinical management practices of TM. Eight cases had a single variable changed each time (classic versus limited TM, unilateral versus bilateral, prior cryptorchidism versus no cryptorchidism) to ascertain the provider's perception of risk. The respondents completed multiple choice questions on initial management, follow-up plan, length and interval of follow-up. Multivariate logistic regression was performed to determine factors associated with decisions on management and follow-up. There were 265 respondents to the survey from 35 countries (Table). Median time in practice was 13 years. Factors that were significantly associated with more aggressive initial management (more than counseling on self-examination) included: not yet in independent practice, low volume TM cases per year, those practicing pediatric and adult urology, classic appearance of TM and cryptorchidism. Factors that were significantly associated with urologist follow-up and active investigation included: European practitioners, low TM case volume per year, those practicing both pediatric urology and pediatric surgery, classic TM appearance and a case history of cryptorchidism. Interval and length of follow-up was wide-ranging, with most respondents favoring annual follow-up. Management of TM varies and a mix of surgeon and case factors significantly influences management strategies. This baseline understanding of the lack of systematic management suggests the need for the development of consensus guidelines and prospective study. Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E
2002-01-01
BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children. PMID:12528583
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GPs' considerations in multimorbidity management: a qualitative study.
Luijks, Hilde D; Loeffen, Maartje J W; Lagro-Janssen, Antoine L; van Weel, Chris; Lucassen, Peter L; Schermer, Tjard R
2012-07-01
Scientific evidence on how to manage multimorbidity is limited, but GPs have extensive practical experience with multimorbidity management. To explore GPs' considerations and main objectives in the management of multimorbidity and to explore factors influencing their management of multimorbidity. Focus group study of Dutch GPs; with heterogeneity in characteristics such as sex, age and urbanisation. The moderator used an interview guide in conducting the interviews. Two researchers performed the analysis as an iterative process, based on verbatim transcripts and by applying the technique of constant comparative analysis. Data collection proceeded until saturation was reached. Five focus groups were conducted with 25 participating GPs. The main themes concerning multimorbidity management were individualisation, applying an integrated approach, medical considerations placed in perspective, and sharing decision making and responsibility. A personal patient-doctor relationship was considered a major factor positively influencing the management of multimorbidity. Mental-health problems and interacting conditions were regarded as major barriers in this respect and participants experienced several practical problems. The concept of patient-centredness overarches the participants' main objectives. GPs' main objective in multimorbidity management is applying a patient-centred approach. This approach is welcomed since it counteracts some potential pitfalls of multimorbidity. Further research should include a similar design in a different setting and should aim at developing best practice in multimorbidity management.
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ERIC Educational Resources Information Center
Allen, Gregory
2013-01-01
This study addressed the problems of hospitals' duplicated effort and ad hoc knowledge management (KM) practices. The purpose of this quantitative study was to examine the focus and type of organizational culture in order to describe and predict the relationship between organizational culture and the affinity for KM of nurses working in health…
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Policy Change and Its Effect on Australian Community-Based Natural Resource Management Practices
ERIC Educational Resources Information Center
Cooke, Penelope R.; Hemmings, Brian C.
2016-01-01
The authors of this article report on a qualitative study of Australian community-based natural resource management groups known as Landcare groups. They discuss how four Landcare groups contributed to sustainability practices and how a policy change implemented in 2003 influenced the efforts of the groups to remain active in their activities.…
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Bonkowski, Sara L; De Gagne, Jennie C; Cade, Makia B; Bulla, Sally A
2018-04-01
Nurses lack adequate pain management knowledge, which can result in poorly managed postsurgical pain. This study aimed to develop, implement, and evaluate pain management education and operational guidelines to improve nursing knowledge and pain management. This quality improvement project employed convenience samples of surgical oncology nurses and postoperative patients. The intervention involved an online module, live education, and operational guideline for pain management. Nurses completed pre- and postintervention practice and attitudes surveys. Random chart reviews of intravenous narcotic administrations the day before discharge were completed to evaluate whether narcotic administration changed after intervention. Readmissions and Hospital Consumer Assessment of Healthcare Providers and Systems data were collected to determine whether the intervention influenced patient satisfaction. A statistically significant improvement in nursing practice and intravenous narcotic administrations demonstrated changes to pain management practices employed by the nursing staff. Although not statistically significant, fewer pain-related readmissions occurred postintervention. Findings demonstrate that targeted pain management continuing education, paired with operational guidelines, improves nursing practice and decreases intravenous narcotic administrations prior to discharge. J Contin Educ Nurs. 2018;49(4):178-185. Copyright 2018, SLACK Incorporated.
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The Theory of Dyadic Illness Management.
Lyons, Karen S; Lee, Christopher S
2018-02-01
Despite the importance of both members of the adult patient-care partner dyad, a majority of research on illness management is focused on the patient or the care partner. The basic principle of the Theory of Dyadic Illness Management is that illness management is a dyadic phenomenon; the theory focuses extensively on the dyad as an interdependent team. The way dyads appraise illness as a unit influences the ways in which they engage in behaviors to manage illness together in a recursive fashion that influences dyadic health. Optimizing the health of both members of the dyad is a goal of the theory. In turn, the health of the dyad can feedback to influence how they appraise and manage illness together. Finally, dyadic illness management is an inherently variable process that is influenced by several contextual factors. Supportive evidence and implications for practice and future research are presented.
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Sletvold, Nina; Dahlgren, Johan P; Oien, Dag-Inge; Moen, Asbjørn; Ehrlén, Johan
2013-09-01
Climate change is expected to influence the viability of populations both directly and indirectly, via species interactions. The effects of large-scale climate change are also likely to interact with local habitat conditions. Management actions designed to preserve threatened species therefore need to adapt both to the prevailing climate and local conditions. Yet, few studies have separated the direct and indirect effects of climatic variables on the viability of local populations and discussed the implications for optimal management. We used 30 years of demographic data to estimate the simultaneous effects of management practice and among-year variation in four climatic variables on individual survival, growth and fecundity in one coastal and one inland population of the perennial orchid Dactylorhiza lapponica in Norway. Current management, mowing, is expected to reduce competitive interactions. Statistical models of how climate and management practice influenced vital rates were incorporated into matrix population models to quantify effects on population growth rate. Effects of climate differed between mown and control plots in both populations. In particular, population growth rate increased more strongly with summer temperature in mown plots than in control plots. Population growth rate declined with spring temperature in the inland population, and with precipitation in the coastal population, and the decline was stronger in control plots in both populations. These results illustrate that both direct and indirect effects of climate change are important for population viability and that net effects depend both on local abiotic conditions and on biotic conditions in terms of management practice and intensity of competition. The results also show that effects of management practices influencing competitive interactions can strongly depend on climatic factors. We conclude that interactions between climate and management should be considered to reliably predict future population viability and optimize conservation actions. © 2013 John Wiley & Sons Ltd.
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McCalmont, Jean C; Jones, Kim D; Bennett, Robert M; Friend, Ronald
(1) To assess providers' experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers' utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations. A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training. The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers' profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9). Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.
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On becoming a coach: a pilot intervention study with managers in long-term care.
Cummings, Greta; Mallidou, Anastasia A; Masaoud, Elmabrok; Kumbamu, Ashok; Schalm, Corinne; Spence Laschinger, Heather K; Estabrooks, Carole A
2014-01-01
Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments. The aim of the study reported here was to pilot how a 2-day coaching workshop ("Coaching for Impressive CARE") conducted as a leadership development strategy influenced frontline care managers' coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers' perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers' intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers' reports of using coaching practices and employee responses after the workshop. We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace. Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees. The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.
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Influences shaping nurses' use of distraction for children's procedural pain.
Olmstead, Deborah L; Scott, Shannon D; Mayan, Maria; Koop, Priscilla M; Reid, Kathy
2014-04-01
This study explored pediatric nurses' choices to use distraction for managing painful procedures. Using interpretive description approaches, interviews with pediatric nurses provided descriptions of choices to manage procedural pain. Nurses' distress influenced distraction use to mitigate the suffering of children and themselves. Newer nurses described task mastery as influencing distraction choices. Nurses' accounts of performing painful procedures on children mirrored children's descriptions of pain from the literature. Nurses' distress and competency performing painful procedures on children influenced practice. Future qualitative studies could extend understanding of pain management choices by pediatric nurses and the impact on undermanaged pain. © 2014, Wiley Periodicals, Inc.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Page, Barbara A, E-mail: barbpage09@gmail.com; Bernoth, Maree; Davidson, Rob
2014-09-15
The purpose of this study was to explore the factors influencing the implementation or the lack of implementation of advanced practitioner role in Australia. This study uses an interpretative phenomenological approach to explore the in-depth real life issues, which surround the advanced practitioner as a solution to radiologist workforce shortages in Australia. Research participants are radiographers, radiation therapists and health managers registered with the Australian Institute of Radiography (AIR) and holding senior professional and AIR Board positions with knowledge of current advanced practice. In total, seven interviews were conducted revealing education, governance, technical, people issues, change management, government, costs andmore » timing as critical factors influencing advanced practice in Australia. Seven participants in this study perceived an advanced practice role might have major benefits and a positive impact on the immediate and long-term management of patients. Another finding is the greater respect and appreciation of each other's roles and expertise within the multidisciplinary healthcare team. Engagement is required of the critical stakeholders that have been identified as ‘blockers’ (radiologists, health departments) as well as identified allies (e.g. emergency clinicians, supportive radiologists, patient advocacy groups). The research supports that the AIR has a role to play for the professional identity of radiographers and shaping the advanced practice role in Australia.« less
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Rogers, Anne; Vassilev, Ivaylo; Pumar, Maria J Jesús; Todorova, Elka; Portillo, Mari Carmen; Foss, Christina; Koetsenruijter, Jan; Ratsika, Nikoleta; Serrano, Manuel; Knutsen, Ingrid A Ruud; Wensing, Michel; Roukova, Poli; Patelarou, Evridiki; Kennedy, Anne; Lionis, Christos
2015-07-08
European countries are increasingly adopting systems of self -care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. To date the focus of policy for engendering greater self- management in the population has been focused in the main on the actions and motivations of individuals. Less attention has been paid to how the broader influences relevant to SMS policy and practice such as those related to food production, distribution and consumption and the structural aspects and economics relating to physical exercise and governance of health care delivery systems might be implicated in the populations ability to self- manage. This study aimed to identify key informants operating with knowledge of both policy and practice related to SMS in order to explore how these influences are seen to impact on the self-management support environment for diabetes type 2. Ninety semi-structured interviews were conducted with key stakeholder informants in Bulgaria, Spain, Greece, Norway, Netherlands and UK. Interviews were transcribed and analysed using thematic and textual analysis. Stakeholders in the six countries identified a range of influences which shaped diabetes self-management (SM). The infrastructure and culture for supporting self- management practice is viewed as driven by political decision-makers, the socio-economic and policy environment, and the ethos and delivery of chronic illness management in formal health care systems. Three key themes emerged during the analysis of data. These were 1) social environmental influences on diabetes self-management 2) reluctance or inability of policy makers to regulate processes and environments related to chronic illness management 3) the focus of healthcare system governance and gaps in provision of self-management support (SMS). Nuances in the salience and content of these themes between partner countries related to the presence and articulation of dedicated prevention and self- management policies, behavioural interventions in primary care, drug company involvement and the impact of measures resulting from economic crises, and differences between countries with higher versus lower social welfare support and public spending on shaping illness management. The results suggest reasons for giving increasing prominence to meso level influences as a means of rebalancing and improving the effectiveness of implementing an agenda for SMS. There is a need to acknowledge the greater economic and policy challenging environment operating in some countries which act as a source of inequality between countries in addressing SMS for chronic illness management and impacts on people's capacity to undertake self-care activities.
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NASA Astrophysics Data System (ADS)
Jamaluddin, Z.; Razali, A. M.; Mustafa, Z.
2015-02-01
The purpose of this paper is to examine the relationship between the quality management practices (QMPs) and organisational performance for the manufacturing industry in Malaysia. In this study, a QMPs and organisational performance framework is developed according to a comprehensive literature review which cover aspects of hard and soft quality factors in manufacturing process environment. A total of 11 hypotheses have been put forward to test the relationship amongst the six constructs, which are management commitment, training, process management, quality tools, continuous improvement and organisational performance. The model is analysed using Structural Equation Modeling (SEM) with AMOS software version 18.0 using Maximum Likelihood (ML) estimation. A total of 480 questionnaires were distributed, and 210 questionnaires were valid for analysis. The results of the modeling analysis using ML estimation indicate that the fits statistics of QMPs and organisational performance model for manufacturing industry is admissible. From the results, it found that the management commitment have significant impact on the training and process management. Similarly, the training had significant effect to the quality tools, process management and continuous improvement. Furthermore, the quality tools have significant influence on the process management and continuous improvement. Likewise, the process management also has a significant impact to the continuous improvement. In addition the continuous improvement has significant influence the organisational performance. However, the results of the study also found that there is no significant relationship between management commitment and quality tools, and between the management commitment and continuous improvement. The results of the study can be used by managers to prioritize the implementation of QMPs. For instances, those practices that are found to have positive impact on organisational performance can be recommended to managers so that they can allocate resources to improve these practices to get better performance.
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Mavronicolas, Heather A; Laraque, Fabienne; Shankar, Arti; Campbell, Claudia
2017-05-01
Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.
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Manowong, Ektewan
2012-01-01
Rapid economic growth and urbanization in developing countries lead to extensive construction activities that generate a large amount of waste. A challenge is how to manage construction waste in the most sustainable way. In the developing world, research on construction waste management is scarce and such academic knowledge needs to be responsive to actual practices in the industry in order to be implemented. As construction projects involve a number of participants and stakeholders, their participation and commitment can have a major influence on the goals of green and sustainable construction for urban development. This study provides a significant step in conducting a very first research of this kind in Thailand by aiming to investigate the level of construction stakeholders' commitment as well as the achievement of construction waste management in order to improve short-term practices and to establish a long-term strategic construction waste management plan. In this study, a structural equation model was employed to investigate the influence of factors that are related to environmental aspects, social aspects, and economic aspect of construction waste management. Concern about health and safety was found to be the most significant and dominant influence on the achievement of sustainable construction waste management. Other factors affecting the successful management of construction waste in Thai construction projects were also identified. It is perceived that this study has potential to contribute useful guidelines for practitioners both in Thailand and other developing countries with similar contexts.
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NASA Astrophysics Data System (ADS)
Spak, S.; Ward, A. S.; Li, Y.; Dalrymple, K. E.
2016-12-01
Nitrogen fertilization is central to contemporary row crop production in the U.S., but resultant nitrate transport leads to eutrophication, hypoxia, and algal blooms throughout the Mississippi River Basin and in coastal waters of the Gulf of Mexico. Effective basin-scale nutrient management requires a comprehensive understanding of the dynamics of nitrate transport in this large river catchment and the roles of individual management practices, that must then be operationalized to optimize management for both local geophysical and agricultural conditions and in response to decadal and inter-annual variations in local and regional climate. Here, we apply ensemble simulations with Agro-IBIS and THMB using spatially and temporally specific land cover, soil, agricultural, topographic, and climate data to simulate the individual and combined effects of land management and climate on historical (1948-2007) nitrate concentrations and transport in the Mississippi River Basin. We further identify sensitivities of in-stream nitrate dynamics to local and regional applications of Best Management Practices. The ensemble resolves the effects of techniques recommended in the Iowa Nutrient Reduction Strategy, including crop rotations, fertilizer management, tillage and residue management, and cover crops. Analysis of the nitrate transport response surfaces identifies non-linear effects of combined nutrient management tactics, and quantifies the stationarity of the relative and absolute influences of land management and climate during the 60-year study period.
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Are Leadership and Management Essential for Good Research? An Interview Study of Genetic Researchers
Antes, Alison L.; Mart, Adelina; DuBois, James M.
2016-01-01
Principal investigators are responsible for a myriad of leadership and management activities in their work. The practices they employ to navigate these responsibilities ultimately influence the quality and integrity of research. However, leadership and management roles in research have received scant empirical examination. Semi-structured interviews with 32 National Institutes of Health (NIH)-funded genetic researchers revealed that they considered leadership and management essential for effective research, but their scientific training inadequately prepared them. We also report management practices that the researchers described employing in their labs, as well as their perceptions of a proposed intervention to enhance laboratory leadership. These findings suggest best practices for the research community, future directions for scientific training, and implications for research on leadership and management in science. PMID:27646401
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Antes, Alison L; Mart, Adelina; DuBois, James M
2016-12-01
Principal investigators are responsible for a myriad of leadership and management activities in their work. The practices they use to navigate these responsibilities ultimately influence the quality and integrity of research. However, leadership and management roles in research have received scant empirical examination. Semi-structured interviews with 32 National Institutes of Health (NIH)-funded genetic researchers revealed that they considered leadership and management essential for effective research, but their scientific training inadequately prepared them. We also report management practices that the researchers described using in their labs, as well as their perceptions of a proposed intervention to enhance laboratory leadership. These findings suggest best practices for the research community, future directions for scientific training, and implications for research on leadership and management in science.
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Hanna, Lisa; May, Carl; Fairhurst, Karen
2011-01-01
Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers' attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients. To investigate practice managers' attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies. We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews. Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand. Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics. Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/communication technologies.
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COLLABORATE©, Part IV: Ramping Up Competency-Based Performance Management.
Treiger, Teresa M; Fink-Samnick, Ellen
The purpose of this fourth part of the COLLABORATE© article series provides an expansion and application of previously presented concepts pertaining to the COLLABORATE paradigm of professional case management practice. The model is built upon a value-driven foundation that: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. As an industry, health care continues to evolve. Terrain shifts and new influences continually surface to challenge professional case management practice. The need for top-performing and nimble professionals who are knowledgeable and proficient in the workplace continues to challenge human resource departments. In addition to care setting knowledge, professional case managers must continually invest in their practice competence toolbox to grow skills and abilities that transcend policies and processes. These individuals demonstrate agility in framing (and reframing) their professional practice to facilitate the best possible outcomes for their clients. Therefore, the continued emphasis on practice competence conveyed through the performance management cycle is an essential ingredient to performance management focused on customer service excellence and organizational improvement. Professional case management transcends professional disciplines, educational levels, and practice settings. Business objectives continue to drive work process and priorities in many practice settings. However, competencies that align with regulatory and accreditation requirements should be the critical driver for consistent, high-quality case management practice. Although there is inherent value in what various disciplines bring to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities.
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Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.
Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y
2010-05-01
This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.
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Puspitasari, Hanni P; Aslani, Parisa; Krass, Ines
2015-01-01
We explored factors influencing Indonesian primary care pharmacists' practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors. We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by "grounded-theory". We extracted five emergent themes/factors: pharmacists' attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists' inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model. Pharmacists' attitudes, knowledge, skills and their working environment appeared to influence pharmacists' contribution in chronic disease management. To develop pharmacists' involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists' practice in Indonesia to achieve continuity of care.
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Paredes, P; de la Peña, M; Flores-Guerra, E; Diaz, J; Trostle, J
1996-04-01
Proper diarrhoea treatment has received greater attention during the last 10 years. However, the unjustified use of medicines to treat simple episodes of acute diarrhoea continues to divert attention and available resources away from appropriate treatment. A study to identify the factors determining prescribing practices for diarrhoea treatment was carried out in a peri-urban part of Lima, Peru in 1991. Physicians were interviewed, and then their practice was assessed by visits of confederates with healthy children described as ill, by interviews with mothers of sick children leaving the clinic, or by both of these methods. Physicians' reported practices in treating diarrhoea cases were compared to their actual practices. Although physicians' knowledge of drug management seemed to influence the low frequency of prescription of antidiarrhoeal drugs, it did not have the same influence on prescription of antimicrobials. Our results suggest that the diagnostic process and consequently the treatment decision do not follow a scientific rationale for this illness. The physicians' prescribing practices seemed to be more related to agreement with social expectations and the caretakers' perception of the physicians' role than they were to the standard biomedical rules of diarrhoea management.
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ERIC Educational Resources Information Center
von Alberti-Alhtaybat, Larissa; Al-Htaybat, Khaldoon; Hutaibat, Khaled
2012-01-01
This article originates from a longitudinal study of management and accounting practices in the English higher education sector. The processes of strategic management and strategic management accounting in several English higher education institutions were investigated, from planning to assessment, and their meaning to members of staff. The study…
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Population Growth and a Sustainable Environment.
ERIC Educational Resources Information Center
Mortimore, Michael; Tiffen, Mary
1994-01-01
Provides a history of farming practices in a densely populated area of Kenya where a recent study of the resource management practices showed positive, not negative, influences of increasing population density on both environmental conservation and productivity. (LZ)
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Listening in the Multicultural Workplace: A Dialogue of Theory and Practice
ERIC Educational Resources Information Center
Purdy, Michael W.; Manning, Linda M.
2015-01-01
This article consists of a dialogue focused on listening philosophy, theory, and inclusive management practices for maximum productivity and performance in multicultural workplaces. The discussion illustrates that listening both influences cultural interactions and is impacted by cultural values and practices. This focus is broadly framed by an…
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Heather R. McCarthy; Ram Oren; Hyun-Seok Kim; Kurt H. Johnsen; Chris Maier; Seth G. Pritchard; Michael A. Davis
2006-01-01
Ice storms are disturbance events with potential impacts on carbon sequestration. Common forest management practices, such as fertilization and thinning, can change wood and stand properties and thus may change vulnerability to ice storm damage. At the same time, increasing atmospheric CO2 levels may also influence ice storm vulnerability. Here...
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Factors affecting reproductive performance of dairy cows.
Coleman, D A; Thayne, W V; Dailey, R A
1985-07-01
We conducted two studies to determine how herd management practices and traits of individual cows affect performance of the herd and of the cow within a herd. Management practices, reproductive performance of the herd, and relationships between management and reproductive performance were characterized on 83 dairy farms with 7596 cows. Data included 21 management variables (e.g., facilities, herd health program, estrous detection program) and 8 performance variables obtained from Dairy Herd Improvement or unofficial records (e.g., size of herd, production, days open). Although varying among herds, annual average herd incidences of reproductive disorders and reproductive performance were similar to those reported. Managerial practices influenced incidences of retained placenta and uterine infection, days open of cows not bred and of all cows, services per conception, and percentages of herd open more than 100 days and culled for low production. Veterinarian was the most consistent variable influencing herd reproductive performance. Data also were collected from production and lifetime records of 2532 cows in 19 herds. Reproductive performance was affected by season of calving, production, maturity, and reproductive disorders. Several cows with extremely poor reproductive records were maintained.
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Carbon dynamics and aggregation in a Vicia faba crop: influence of management practice and cultivar
NASA Astrophysics Data System (ADS)
Sánchez-Navarro, Virginia; Zornoza, Raúl; Faz, Ángel; Fernández, Juan
2016-04-01
In this study, we assessed the influence of a legume crop (Vicia faba) on the soil properties related to the carbon (C) cycle and soil aggregation, taking into account two cultivars (Muchamiel and Palenca) and two different management practices (conventional and organic). The study was randomly designed in blocks with four replications, in plots of 10 m2. Faba bean crop spanned from 24 November 2014 to 2 March 2015. We took a soil sampling (0-30 cm) from each plot at the end of the cycle to measure soil organic C, recalcitrant C, labile C fractions, microbial biomass C (MBC), aggregate stability and the enzyme activities β-glucosidase, β-glucosaminidase, dehydrogenase, cellulose and arylesterase. Results showed that the cultivar and the management practice had no significant effect on any of the analyzed properties. Significant positive correlations were only observed between soil organic C and arylesterase activity, recalcitrant C and labile C fractions, and recalcitrant C with arylesterase and cellulase activities. So, it seems that the selected cultivars and management practices had similar effects on C dynamics and aggregation. Both management practices maintain the same levels of soil organic C, the different organic C pools, and aggregate stability. In addition, soil microorganisms are responding to the recalcitrant fraction of the organic carbon by release of cellulases and arylesterases. Acknowledgements: This research was financed by the FP7 European Project Eurolegume (FP7-KBBE- 613781).
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Purahong, Witoon; Kapturska, Danuta; Pecyna, Marek J; Jariyavidyanont, Katalee; Kaunzner, Jennifer; Juncheed, Kantida; Uengwetwanit, Tanaporn; Rudloff, Renate; Schulz, Elke; Hofrichter, Martin; Schloter, Michael; Krüger, Dirk; Buscot, François
2015-05-01
Forest management practices (FMPs) significantly influence important ecological processes and services in Central European forests, such as leaf litter decomposition and nutrient cycling. Changes in leaf litter diversity, and thus, its quality as well as microbial community structure and function induced by different FMPs were hypothesized to be the main drivers causing shifts in decomposition rates and nutrient release in managed forests. In a litterbag experiment lasting 473 days, we aimed to investigate the effects of FMPs (even-aged timber management, selective logging and unmanaged) on bacterial and fungal communities involved in leaf litter degradation over time. Our results showed that microbial communities in leaf litter were strongly influenced by both FMPs and sampling date. The results from nonmetric multidimensional scaling (NMDS) ordination revealed distinct patterns of bacterial and fungal successions over time in leaf litter. We demonstrated that FMPs and sampling dates can influence a range of factors, including leaf litter quality, microbial macronutrients, and pH, which significantly correlate with microbial community successions.
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Torres, Calia A; Thorn, Beverly E; Kapoor, Shweta; DeMonte, Colette
2017-11-01
Most studies done with Hispanics illustrate their preference for self-management practices; therefore, examining the factors driving patients to seek medical care for pain management will help elucidate what patients want and need from their doctors for pain management. The aim of the present study was to obtain patients' perspectives and enhance our understanding of the cultural beliefs influencing pain management decisions of foreign-born Spanish-speaking Hispanics with low acculturation. Twenty-four individuals (17 females and 7 males) with self-reported chronic pain completed the study. Participants attended a focus group and shared about pain management practices and their experiences with medical care for pain management. Descriptive data on pain and mood variables were collected to examine how this population compares with the norms reported in the pain literature for Hispanics. Participants reported a preference for pain self-management and noninvasive medical treatments and expressed negative attitudes toward pain medications, although wanting the option of pain medications as a "last resort." Satisfaction with medical care for pain was highly influenced by the participants' expectations and preference for personal, warm, and friendly interactions. Our findings are consistent with previous reports on Hispanics' preference for self-care practices. Perhaps foreign-born Hispanics may rely on self-care practices and delay medical attention for pain management because of their unfamiliarity with the US health care system. Other potential explanations for a reliance on self-care for pain management involve patients having a limited understanding of or access to effective treatment options for chronic pain and negative experiences with US medical providers. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
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Development and utility of the front line manager's quick reference guide.
DOT National Transportation Integrated Search
2013-05-01
Air traffic control Front Line Managers (FLMs) influence the prevention of operational incidents (OIs) and runway incursions (RIs) through practices that enable safe controller performance and mitigate problems related to specific contributing fac...
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Leadership styles of Finnish nurse managers and factors influencing it.
Vesterinen, Soili; Isola, Arja; Paasivaara, Leena
2009-05-01
The purpose of the present study was to explore nurse managers' perceptions of their leadership styles and factors influencing it. It is a challenge for nurse managers to retain nurses in hospitals and to ensure a high quality of care in nursing practice. Leadership style is an important part of leadership. Knowledge concerning nurse managers' resonant and non-resonant leadership styles provides nurse managers with tools to reflect on their own leadership style. Open-ended, tape-recorded interviews were conducted with 13 nurse managers from five Finnish hospitals and two long-term care facilities. The data were analysed using qualitative content analysis. Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. Factors that influence leadership style were identified: earlier superiors, values, information, cooperation, employees and education. The results of this study show that Finnish nurse managers use both resonant and non-resonant leadership styles. The findings of this study show that nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles and factors influencing it among nurse managers providing future leadership and management education.
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Rundall, Thomas G.; Wu, Frances M.; Lewis, Valerie A.; Schoenherr, Karen E.; Shortell, Stephen M.
2017-01-01
Background The accountable care organization (ACO) is a new type of health care organization incentivized to improve quality of care, improve population health, and reduce the total cost of care. An ACO’s success in meeting these objectives will depend greatly upon its ability to improve patient care management. Numerous studies have found relational coordination to be positively associated with key measures of organizational performance in health care organizations, including quality and efficiency. Purpose The purpose of this paper is twofold: (1) identify the extent to which ACO leaders are aware of the dimensions of relational coordination, and (2) identify the ways these leaders believe the dimensions influenced care management practices in their organization. Methodology/Approach We performed content analysis of interviews with managerial and clinical leaders from a diverse group of 11 ACOs to assess awareness of relational coordination and identify the ways that dimensions of relational coordination were perceived to influence development of care management practices. Findings ACO leaders mentioned four relational coordination dimensions: shared goals, frequency of communication, timeliness of communication, and problem solving communication. Three dimensions – shared knowledge of team members’ tasks, mutual respect, and accuracy of communication – were not mentioned. Our analysis identified numerous ways leaders believed the four mentioned dimensions contributed to the development of care management, including contributions to standardization of care, patient engagement, coordination of care, and care planning. Discussion We propose two hypotheses for future research on relational coordination and care management. Practice Implications If relational coordination is to have a beneficial influence on ACO performance, organizational leaders must become more aware of relational coordination and its various dimensions and become cognizant of relational coordination’s influence on care management in their ACO. We suggest a number of means by which ACO leaders could become more aware of relational coordination and its potential effects. PMID:25978003
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Five Approaches to Avoid When Managing the Middle School Classroom
ERIC Educational Resources Information Center
Englehart, Joshua M.
2013-01-01
Too often, teachers encountering difficulties with classroom management focus only on the students rather than critically examining the influence of their own approaches on student behavior. Given the particular challenges that middle school students present, certain practices and expectations exacerbate management issues, and a lack of awareness…
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The assessment of land use and land cover is an extremely important activity for contemporary land management. A large body of current literature suggests that human land-use practice is the most important factor influencing natural resource management and environmental condition...
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ERIC Educational Resources Information Center
Lake, Robin; Dusseault, Brianna; Bowen, Melissa; Demeritt, Allison; Hill, Paul
2010-01-01
The National Study of CMO (charter management organizations) Effectiveness is a national, longitudinal research effort designed to measure how nonprofit charter school management organizations (CMOs) affect student achievement, and to examine the internal structures, practices, and policy contexts that may influence these outcomes. The study began…
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Impact of production practices on physicochemical properties of rice grain quality.
Bryant, Rolfe J; Anders, Merle; McClung, Anna
2012-02-01
Rice growers are interested in new technologies that can reduce input costs while maintaining high field yields and grain quality. The bed-and-furrow (BF) water management system benefits farmers through decreased water usage, labor, and fuel as compared to standard flood management. Fertilizer inputs can be reduced by producing rice in rotation with soybeans, a nitrogen-fixing crop, and with the use of slow-release fertilizers that reduce nitrogen volatilization and run-off. However, the influence of these cultural management practices on rice physicochemical properties is unknown. Our objective was to evaluate the influence of nitrogen fertilizer source, water management system, and crop rotation on rice grain quality. Grain protein concentration was lower in a continuous rice production system than in a rice-soybean rotation. Neither amylose content nor gelatinization temperature was altered by fertilizer source, crop rotation, or water management. BF water management decreased peak and breakdown viscosities relative to a flooded system. Peak and final paste viscosities were decreased by all fertilizer sources, whereas, crop rotation had no influence on the Rapid Visco Analyser profile. Sustainable production systems that decrease water use and utilize crop rotations and slow-release fertilizers have no major impact on rice physicochemical properties. Published 2011 by John Wiley & Sons, Ltd.
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Sortedahl, Charlotte; Mottern, Nina; Campagna, Vivian
The purpose of this article is to examine how case managers are routinely confronted by ethical dilemmas within a fragmented health care system and given the reality of financial pressures that influence life-changing decisions. The Code of Professional Conduct for Case Managers (Code), published by the Commission for Case Manager Certification, acknowledges "case managers may often confront ethical dilemmas" (Code 1996, Rev. 2015). The Code and expectations that professional case managers, particularly those who are board certified, will uphold ethical and legal practice apply to case managers in every practice setting across the full continuum of health care. This discussion acknowledges the ethical dilemmas that case managers routinely confront, which empowers them to seek support, guidance, and resources to support ethical practice. In addition, the article seeks to raise awareness of the effects of burnout and moral distress on case managers and others with whom they work closely on interdisciplinary teams.
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Nicholls, Dasha; Hudson, Lee; Mahomed, Fermeda
2011-10-01
Clinical confidence and coordinated multidisciplinary care can influence the course of anorexia nervosa in children and adolescents. Sicker and younger patients with anorexia nervosa often present first to a paediatrician, requiring early recognition and appropriate management. Paediatric knowledge and skills are also needed to manage the impact of eating disorders on growth and development. This review provides practical guidance on the management of anorexia nervosa for paediatricians, in the areas of assessment, acute management and re-feeding, and long-term monitoring. In the absence of a strong evidence base for some of these recommendations, local protocols based on best practice guidelines can reduce anxiety, increase cooperation and reduce risk.
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Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists
Puspitasari, Hanni P.; Aslani, Parisa; Krass, Ines
2015-01-01
Objectives: We explored factors influencing Indonesian primary care pharmacists’ practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors. Methods: We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by “grounded-theory”. Results: We extracted five emergent themes/factors: pharmacists’ attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists’ inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model. Conclusion: Pharmacists’ attitudes, knowledge, skills and their working environment appeared to influence pharmacists’ contribution in chronic disease management. To develop pharmacists’ involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists’ practice in Indonesia to achieve continuity of care. PMID:26445618
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Uncovering middle managers' role in healthcare innovation implementation
2012-01-01
Background Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Discussion Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Summary Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation. PMID:22472001
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Uncovering middle managers' role in healthcare innovation implementation.
Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J
2012-04-03
Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.
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'Lending the space': midwives' perceptions of birth space and clinical risk management.
Seibold, Carmel; Seibold, Camel; Licqurish, Sharon; Rolls, Colleen; Hopkins, Finbar
2010-10-01
to explore and describe midwives perceptions of birth space and clinical risk management and their impact on practice both before and after a move to a new facility. an exploratory descriptive study utilising a modified participatory approach and observation and focus groups for data collection. a major metropolitan maternity hospital in Victoria, Australia. 18 midwives, including graduate year midwives, caseload midwives and hospital midwives working normal shifts, employed within a hospital. the major themes identified were perceptions of birth space, perceptions of risk management, influence of birth space and risk management on practice and moving but not changing: geographical space and practice. Midwives desire to create the ideal birth space was hampered by a prevailing biomedical discourse which emphasised risk. Midwives in all three groups saw themselves as the gatekeepers, 'holding the space' or 'providing a bridge' for women, often in the face of a hierarchical hospital structure with obstetricians governing practice. This situation did not differ significantly after the relocation to the new hospital. Despite a warmer, more spacious and private birth space midwives felt the care was still influenced by the old hierarchical hospital culture. Caseload midwives felt they had the best opportunity to make a difference to women's experience because they were able, through continuity of care, to build trusting relationships with women during the antenatal period. although the physical environment can make a marginal contribution to an optimal birth space, it has little effect on clinical risk management practices within a major public hospital and the way in which this impacts midwives' practice. The importance of place and people are the key to providing an optimal birth space, as are women centred midwifery models of care and reasonable workloads. Copyright © 2010 Elsevier Ltd. All rights reserved.
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Coulam, Robert; Kralewski, John; Dowd, Bryan; Gans, David
2016-01-01
Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators. To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States. We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues. Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators' recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare's PQRS reports impeded use of the data by administrators to support quality management. Group practice administrators are playing a prominent role in activities related to the quality of patient care--they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results. More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if supported by more useful forms of quality reporting.
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Baker, Francis X; Gallagher, Colleen M
2017-10-01
Undue influence from family members of patients with advanced cancer remains a serious ethical problem in end-of-life decision making. Despite the wealth of articles discussing the problem of undue influence, little has been written by way of practical guidance to help clinicians identify and effectively manage situations of undue influence. This article briefly lays out how to identify and manage situations of undue influence sensitively and effectively. We explain how undue influence may present itself in the clinic and distinguish it from ethically permissible expressions of relational autonomy. In addition, we lay out a process by which any clinician suspecting undue influence may gather additional information and, if necessary, conduct a family meeting to address the undue influence. It is our hope that by providing clinicians at all levels of patient care with such guidance, they will feel empowered to respond to cases of undue influence when they arise.
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Garbach, Kelly; Morgan, Geoffrey P
2017-12-15
Management decisions underpinning availability of ecosystem services and the organisms that provide them in agroecosystems, such as pollinators and pollination services, have emerged as a foremost consideration for both conservation and crop production goals. There is growing evidence that innovative management practices can support diverse pollinators and increase crop pollination. However, there is also considerable debate regarding factors that support adoption of these innovative practices. This study investigated pollination management practices and related knowledge systems in a major crop producing region of southwest Michigan in the United States, where 367 growers were surveyed to evaluate adoption of three innovative practices that are at various stages of adoption. The goals of this quantitative, social survey were to investigate grower experience with concerns and benefits associated with each practice, as well as the influence of grower networks, which are comprised of contacts that reflect potential pathways for social and technical learning. The results demonstrated that 17% of growers adopted combinations of bees (e.g. honey bees, Apis mellifera, with other species), representing an innovation in use by early adopters; 49% of growers adopted flowering cover crops, an innovation in use by the early majority 55% of growers retained permanent habitat for pollinators, an innovation in use by the late majority. Not all growers adopted innovative practices. We found that growers' personal experience with potential benefits and concerns related to the management practices had significant positive and negative relationships, respectively, with adoption of all three innovations. The influence of these communication links likely has different levels of importance, depending on the stage of the adoption that a practice is experiencing in the agricultural community. Social learning was positively associated with adopting the use of combinations of bees, highlighting the potentially critical roles of peer-to-peer networks and social learning in supporting early stages of adoption of innovations. Engaging with grower networks and understanding grower experience with benefits and concerns associated with innovative practices is needed to inform outreach, extension, and policy efforts designed to stimulate management innovations in agroecosystems. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Chronic disease self-management: views among older adults of Chinese descent.
Wang, Jing; Matthews, Judith Tabolt
2010-01-01
To understand how Chinese culture influences chronic disease self-management, we conducted focus groups with older adults of Chinese descent. Specifically, we explored their perceptions and self-management practices regarding treatment adherence, lifestyle decisions, and patient-provider communication within the context of their culture. Copyright 2010. Published by Mosby, Inc.
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Management Style and School Violence: South African Perspectives
ERIC Educational Resources Information Center
Netshitangani, Tshilidzi
2018-01-01
Purpose: The purpose of this paper is to examine the reduction of school violence from the management point of view. It reflects on the utterances by teachers, principals, learners and members of school governing bodies (SGBs) to establish the influence that school management practices can have on the prevalence of school violence.…
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Rose, Danielle E; Tisnado, Diana M; Tao, May L; Malin, Jennifer L; Adams, John L; Ganz, Patricia A; Kahn, Katherine L
2012-06-01
Physician co-management, representing joint participation in the planning, decision-making, and delivery of care, is often cited in association with coordination of care. Yet little is known about how physicians manage tasks and how their management style impacts patient outcomes. To describe physician practice style using breast cancer as a model. We characterize correlates and predictors of physician practice style for 10 clinical tasks, and then test for associations between physician practice style and patient ratings of care. We queried 347 breast cancer physicians identified by a population-based cohort of women with incident breast cancer regarding care using a clinical vignette about a hypothetical 65-year-old diabetic woman with incident breast cancer. To test the association between physician practice style and patient outcomes, we linked medical oncologists' responses to patient ratings of care (physician n=111; patient n=411). After adjusting for physician and practice setting characteristics, physician practice style varied by physician specialty, practice setting, financial incentives, and barriers to referrals. Patients with medical oncologists who co-managed tasks had higher patient ratings of care. Physician practice style for breast cancer is influenced by provider and practice setting characteristics, and it is an important predictor of patient ratings. We identify physician and practice setting factors associated with physician practice style and found associations between physician co-management and patient outcomes (e.g., patient ratings of care). © Health Research and Educational Trust.
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What roles do middle managers play in implementation of innovative practices?
Engle, Ryann L.; Lopez, Emily R.; Gormley, Katelyn E.; Chan, Jeffrey A.; Charns, Martin P.; Lukas, Carol VanDeusen
2017-01-01
Background: Middle managers play key roles in hospitals as the bridge between senior leaders and frontline staff. Yet relatively little research has focused on their role in implementing new practices. Purpose: The aim of this study was to expand the understanding of middle managers’ influence in organizations by looking at their activities through the lens of two complementary conceptual frameworks. Methodology/Approach: We analyzed qualitative data from 17 Veterans Affairs Medical Centers with high and low potential to change organizational practices. We analyzed 98 interviews with staff ranging from senior leaders to frontline staff to identify themes within an a priori framework reflecting middle manager activities. Findings: Analyses yielded 14 emergent themes that allowed us to classify specific expressions of middle manager commitment to implementation of innovative practices (e.g., facilitate improvement innovation, garner staff buy-in). In comparing middle manager behaviors in high and low change potential sites, we found that most emergent themes were present in both groups. However, the activities and interactions described differed between the groups. Practice Implications: Middle managers can use the promising strategies identified by our analyses to guide and improve their effectiveness in implementing new practices. These strategies can also inform senior leaders striving to guide middle managers in those efforts. PMID:26488239
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Drury, Peta; McInnes, Elizabeth; Hardy, Jennifer; Dale, Simeon; Middleton, Sandy
2016-04-01
The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence-based practice (EBP) and readiness for change. Overall Nurse Managers reported high-level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP. © 2015 John Wiley & Sons Australia, Ltd.
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ERIC Educational Resources Information Center
Wankel, Charles, Ed.; DeFillippi, Robert, Ed.
This book series focuses on trends in theory and practice likely to influence 21st century management education. This first volume examines a series of innovative and distinctive approaches to rethinking management education for the 21st century. Part 1 of the collection, "Rethinking What We Teach," contains: (1) "Development of Political Skill"…
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Landscape influence on soil carbon and nutrient levels
USDA-ARS?s Scientific Manuscript database
Past runoff, erosion, and management practices influence nutrient levels on the landscape. These starting levels affect future nutrient transport due to runoff, erosion, and leaching events. The purpose of this study was to examine closed-depression landscape effects on surface soil organic matter, ...
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Coventry, Peter A; Fisher, Louise; Kenning, Cassandra; Bee, Penny; Bower, Peter
2014-10-31
Primary care is increasingly focussed on the care of people with two or more long-term conditions (multimorbidity). The UK Department of Health strategy for long term conditions is to use self-management support for the majority of patients but there is evidence of limited engagement among primary care professionals and patients with multimorbidity. Furthermore, multimorbidity is more common in areas of socioeconomic deprivation but deprivation may act as a barrier to patient engagement in self-management practices. Effective self-management is considered critical to meet the needs of people living with long term conditions but achieving this is a significant challenge in patients with multimorbidity. This study aimed to explore patient and practitioner views on factors influencing engagement in self-management in the context of multimorbidity. A qualitative study using individual semi-structured interviews with 20 patients and 20 practitioners drawn from four general practices in Greater Manchester situated in areas of high and low social deprivation. Three main factors were identified as influencing patient engagement in self-management: capacity (access and availability of socio-economic resources and time; knowledge; and emotional and physical energy), responsibility (the degree to which patients and practitioners agreed about the division of labour about chronic disease management, including self-management) and motivation (willingness to take-up types of self-management practices). Socioeconomic deprivation negatively impacted on all three factors. Motivation was especially reduced in the presence of mental and physical multimorbidity. Full engagement in self-management practices in multimorbidity was only present where patients' articulated a sense of capacity, responsibility, and motivation. Patient 'know-how' or interpretive capacity to self-manage multimorbidity is potentially an important precursor to responsibility and motivation, and might be a critical target for intervention. However, individual and social resources are needed to generate capacity, responsibility, and motivation for self-management, pointing to a balanced role for health services and wider enabling networks.
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Survey of Irish general practitioners' preferences for continuing professional development.
Maher, B; O'Neill, R; Faruqui, A; Bergin, C; Horgan, M; Bennett, D; O'Tuathaigh, C M P
2018-01-01
Doctors' continuing professional development (CPD) training needs are known to be strongly influenced by national and local contextual characteristics. Given the changing national demographic profile and government-mandated changes to primary care health care provision, this study aimed to investigate Irish General Practitioners' (GPs) perceptions of, and preferences for, current and future CPD programmes. A cross-sectional questionnaire, using closed- and open-ended questions, was administered to Irish GPs, focusing on training needs analysis; CPD course content; preferred format and the learning environment. The response rate was 719/1000 (71.9%). GPs identified doctor-patient communication as the most important and best-performed GP skill. Discrepancies between perceived importance (high) and current performance (low) emerged for time/workload management, practice finance and business skills. GPs identified clinically-relevant primary care topics and non-clinical topics (stress management, business skills, practice management) as preferences for future CPD. Flexible methods for CPD delivery were important. Gender and practice location (urban or rural) significantly influenced CPD participation and future course preference. The increasing diversity of services offered in the Irish primary care setting, in both clinical and non-clinical areas, should be tailored based to include GP practice location and structure.
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How Does Education and Training Impact on Management Practices? CRLRA Discussion Paper Series.
ERIC Educational Resources Information Center
Kilpatrick, Sue
A study examined the impact of agricultural education and training on farm business practice and the influence of training on changes to farming practice in Australia. Data were from an additional set of questions on the Australian Bureau of Statistics' 1993-94 Agricultural Financial Survey and an interview survey of 65 Tasmanian farmers. Findings…
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Barasa, Edwine W; Cleary, Susan; English, Mike; Molyneux, Sassy
2016-09-30
Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findings RESULTS: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes.
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Papagiannakis, Giorgos; Lioukas, Spyros
2012-06-15
We examine whether managers' values, attitudes, and perceptions influence the greening of organizations. To that purpose, we specify and test a model of corporate environmental responsiveness (CER), drawing upon a modified version of the theory of planned behavior and the value-belief-norm theory. Based on survey data from 142 Greek companies, we find that top managers' personal values influence responses indirectly, through shaping their environmental attitudes, while direct relationship is not significant. Subjective norms, expressing stakeholder expectations, do affect CER, with their effect being stronger than that of attitudes. Managers' perceived ability to handle environmental issues also appears to influence responses. Results have theoretical implications, indicating the significant role of managers' values, attitudes and perceptions in a firm's environmental response. Practical implications are discussed in relation to selection of managers and training. Copyright © 2012 Elsevier Ltd. All rights reserved.
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THE USE OF LANDSCAPE SCIENCE FOR THE ASSESSMENT OF ENVIROMENTAL SECURITY
The assessment of land use and land cover is an extremely important activity for contemporary land management. Human land-use practices (including type, magnitude, and distribution) are the most important factors influencing
environmental management at local, regional, nat... -
Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy
2015-01-01
Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.
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2011-01-01
Background This paper, which draws upon an Emancipatory Action Research (EAR) approach, unearths how the complexities of context influence the realities of nursing practice. While the intention of the project was to identify and change factors in the practice context that inhibit effective person-centred pain management practices with older people (65 years or older), reflective critical engagement with the findings identified that enhancing pain management practices with older people was dependent on cultural change in the unit as a whole. Methods An EAR approach was utilised. The project was undertaken in a surgical unit that conducted complex abdominal surgery. Eighty-five percent (n = 48) of nursing staff participated in the two-year project (05/NIR02/107). Data were obtained through the use of facilitated critical reflection with nursing staff. Results Three key themes (psychological safety, leadership, oppression) and four subthemes (power, horizontal violence, distorted perceptions, autonomy) were found to influence the way in which effective nursing practice was realised. Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice. Conclusions Whilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature. Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments. PMID:21284857
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Safety management in a relationship-oriented culture.
Hsu, Shang Hwa; Lee, Chun-Chia
2012-01-01
A relationship-oriented culture predominates in the Greater China region, where it is more important than in Western countries. Some characteristics of this culture influence strongly the organizational structure and interactions among members in an organization. This study aimed to explore the possible influence of relationships on safety management in relationship-oriented cultures. We hypothesized that organizational factors (management involvement and harmonious relationships) within a relationship-oriented culture would influence supervisory work (ongoing monitoring and task instructions), the reporting system (selective reporting), and teamwork (team communication and co-ordination) in safety management at a group level, which would in turn influence individual reliance complacency, risk awareness, and practices. We distributed a safety climate questionnaire to the employees of Taiwanese high-risk industries. The results of structural equation modeling supported the hypothesis. This article also discusses the findings and implications for safety improvement in countries with a relationship-oriented culture.
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Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede; Børøsund, Elin; Ruland, Cornelia M
2015-06-01
The role of nurse and physician managers is considered crucial for implementing eHealth interventions in clinical practice, but few studies have explored this. The aim of the current study was to examine the perceptions of nurse and physician managers regarding facilitators, barriers, management role, responsibility, and action taken in the implementation of an eHealth intervention called Choice into clinical practice. Individual qualitative interviews were conducted with six nurses and three physicians in management positions at five hospital units. The findings revealed that nurse managers reported conscientiously supporting the implementation, but workloads prevented them from participating in the process as closely as they wanted. Physician managers reported less contribution. The implementation process was influenced by facilitating factors such as perceptions of benefits from Choice and use of implementation strategies, along with barriers such as physician resistance, contextual factors and difficulties for front-line providers in learning a new way of communicating with the patients. The findings suggest that role descriptions for both nurse and physician managers should include implementation knowledge and implementation skills. Managers could benefit from an implementation toolkit. Implementation management should be included in management education for healthcare managers to prepare them for the constant need for implementation and improvement in clinical practice.
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The impact of social context on self-management in women living with HIV.
Webel, Allison R; Cuca, Yvette; Okonsky, Jennifer G; Asher, Alice K; Kaihura, Alphoncina; Salata, Robert A
2013-06-01
HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicted all domains of HIV self-management including daily health practices (F = 5.40, adjusted R(2) = 0.27, p < 0.01), HIV social support (F = 4.50, adjusted R(2) = 0.22, p < 0.01), and accepting the chronic nature of HIV (F = 5.57, adjusted R(2) = 0.27, p < 0.01). We found evidence to support the influence of the traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women's social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population. Copyright © 2013 Elsevier Ltd. All rights reserved.
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The Impact of Social Context on Self-Management in Women Living with HIV
Webel, Allison R.; Cuca, Yvette; Okonsky, Jennifer G.; Asher, Alice K.; Kaihura, Alphoncina; Salata, Robert A.
2013-01-01
HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicated all domains of HIV self-management including daily health practices (F=5.40, adjusted R2=0.27, p<0.01), HIV social support (F=4.50, adjusted R2=0.22, p<0.01), and accepting the chronic nature of HIV (F=5.57, adjusted R2=0.27, p<0.01). We found evidence to support the influence of the traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women’s social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population. PMID:23631790
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Can short-term pasture management increase C balance in the Atlantic Rainforest?
da Rocha Junior, Paulo Roberto; Andrade, Felipe Vaz; Santos Satiro, Lucas; Donagemma, Guilherme Kangussú; de Sá Mendonça, Eduardo
2018-05-11
Few studies have shown the importance of different pasture management practices on C storage and the reduction of CO 2 -C emissions in tropical conditions. The objective of the present study was to determine short-term changes in C pools and C balance from different pasture management practices established in the Atlantic Rainforest. A field study was carried out in Alegre, ES, Brazil from September 2013 to August 2014 to investigate the first-year effect of pasture management practices on a Udult clayey soil. The different pasture management practices studied included the following: control (CON), chiseled (CHI), fertilized (FER), burned (BUR), integrated with crop-livestock (iCL) systems, and plowed and harrowed (PH). Monthly disturbed and undisturbed soil samples were taken at two different layers (0.00-0.05 and 0.05-0.20 m) for chemical, physical, and organic matter characterization. C inputs monitored in aboveground pools included plant aerial parts and litter, and belowground pools included roots and soil C stocks. C outputs monitored were CO 2 -C emissions, erosion water, and sediment. C balance was considered the difference between inputs and outputs in each treatment during four seasons. The spring and summer seasons had a strong influence on C inputs and outputs where there is significant difference between spring and summer, while the autumn and winter seasons had less influence. All pasture management practices exhibited positive C balance after 1 year. High values of C balance were verified in pastures fertilized (FER) (53.04 Mg ha -1 year -1 . Intermediate C balance was found in the burned (BUR) (40.84 Mg ha -1 year -1 ), traditional control (CON) (40.31 Mg ha -1 year -1 ), and in the plowing and harrowing (PH) (40.02 Mg ha -1 year -1 ) management practices. The practices of chiseled (40.00 Mg ha -1 year -1 ) and integrated crop-livestock systems (iCL) (59.06 Mg ha -1 year -1 ) resulted in low C balance.
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Normal tension glaucoma management: a survey of contemporary practice.
Symes, Richard J; Mikelberg, Frederick S
2017-08-01
The aim of this study was to investigate contemporary practice patterns with respect to normal tension glaucoma (NTG) management and to determine whether the 2 largest NTG trials have influenced ophthalmologists' clinical practice. A survey questionnaire was sent to ophthalmologists via the American Glaucoma Society, the Canadian Glaucoma Society, and the Canadian Ophthalmological Society. The questionnaire was designed to investigate ophthalmologists' usual practice with respect to NTG and the extent to which practice has been influenced by the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Low pressure Glaucoma Treatment Study (LoGTS). In total, 419 ophthalmologists completed the survey. Of these, 264 respondents were glaucoma subspecialists. The survey showed that 95% and 64% of ophthalmologists were familiar with the CNTGS and the LoGTS, respectively. Of the respondents, 70% indicated that they would initiate treatment in mild-to-moderate NTG without waiting for documented disease progression. Of the respondents, 61% of the total surveyed and 50% of the glaucoma subspecialists felt that the LoGTS results had no impact on their usual clinical practice. The first-choice topical drug for NTG was a prostaglandin analogue (88% of respondents) or brimonidine (10% of respondents). Most ophthalmologists treat NTG more aggressively than recommended by the CTNGS protocol. Most ophthalmologists felt that the LoGTS results had no impact on their normal clinical practice. The prostaglandin analogues are, by far, the most popular choice of drug for contemporary management of NTG. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
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Influences of Organizational Culture and Climate on Individual Creativity.
ERIC Educational Resources Information Center
Tesluk, Paul E.; And Others
1997-01-01
Provides a framework for conceptualizing and reviewing the literature on the influences of organizational culture and climate on individual creativity. Discusses how certain environmental conditions, strategic approaches, and top management values and actions impact individual creativity. Examples of organizational practices that foster creativity…
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Influence of poultry litter and double cropping on soybean yield
USDA-ARS?s Scientific Manuscript database
Continuous cultivation of mono-cropping systems coupled with inorganic fertilizer consumption has led to a decline in soil fertility, negatively influencing crop yields. Poultry litter application and double cropping are two management practices that could be used with conservation tillage to increa...
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A Qualitative Study of Hospitalists' Perceptions of Patient Satisfaction Metrics on Pain Management.
Calcaterra, Susan L; Drabkin, Anne D; Doyle, Reina; Leslie, Sarah E; Binswanger, Ingrid A; Frank, Joseph W; Reich, Jennifer A; Koester, Stephen
2017-01-01
Hospital initiatives to promote pain management may unintentionally contribute to excessive opioid prescribing. To better understand hospitalists' perceptions of satisfaction metrics on pain management, the authors conducted 25 interviews with hospitalists. Transcribed interviews were systematically analyzed to identify emergent themes. Hospitalists felt institutional pressure to earn high satisfaction scores for pain, which they perceived influenced practices toward opioid prescribing. They felt tying compensation to satisfaction scores commoditized pain. Hospitalists believed satisfaction would improve with increased time spent at the bedside. Focusing on methods to improve patient-physician communication, while maintaining efficiency in clinical practice, may promote both patient-centered pain management and satisfaction.
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Ball, Brita; Wilcock, Anne; Aung, May
2009-06-01
Small and medium sized food businesses have been slow to adopt food safety management systems (FSMSs) such as good manufacturing practices and Hazard Analysis Critical Control Point (HACCP). This study identifies factors influencing workers in their implementation of food safety practices in small and medium meat processing establishments in Ontario, Canada. A qualitative approach was used to explore in-plant factors that influence the implementation of FSMSs. Thirteen in-depth interviews in five meat plants and two focus group interviews were conducted. These generated 219 pages of verbatim transcripts which were analysed using NVivo 7 software. Main themes identified in the data related to production systems, organisational characteristics and employee characteristics. A socio-psychological model based on the theory of planned behaviour is proposed to describe how these themes and underlying sub-themes relate to FSMS implementation. Addressing the various factors that influence production workers is expected to enhance FSMS implementation and increase food safety.
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Walshe, Catherine; Todd, Chris; Caress, Ann-Louise; Chew-Graham, Carolyn
2008-04-01
Policies emphasise the importance of collaborative working in community palliative care. Collaborations are generally formed through formal and informal referral processes, but little is known about what influences professionals' decisions to refer to such services. To explore the influences on referrals within general and specialist community palliative care services. Qualitative, multiple-case study. Three primary care trusts in the north-west of England. Multiple data collection methods were employed, including documentary analysis, observation of referral team meetings and interviews. This paper primarily reports data from interviews with 47 health professionals, including GPs, district nurses, and specialist palliative care professionals. Judgements -- positive and negative -- about aspects of fellow professionals' performances appeared to influence referral decisions and ongoing collaboration and care. Attributes upon which these judgements were based included professional responsiveness and communication, respect, working and workload management practices, perceived expertise, and notions of elite practice. The effects of such judgements on referral and healthcare practices were altered by professional "game playing" to achieve professionals' desired outcomes. Palliative care policies and protocols need to take account of these complex and subtle influences on referrals and collaboration. In particular, teamwork and partnership are encouraged within palliative care work, but critical judgements indicate that such partnerships may be difficult or fragile. It is likely that such judgemental attitudes and practices affect many aspects of primary care, not just palliative care.
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Research on Influencing Factors of Salespeople's Empowerment Readiness in Green Energy Enterprise
NASA Astrophysics Data System (ADS)
Dong, Yuan; Liu, Xiaohui
As market competition in green energy enterprises continues to intensify, marketing activities are enlarging and customer demand is increasingly growing and diversifying. More and more green energy enterprises have empowered their own salespeople. And managers in green energy enterprises are more concerned with the issues which employees suit to be empowered and which factors will influence employee empowerment readiness. This paper proposes the definition of salespeople's empowerment readiness, analyzes influencing factors of salespeople's empowerment readiness, discusses the effect mechanism of influencing factors of salespeople's empowerment readiness, finally, and puts forward some suggestions to enhance salespeople's empowerment readiness from the perspective of human resource management practice.
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Fleiszer, Andrea R; Semenic, Sonia E; Ritchie, Judith A; Richer, Marie-Claire; Denis, Jean-Louis
2016-04-01
To describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines (BPG) program on inpatient units. Several factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. A qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability. Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements. As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities. © 2015 John Wiley & Sons Ltd.
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Siu, Heidi; Spence Laschinger, Heather K; Finegan, Joan
2008-05-01
The aim of this study was to examine the impact of nurses' perceived professional practice environment on their quality of nursing conflict management approaches and ultimately their perceptions of unit effectiveness from the perspective of Deutsch's theory of constructive conflict management. Rising reports of hostility and conflict among Canadian nurses are a concern to nurses' health and the viability of effective patient care delivery. However, research on the situational factors that influence nurses' ability to apply effective conflict resolution skills that lead to positive results in practice is limited. A nonexperimental, predictive design was used in a sample of 678 registered nurses working in community hospitals within a large metropolitan area in Ontario. The results supported a modified version of the hypothesized model [chi2(1) = 16.25, Goodness of Fit = 0.99, Comparative Fit Index = 0.98, Root-Mean-Square Error of Approximation = 0.15] linking professional practice environment and core self-evaluation to nurses' conflict management and, ultimately, unit effectiveness. Professional practice environment, conflict management, and core-self evaluation explained approximately 46.6% of the variance in unit effectiveness. Positive professional practice environments and high core self-evaluations predicted nurses' constructive conflict management and, in turn, greater unit effectiveness.
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Restoring wisdom to the practice of psychiatry.
Boyce, Philip
2006-03-01
While psychiatry is an exciting and rewarding discipline of medicine, the practice of psychiatry has become increasingly simplistic. This address seeks to identify some of the influences that underlie this phenomenon. The influences include an increased demand for services and pressure on beds, the sway of the pharmaceutical industry with a biological approach being promulgated, excessive managerial constraints with an emphasis on efficiency versus effectiveness, and the acceptance of DSM diagnostic categories of uncertain validity. I argue that we need to rediscover a more wise approach to psychiatric practice. We have to insist upon changes to our training such that trainees are encouraged to get to know their patients and understand them from a biopsychosocial perspective. As a profession, we have to insist on proper care for our patients and work with managers and bureaucrats to ensure that the management of our patients is centred on quality of care and effectiveness over and above efficiency.
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Managing Employee Assistance Programmes.
ERIC Educational Resources Information Center
Schmidenberg, Olive C.; Cordery, John L.
1990-01-01
Interviews with 20 branch managers and 20 accountants in an Australian bank determined factors influencing the success of an employee assistance program (EAP). It was found that policies requiring supervisors to act against normal managerial practice doom EAPs to failure. Organizational analysis to integrate the EAP within existing organizational…
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NASA Astrophysics Data System (ADS)
Easterday, K.; Kelly, M.; McIntyre, P. J.
2015-12-01
Climate change is forecasted to have considerable influence on the distribution, structure, and function of California's forests. However, human interactions with forested landscapes (e.g. fire suppression, resource extraction and etc.) have complicated scientific understanding of the relative contributions of climate change and anthropogenic land management practices as drivers of change. Observed changes in forest structure towards smaller, denser forests across California have been attributed to both climate change (e.g. increased temperatures and declining water availability) and management practices (e.g. fire suppression and logging). Disentangling how these drivers of change act both together and apart is important to developing sustainable policy and land management practices as well as enhancing knowledge of human and natural system interactions. To that end, a comprehensive historical dataset - the Vegetation Type Mapping project (VTM) - and a modern forest inventory dataset (FIA) are used to analyze how spatial variations in vegetation composition and structure over a ~100 year period can be explained by land ownership.Climate change is forecasted to have considerable influence on the distribution, structure, and function of California's forests. However, human interactions with forested landscapes (e.g. fire suppression, resource extraction and etc.) have complicated scientific understanding of the relative contributions of climate change and anthropogenic land management practices as drivers of change. Observed changes in forest structure towards smaller, denser forests across California have been attributed to both climate change (e.g. increased temperatures and declining water availability) and management practices (e.g. fire suppression and logging). Disentangling how these drivers of change act both together and apart is important to developing sustainable policy and land management practices as well as enhancing knowledge of human and natural system interactions. To that end, a comprehensive historical dataset - the Vegetation Type Mapping project (VTM) - and a modern forest inventory dataset (FIA) are used to analyze how spatial variations in vegetation composition and structure over a ~100 year period can be explained by land ownership.
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Longmore, Bruce; Ronnie, Linda
2014-03-26
Human resource management (HRM) practices have the potential to influence the retention of doctors in the public health sector. To explore the key human resource (HR) practices affecting doctors in a medical complex in the Eastern Cape, South Africa. We used an open-ended questionnaire to gather data from 75 doctors in this setting. The most important HR practices were paying salaries on time and accurately, the management of documentation, communication, HR staff showing that they respected and valued the doctors, and reimbursement for conferences and special leave requests. All these practices were judged to be poorly administered. Essential HR characteristics were ranked in the following order: task competence of HR staff, accountability, general HR efficiency, occupation-specific dispensation adjustments and performance management and development system efficiency, and availability of HR staff. All these characteristics were judged to be poor. HRM practices in this Eastern Cape medical complex were inadequate and a source of frustration. This lack of efficiency could lead to further problems with regard to retaining doctors in public sector service.
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Newnam, Sharon; Warmerdam, Amanda; Sheppard, Dianne; Griffin, Mark; Stevenson, Mark
2017-05-01
It has been estimated that one-third of all work-related deaths occur while driving for work-related purposes. Despite this, many organisations are unaware of the practices, beyond those that identify and control the impact of unforeseen events (i.e., risk management), that predispose drivers to risk. This study addresses the issue by identifying the management practices operationalised as, High Performance Workplace Systems (HPWS) that influence safe driver behaviour. The study also explores the value given to safety by senior level management as a moderator of the relationship between HPWS practices and driver behaviour. Each factor was tested within a two level hierarchical model consisting of 911 drivers, nested within 161 supervisors and 83 organisations. The findings highight that under conditions of high investment in job and work design, communication and selection practices, drivers reported poorer driving behaviour. An interaction effect also demonstrated that under conditions of high investment in remuneration, drivers reported safer behaviour, but only when they perceived that managers valued and prioritised safety. The findings challenge current thinking in the management of workplace road safety. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Anna-Liisa Sippola
2002-01-01
The present status of species and habitats in Finnish wilderness areas is largely a consequence of past administrative, use, and management traditions in northern Finland. The existing wilderness legislation sets a framework for management, but historical uses and administrative decisions have influenced many prevailing practices. In addition, management of many uses...
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ERIC Educational Resources Information Center
Putman, S. Michael
2013-01-01
Research has shown efficacy exerts a powerful influence on behavior. Classroom management represents one vehicle for demonstrations of these behaviors, yet few instruments focus solely on the measurement of this domain-specific form of efficacy. This research explored the relationship between teacher self-efficacy and classroom management through…
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Influence of management practices on microbial nitrogen cyclers in agricultural soils
NASA Astrophysics Data System (ADS)
García-Orenes, Fuensanta; Morugán-Coronado, Alicia; McMillan, Mary; Pereg, Lily
2016-04-01
Agricultural land management has great influences on soil properties, in particular on microbial communities, due to their sensitivity to the perturbations of the soils. This is even more relevant in Mediterranean agricultural areas under semi-arid conditions. The Mediterranean belt is suffering from an intense degradation of its soils due to the millennia of intense land use and due to unsustainable management practices. As a consequence this area is suffering from a depletion of N content. In this work we investigated the effect of several traditional agricultural management practices on specific functional groups related to the nitrogen cycle in the soil. A field experiment was performed with orchard orange trees (citrus sinesis) in Eastern Spain to assess the long-term effects of ploughing with inorganic fertilization (PI) and ecological practices (EP) (chipped pruned branches and weeds as well as manure from sheep and goats) on microbes that can undertake nitrogen fixation and denitrification. Nine samples of soil were taken from every treatment, near the drip irrigation point and in a zone without the influence of drip irrigation (between trees row), and total DNA extracted. DNA samples were stored at minus-20°C to be analysed by qPCR. Microbial populations involved in the N biochemical cycle were analysed by targeted amplification of key functional biomarker genes: the abundance of nifH (nitrogen fixation), nirS, nirK and nosZ (denitrification) detected by quantitative PCR (qPCR) has shown significant differences between treatments with higher abundance of all four genes in soils from ecological agricultural treatments. This may indicate that the ecological treatment created conditions that are more suitable for N cyclers in the soil and a better fertility and quality status of these soils.
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Factors influencing the development of evidence-based practice among nurses: a self-report survey
2012-01-01
Background Health authorities in several countries have decided that the health care services should be evidence-based. Recent research indicates that evidence-based practice may be more successfully implemented if the interventions overcome identified barriers. Aims The present study aimed to examine factors influencing the implementation of evidence-based practice among nurses in a large Norwegian university hospital. Methods Cross-sectional data was collected from 407 nurses during the period November 8 to December 3, 2010, using the Norwegian version of Developing Evidence-based Practice questionnaire (DEBP). The DEBP included data on various sources of information used for support in practice, on potential barriers for evidence-based practice, and on self-reported skills on managing research-based evidence. The DEBP was translated into Norwegian in accordance with standardized guidelines for translation and cultural adaptation. Results Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse’s age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. Conclusion Skills in evidence-based practice seem to reduce barriers to using research evidence and to increase use of research evidence in clinical practice. PMID:23092366
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Brazil, Kevin; Cloutier, Michelle M; Tennen, Howard; Bailit, Howard; Higgins, Pamela S
2008-04-01
The purpose of this study was to examine the challenges of integrating an asthma disease management (DM) program into a primary care setting from the perspective of primary care practitioners. A second goal was to examine whether barriers differed between urban-based and nonurban-based practices. Using a qualitative design, data were gathered using focus groups in primary care pediatric practices. A purposeful sample included an equal number of urban and nonurban practices. Participants represented all levels in the practice setting. Important themes that emerged from the data were coded and categorized. A total of 151 individuals, including physicians, advanced practice clinicians, registered nurses, other medical staff, and nonmedical staff participated in 16 focus groups that included 8 urban and 8 nonurban practices. Content analyses identified 4 primary factors influencing the implementation of a DM program in a primary care setting. They were related to providers, the organization, patients, and characteristics of the DM program. This study illustrates the complexity of the primary care environment and the challenge of changing practice in these settings. The results of this study identified areas in a primary care setting that influence the adoption of a DM program. These findings can assist in identifying effective strategies to change clinical behavior in primary care practices.
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Time management strategies in nursing practice.
Waterworth, Susan
2003-09-01
With the increasing emphasis on efficiency and effectiveness in health care, how a nurse manages her time is an important consideration. Whilst time management is recognized as an important component of work performance and professional nursing practice, the reality of this process in nursing practice has been subject to scant empirical investigation. To explore how nurses organize and manage their time. A qualitative study was carried out, incorporating narratives (22 nurses), focus groups (24 nurses) and semi-structured interviews (22 nurses). In my role as practitioner researcher I undertook observation and had informal conversations, which provided further data. Study sites were five health care organizations in the United Kingdom during 1995-1999. Time management is complex, with nurses using a range of time management strategies and a repertoire of actions. Two of these strategies, namely routinization and prioritizing, are discussed, including their implications for understanding time management by nurses in clinical practice. Ignoring the influence of 'others', the team and the organization perpetuates a rather individualistic and self-critical perspective of time management. This may lead to a failure to address problems in the organizing of work, and the co-ordinating of care involving other health care workers.
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Managing diversity in health services organizations.
Muller, H J; Haase, B E
1994-01-01
The changing ethnic, racial, and gender workforce characteristics require innovations in management philosophy and practice. Valuing employees' differences is believed to be a competitive advantage in many modern corporations. This article offers recommendations to health care managers for rethinking and improving the management of their heterogeneous workforces. A conceptual framework and evaluative criteria are developed in an attempt to better understand the factors that influence effective diversity management. The experiences of health services institutions in the Southwest (already a multicultural region) are studied to illustrate various approaches to diversity management. Leader philosophy and support, organizational policies and programs, workforce composition, structural integration, and organizational type constitute the main elements in this study. As the nation debates restructuring the health industry, it should also take the opportunity to integrate a management philosophy that values diversity and its practice.
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Silvicultural research and the evolution of forest practices in the Douglas-fir region.
Robert O. Curtis; Dean S. DeBell; Richard E. Miller; Michael Newton; J. Bradley St. Clair; William I. Stein
2007-01-01
Silvicultural practices in the Douglas-fir region evolved through a combination of formal research, observation, and practical experience of forest managers and silviculturists, and changing economic and social factors. This process began more than a century ago and still continues. It has had a great influence on the economic well-being of the region and on the...
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Muhammad Masum, Abdul Kadar; Azad, Md. Abul Kalam; Hoque, Kazi Enamul; Beh, Loo-See
2015-01-01
The paper aims to examine the influence of human resource management (HRM) practices on bank efficiency using Malmquist index of total factor productivity. The model comprises HRM index that represents the quality of HRM practices. The results are decomposed into three efficiency scores, namely, technical efficiency, pure efficiency, and scale efficiency. In this study, panel data for 44 banks in Bangladesh are used for the period 2008-2013. This paper reveals that foreign banks are ahead in converting the influence of HRM practices into efficiency scores (0.946>0.833). On the other hand, domestic banks performed better than foreign banks in terms of pure efficiency and scale efficiency. But, in terms of technical efficiency, the domestic banks are regressed by 6.7% annually whereas foreign banks are progressed with a yearly value of 5.8%. The results are robust, because the Mann-Whitney test and Kruskall-Wallis test (non-parametric tests) also confirm the same results. This study emphasizes HRM practices in the banking industry to ensure efficiency in the long-term scenario. Domestic banks are suggested to ensure continuous development in HRM practices in order to compete with foreign banks. PMID:26221727
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Masum, Abdul Kadar Muhammad; Azad, Md Abul Kalam; Hoque, Kazi Enamul; Beh, Loo-See
2015-01-01
The paper aims to examine the influence of human resource management (HRM) practices on bank efficiency using Malmquist index of total factor productivity. The model comprises HRM index that represents the quality of HRM practices. The results are decomposed into three efficiency scores, namely, technical efficiency, pure efficiency, and scale efficiency. In this study, panel data for 44 banks in Bangladesh are used for the period 2008-2013. This paper reveals that foreign banks are ahead in converting the influence of HRM practices into efficiency scores (0.946>0.833). On the other hand, domestic banks performed better than foreign banks in terms of pure efficiency and scale efficiency. But, in terms of technical efficiency, the domestic banks are regressed by 6.7% annually whereas foreign banks are progressed with a yearly value of 5.8%. The results are robust, because the Mann-Whitney test and Kruskall-Wallis test (non-parametric tests) also confirm the same results. This study emphasizes HRM practices in the banking industry to ensure efficiency in the long-term scenario. Domestic banks are suggested to ensure continuous development in HRM practices in order to compete with foreign banks.
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Cochrane, Frances Clare; Brown, Louise; Siyambalapitiya, Samantha; Plant, Christopher
2016-10-01
This study explored speech-language pathologists' (SLPs) perspectives about factors that influence clinical management of Aboriginal and Torres Strait Islander adults with acquired communication disorders (e.g. aphasia, motor speech disorders). Using a qualitative phenomenological approach, seven SLPs working in North Queensland, Australia with experience working with this population participated in semi-structured in-depth interviews. Qualitative content analysis was used to identify categories and overarching themes within the data. Four categories, in relation to barriers and facilitators, were identified from participants' responses: (1) The Practice Context; (2) Working Together; (3) Client Factors; and (4) Speech-Language Pathologist Factors. Three overarching themes were also found to influence effective speech pathology services: (1) Aboriginal and Torres Strait Islander Cultural Practices; (2) Information and Communication; and (3) Time. This study identified many complex and inter-related factors which influenced SLPs' effective clinical management of this caseload. The findings suggest that SLPs should employ a flexible, holistic and collaborative approach in order to facilitate effective clinical management with Aboriginal and Torres Strait Islander people with acquired communication disorders.
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Rundall, Thomas G; Wu, Frances M; Lewis, Valerie A; Schoenherr, Karen E; Shortell, Stephen M
2016-01-01
The accountable care organization (ACO) is a new type of health care organization incentivized to improve quality of care, improve population health, and reduce the cost of care. An ACO's success in meeting these objectives depends greatly upon its ability to improve patient care management. Numerous studies have found relational coordination to be positively associated with key measures of organizational performance in health care organizations, including quality and efficiency. The purpose of this paper is twofold: (a) identify the extent to which ACO leaders are aware of the dimensions of relational coordination, and (b) identify the ways these leaders believe the dimensions influenced care management practices in their organization. We performed content analysis of interviews with managerial and clinical leaders from a diverse group of 11 ACOs to assess awareness of relational coordination and identify the ways that dimensions of relational coordination were perceived to influence development of care management practices. ACO leaders mentioned four relational coordination dimensions: shared goals, frequency of communication, timeliness of communication, and problem solving communication. Three dimensions - shared knowledge of team members' tasks, mutual respect, and accuracy of communication - were not mentioned. Our analysis identified numerous ways leaders believed the four mentioned dimensions contributed to the development of care management, including contributions to standardization of care, patient engagement, coordination of care, and care planning. We propose two hypotheses for future research on relational coordination and care management. If relational coordination is to have a beneficial influence on ACO performance, organizational leaders must become more aware of relational coordination and its various dimensions and become cognizant of relational coordination's influence on care management in their ACO. We suggest a number of means by which ACO leaders could become more aware of relational coordination and its potential effects.
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Predictors of Adolescents’ Health- promoting Behaviors Guided by Primary Socialization Theory
Rew, Lynn; Arheart, Kristopher L.; Thompson, Sanna; Johnson, Karen
2013-01-01
Purpose The purpose of this study was to determine the influence of parents and peers on adolescents’ health-promoting behaviors, framed by Primary Socialization Theory. Design and Method Longitudinal data collected annually from 1,081 rural youth (mean age = 17 ±.7; 43.5% males; 44% Hispanic) and once from their parents were analyzed using generalized linear models. Results Parental monitoring and adolescent’s religious commitment significantly predicted all health-promoting behaviors (nutrition, physical activity, safety, health practices awareness, stress management). Other statistically significant predictors were parent’s responsiveness and health-promoting behaviors. Peer influence predicted safety and stress management. Practice Implications Nurses may facilitate adolescents’ development of health-promoting behaviors through family-focused interventions. PMID:24094123
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The influence of ethics on leadership.
Kraemer, A M
1995-05-01
Value driven ethical leadership is needed today. The housekeeping field employs a diverse work force, and managers must develop and empower workers to attain organization goals. As managers, we must understand and develop our personal value structures that affect our decision making. This paper reviews Lawrence Kohlberg's study of moral behavior and how those stages are relevant to ethical management practices. It also addresses ways to overcome some obstacles in understanding and dealing with personal values that may threaten moral and ethical practices. Mature ethical principles and good communication are the foundation for and foster strong leadership for the future.
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Bandeira, Maria da C A; Brito, Gustavo A; da Penha, Adriane; Santos, Ciro L C; Rebêlo, José M M
2017-06-01
We investigated whether biting midges in peridomestic environments are affected by environmental management practices and the presence of domestic animals. We used CDC light traps to collect midges in 112 residences across 24 locations along tourism routes of Maranhão, Brazil. The collection areas were characterized as follows: i) peridomestic area with domestic animals and without management (dirty); ii) peridomestic with domestic animals and management (clean); iii) peridomestic without animals and with management (clean); iv) peridomestic without animals and without management (dirty). The first two treatments had higher biting midge species richness and abundance, respectively. Generalized linear models indicated a positive correlation between the presence of domestic animals and midge abundance, with an approximate four-fold increase in Culicoides (Diptera: Ceratopogonidae) abundance in peridomestic areas with animals. The same model showed that domestic animals have no influence on richness. Environmental management does not appear to influence species richness or abundance of biting midges. © 2017 The Society for Vector Ecology.
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Antunes, Maria João Lobo; Ahlin, Eileen M
2018-02-01
Experiences with neighborhood violence can produce negative consequences in youth, including stress, anxiety, and deviant behavior. Studies report that immigrant and minority youth are more likely to be exposed to violence but less likely to perpetrate it. Similarly, research shows parenting practices are differentially adopted by Blacks, Whites, and Hispanics. Although family management strategies can often act as a barrier to the detrimental effects of exposure to community violence (ETV-C), there is a paucity of investigation on how Hispanic subgroups (e.g., Puerto Rican, Mexican) and immigrant families employ such practices in protecting their children against victimization and violence in the community. Applying an ecological framework, we use data from the Project on Human Development in Chicago Neighborhoods to examine the role of parenting and peer relationships on youth ETV-C, across race/ethnicity and immigrant generational status. Our sample is drawn from Cohorts 9, 12, and 15, and is over 40% Hispanic-Latino. We investigate the differences in within and outside the home family management strategies in terms of both race/ethnicity and immigrant generational status. Our work also seeks to determine the effects of race/ethnicity and immigrant status on youth ETV-C, while examining the influence of family management and peer relations. Results indicate that the adoption of family management practices is not homogeneous across Hispanic subgroups or immigrant generational status, and parenting practices seem to mediate the relationship between these characteristics and exposure to violence. Variations in parenting practices underscore the need to disentangle the cultural plurality of racial/ethnic grouping and how immigrant generational status influences parenting choices that protect children from exposure to violence in the community.
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Innovation characteristics and intention to adopt sustainable facilities management practices.
Lee, So Young; Kang, Mihyun
2013-01-01
Sustainable facilities management (SFM) is important because typical buildings consume more resources and energy than necessary, negatively impact the environment and generate lots of waste (US Department of Energy, 2003, Green Buildings). This study examined innovation characteristics that relate to facility managers' intention to adopt SFM practices. Based on the diffusion of innovations theory (Rogers 1962, 1995, Diffusion of Innovations. 4th ed. New York: The Free Press), an SFM innovation and adoption model was proposed. A survey was conducted with a convenience sample of 240 public facilities managers in 25 facilities management divisions in Seoul, Korea, and its metropolitan areas. Structural equation modelling was employed to analyse the data. The results showed that economic advantage and human comfort aspects are predictors for the intention of SFM adoption. Observability is positively relevant to the intention of SFM adoption. Complexity, however, is not a significant predictor for the intention of SFM adoption. Practical implications for sustainable products and systems and the built environment are suggested. To incorporate an innovation like sustainable practices, it is required to meet the needs of potential adopters. Innovation characteristics that influence facility managers' intention to adopt sustainable facilities management were examined. A survey was conducted. Economic advantage, human comfort and observability are predictors for the intention of adoption of sustainable practice.
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Excess nitrogen (N) in freshwater systems, estuaries, and coastal areas has well-documented deleterious effects on ecosystems. Ecological engineering practices (EEPs) may be effective at decreasing nonpoint source N leaching to surface and groundwater. However, few studies have s...
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Enhancing the quality of supportive supervisory behavior in long-term care facilities.
McGillis Hall, Linda; McGilton, Katherine S; Krejci, Janet; Pringle, Dorothy; Johnston, Erin; Fairley, Laura; Brown, Maryanne
2005-04-01
The practices of managers and registered nurses (RNs) in long-term care facilities are frequently ineffective in assisting the licensed practical nurses (LPNs) and healthcare aides (HCAs) whom they supervise. Little research exists that examines the area of supportive relationships between nursing staff and supervisors in these settings. The purpose of this study was to gather data that could improve management practices in long-term care residential facilities and enhance the quality of the supervisory relationships between supervisors (nurse managers and RNs) and care providers (HCAs and LPNs) in these settings. The study also identified factors that influence the supervisors' ability to establish supportive relationships with care providers. The challenges and barriers to nurse managers and leaders related to enacting supportive behaviors are discussed as well as their implications for long-term care settings.
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Factors that influence producer decisions to implement management strategies.
Field, Thomas G
2014-12-01
Cow-calf enterprises in the USA are widely divergent in size, locale, resource availability, management skill, and market focus. Furthermore, variation exists in dependence on the cow-calf enterprise as a primary source of income, perception about the utility of a particular management practice or technology, and assessment of cost: benefit resulting from implementation impact decisions. Enterprises with larger cow inventories, greater dependence on income from the cattle enterprise, and that retain ownership further into the supply chain beyond the cow-calf operation are more likely to institute management protocols such as vaccination programs, defined calving seasons, and reproductive technologies. Successful cow-calf managers place the highest priority on herd nutrition, pasture and range management, herd health, financial management marketing, production management, and genetics. Management practices are more likely to be adopted when they align with a manager's perception of the utility, labor availability, favorable cost: benefit outcomes and profit motivation.
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Weaver, Robert R; Lemonde, Manon; Payman, Naghmeh; Goodman, William M
2014-02-01
While the "social determinants of health" view compels us to explore how social structures shape health outcomes, it often ignores the role individual agency plays. In contrast, approaches that focus on individual choice and personal responsibility for health often overlook the influence of social structures. Amartya Sen's "capabilities" framework and its derivative the "health capabilities" (HC) approach attempts to accommodate both points of view, acknowledging that individuals function under social conditions over which they have little control, while also acting as agents in their own health and well-being. This paper explores how economic, social, and cultural resources shape the health capability of people with diabetes, focusing specifically on dietary practices. Health capability and agency are central to dietary practices, while also being shaped by immediate and broader social conditions that can generate habits and a lifestyle that constrain dietary behaviors. From January 2011 to December 2012, we interviewed 45 people with diabetes from a primary care clinic in Ontario (Canada) to examine how their economic, social, and cultural resources combine to influence dietary practices relative to their condition. We classified respondents into low, medium, and high resource groups based on economic circumstances, and compared how economic resources, social relationships, health-related knowledge and values combine to enhance or weaken health capability and dietary management. Economic, social, and cultural resources conspired to undermine dietary management among most in the low resource group, whereas social influences significantly influenced diet among many in the medium group. High resource respondents appeared most motivated to maintain a healthy diet, and also had the social and cultural resources to enable them to do so. Understanding the influence of all three types of resources is critical for constructing ways to enhance health capability, chronic disease self-management, and health. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.
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NASA Astrophysics Data System (ADS)
Milano, Regina Nicole
The lack of resolution in the on-going animal dissection debate inspired this mixed methods study to identify Connecticut secondary biology teachers' dissection practices and the influences that lead to their adoption. Qualitative findings indicate past experiences, managing objections to dissection, school culture, goals of biology teaching and ethics as major influences on dissection practices with 58.4% (n=7) of the sample dissecting and 41.6% not dissecting (n=5). Quantitative findings reveal gender, standards and curriculum, advantages of dissection and experiences as a student as major influences on dissection practices with 71.9% (n=92) of the sample dissecting and 28.1% (n=36) not dissecting. The study concludes that dissection policies are necessary and imminent in Connecticut school districts. Furthermore, it advises teacher-initiated, qualitative and quantitative assessments to expose disparities between student dissection perspectives and their own, prior to conducting dissection. Finally, it provides suggestions for addressing potential differences including administrative involvement.
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Improving fruit quality and phytochemical content through better nutrient management practices
USDA-ARS?s Scientific Manuscript database
Consumer preference quality traits (e.g. taste, texture) of muskmelons (Cucumis melo L.) and many other fruits are strongly influenced by cultivar as well as soil properties, such as soil type and nutrient supply capacity. Among nutrients, potassium (K) has the strongest influence on quality parame...
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Birken, Sarah A; DiMartino, Lisa D; Kirk, Meredith A; Lee, Shoou-Yih D; McClelland, Mark; Albert, Nancy M
2016-01-04
The theory of middle managers' role in implementing healthcare innovations hypothesized that middle managers influence implementation effectiveness by fulfilling the following four roles: diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. The theory also suggested several activities in which middle managers might engage to fulfill the four roles. The extent to which the theory aligns with middle managers' experience in practice is unclear. We surveyed middle managers (n = 63) who attended a nursing innovation summit to (1) assess alignment between the theory and middle managers' experience in practice and (2) elaborate on the theory with examples from middle managers' experience overseeing innovation implementation in practice. Middle managers rated all of the theory's hypothesized four roles as "extremely important" but ranked diffusing and synthesizing information as the most important and selling innovation implementation as the least important. They reported engaging in several activities that were consistent with the theory's hypothesized roles and activities such as diffusing information via meetings and training. They also reported engaging in activities not described in the theory such as appraising employee performance. Middle managers' experience aligned well with the theory and expanded definitions of the roles and activities that it hypothesized. Future studies should assess the relationship between hypothesized roles and the effectiveness with which innovations are implemented in practice. If evidence supports the theory, the theory should be leveraged to promote the fulfillment of hypothesized roles among middle managers, doing so may promote innovation implementation.
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Strauch, Ayron M; Rurai, Masegeri T; Almedom, Astier M
2016-09-15
Social, religious and economic facets of rural livelihoods in Sub-Saharan Africa are heavily dependent on natural resources, but improper resource management, drought, and social instability frequently lead to their unsustainable exploitation. In rural Tanzania, natural resources are often governed locally by informal systems of traditional resource management (TRM), defined as cultural practices developed within the context of social and religious institutions over hundreds of years. However, following independence from colonial rule, centralized governments began to exercise jurisdictional control over natural resources. Following decades of mismanagement that resulted in lost ecosystem services, communities demanded change. To improve resource protection and participation in management among stakeholders, the Tanzanian government began to decentralize management programs in the early 2000s. We investigated these two differing management approaches (traditional and decentralized government) in Sonjo communities, to examine local perceptions of resource governance, management influences on forest use, and their consequences for forest and water resources. While 97% of households understood the regulations governing traditionally-managed forests, this was true for only 39% of households for government-managed forests, leading to differences in forest use. Traditional management practices resulted in improved forest condition and surface water quality. This research provides an essential case study demonstrating the importance of TRM in shaping decision frameworks for natural resource planning and management. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Adult Dental Trauma: What Should the Dental Practitioner Know?
Chauhan, Ravi; Rasaratnam, Lakshmi; Alani, Aws; Djemal, Serpil
2016-05-01
The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.
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Oak silviculture, management, and defoliation effects in France and Germany
Kurt W. Gottschalk
1993-01-01
A study tour of four areas of France and Germany (two in each country) was conducted to examine oak silvicultural and managerial practices and the influence of insect defoliators on the ecology and management of oak forests. The French and German situations may provide useful information for managing oak forests and gypsy moth in the United States, especially the...
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Rafferty, Rae; Fairbrother, Greg
2015-06-01
To introduce a theory which describes the process of and explicates the factors moderating, the acquisition and integration of leadership coaching skills into the routine practice of senior nurses and midwives. Organizations invest significant resources in leadership coaching programs to ensure that coaching is embedded as a core function of the manager's role. However, even after training, many managers remain unable to undertake this role successfully. The process by which health professionals translate 'manager as coach' training into successful practice outcomes, has remained largely unexplored. A grounded theory study design. Data, collected between February 2012-May 2013, included in-depth interviews with 20 senior nurses and midwives who had attended a leadership coaching program and analysis of nine reflective practice journals. Multiple researchers coded and analysed the data using constant comparative techniques. The outcomes of coaching training ranged from inappropriate use of the coaching skills through to transformed managerial practice. These outcomes were influenced by the dynamic interaction of three central domains of the emergent theoretical model: pre-existing individual perceptions, program elements and contemporaneous experiences. Interactions occurred within the domains and between them, impacting on activators such as courage, motivation, commitment and confidence. The study offers new insights into how senior nurses and midwives acquire and integrate coaching skills into their routine practice. The process is described as multifactorial and dynamic and has implications for the training design, delivery and organizational support of future leadership coaching programs. © 2015 John Wiley & Sons Ltd.
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Moggy, M A; Pajor, E A; Thurston, W E; Parker, S; Greter, A M; Schwartzkopf-Genswein, K S; Campbell, J R; Windeyer, M C
2017-02-01
The implementation of on-farm pain mitigation strategies is dependent on feasibility and importance to producers. Currently, there is a lack of information regarding adoption of management practices associated with pain in cattle within the Canadian beef industry. The objective of this mixed methods study was to describe pain-associated practices implemented on farm and producer perceptions toward pain mitigation strategies. A questionnaire about calving management and calf processing was delivered to 109 cow-calf producers in western Canada. In addition, 15 respondents were purposively selected based on questionnaire responses to participate in individual semistructured, on-farm interviews. The prevalence of pain mitigation strategies used for dystocia and cesarean section by respondents were 46 and 100%, respectively. The majority of operations reported castrating and dehorning calves before 3 mo of age (95 and 89%, respectively). The majority of operations did not use pain mitigation strategies for castration and dehorning (90 and 85%, respectively). Branding was practiced by 57% of respondents, 4% of which used pain mitigation. Thematic content analysis revealed that producers' perception of pain were influenced by what they referred to as "common sense," relatability to cattle, visual evidence of pain, and age of the animal. Factors that influenced participant rationale for the implementation of pain mitigation practices included access to information and resources, age of the animal, benefit to the operation, cost and logistics, market demands, and personal conscience. Overall, management practices were generally in compliance with published Canadian guidelines. Results of this study may provide direction for future policy making, research, and extension efforts to encourage the adoption of pain mitigation strategies.
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“We Are All Gonna Get Diabetic These Days”
Pyatak, Elizabeth A.; Florindez, Daniella; Peters, Anne L.; Weigensberg, Marc J.
2014-01-01
Purpose The purpose of this study was to investigate how an intergenerational legacy of type 2 diabetes affected the knowledge, attitudes, and treatment strategies of Hispanic young adults with diabetes. Methods Eight Hispanic young adults (ages 18-30 years) participated in a series of in-home longitudinal qualitative interviews, and 11 of their family members completed single in-home interviews, regarding their diabetes management practices. Interview transcripts were analyzed thematically by a team of researchers. Results Five themes emerged that characterized the influence of an intergenerational legacy of diabetes on young adults: food and family (how meal preparation and eating are shared within families), doing together (activity participation is contingent on others’ participation), knowledge and expectations (expectations for the future and understandings of diabetes are shaped by family members), miscarried helping (well-intentioned actions have negative consequences), and reciprocal support (children and parents support each other’s diabetes care). Conclusions Hispanic young adults’ knowledge, attitudes, and self-care practices related to diabetes are strongly influenced by the diabetes management practices of family members with diabetes, which often depart from current standards of diabetes care. Care providers should consider family members as a potentially significant influence, either positive or negative, on the diabetes self-care practices of this population. PMID:24867918
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Tillage and planting date effects on weed dormancy, emergence, and early growth in organic corn
USDA-ARS?s Scientific Manuscript database
Weed management is a major constraint to adoption of reduced-tillage practices for organic grain production. Tillage, cover crop management, and crop planting date are all factors that influence the periodicity and growth potential of important weed species in these systems. Therefore, we assessed...
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Organizational Behavior: Where Does It Fit in Today's Management Curriculum?
ERIC Educational Resources Information Center
Singh, Robert P.; Schick, Allen G.
2007-01-01
Maximizing shareholder value is the dominant goal that influences management decision making in business practice. This goal--with rapid improvements in technology, changes in capital markets, and global competition--has altered employment relations between workers and top executives. The authors' purpose in this article was to share thoughts and…
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Factors influencing sediment plume development from forest roads
Johnny M. Grace
2005-01-01
Southern forests, which rely on intensive management practices, are some of the most productive forests in the United States. Intensive forest management utilizes forest operations, such as site preparation, fertilization, thinning, and harvesting, to increase site productivity and reduce rotation time. These forest operations are essential to meet the ever-...
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Do plant population and planting date make a difference in corn production?
USDA-ARS?s Scientific Manuscript database
One management practice that can positively or negatively impact corn yield is plant population. Yield potential can also be influenced by the date of planting, which is strongly linked to the at-planting and in-season weather and climatic conditions. Even when considering management changes, we nee...
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AN EVALUATION OF HYDROLOGIC RESPONSE TO 25 YEARS OF LANDSCAPE CHANGE IN A SEMI-ARID WATERSHED
The assessment of land use and land cover is an extremely important activity for contemporary land management. A large body of current literature suggests that human land-use practices are the most important factor influencing natural resource management at multiple scales. D... -
UK Survey of Clinical Consistency in Tracheostomy Management
ERIC Educational Resources Information Center
McGowan, Susan L.; Ward, Elizabeth C.; Wall, Laurelie R.; Shellshear, Leanne R.; Spurgin, Ann-Louise
2014-01-01
Background: Many speech and language therapists (SLTs) work with patients who have a tracheostomy. There is limited information about their working practices and the extent to which recent publications and research have influenced the speech and language therapy management of the tracheostomized patient. Aims: This study reviews the current…
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Improving Nursing Home Staff Knowledge and Attitudes about Pain
ERIC Educational Resources Information Center
Jones, Katherine R.; Fink, Regina; Pepper, Ginny; Hutt, Eveyln; Vojir, Carol P.; Scott, Jill; Clark, Lauren; Mellis, Karen
2004-01-01
Purpose: Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain. Design and Methods: Twelve nursing homes participated in this intervention study: six…
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Nurse managers and the sandwich support model.
Chisengantambu, Christine; Robinson, Guy M; Evans, Nina
2018-03-01
To explore the interplay between the work of nurse managers and the support they receive and provide. Support is the cornerstone of management practices and is pivotal in employees feeling committed to an organisation. Support for nurse managers is integral to effective health sector management; its characteristics merit more attention. The experiences of 15 nurse managers in rural health institutions in South Australia were explored using structured interviews, observation and document review. Effective decision making requires adequate support, which influences the perceptions and performance of nurse managers, creating an environment in which they feel appreciated and valued. An ideal support system is proposed, the "sandwich support model," to promote effective functioning and desirable patient outcomes via support "from above" and "from below." The need to support nurse managers effectively is crucial to how they function. The sandwich support model can improve management practices, more effectively assisting nurse managers. Organisations should revisit and strengthen support processes for nurse managers to maximize efficiencies. This paper contributes to understanding the importance of supporting nurse managers, identifying the processes used and the type of support offered. It highlights challenges and issues affecting support practices within the health sector. © 2017 John Wiley & Sons Ltd.
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Soil management and green water in sloping rainfed vineyards
NASA Astrophysics Data System (ADS)
José Marqués Pérez, María; Ruíz-Colmenero, Marta; García-Díaz, Andrés; Bienes Allas, Ramón
2017-04-01
Improved crop production in areas with restricted water availability is of particular interest. Farmers need to maximize the water use efficiency when the possibilities of further extension of irrigation are limited and water is becoming scarce and expensive. Water in rainfed crops depends on rainfall depth and soil characteristics such as texture and structure, water holding capacity, previous moisture, infiltration, soil surface conditions, steepness and slope length. Land management practices can be used to maximise water availability. In previous studies the unwillingness of farmers to change their practices towards more sustainable use was mainly due to the worry about water competition. This work is aimed at understanding the influence of management practices in the water partitioning of this land use. This study was conducted in a sloping vineyard in the centre of Spain. A rain gauge recorded rainfall depth and intensity in the area. Three different soil management practices were considered: 1) traditional tillage, 2) permanent cover and 3) mowed cover of cereals, both sown in the strips between vines. Two moisture sensors were buried at 10 and 35 cm depths. Three replicates per management practice were performed. It is expected that the lack of tillage increase the potential for litter to protect the soil surface against raindrop impact and to contribute to increasing soil organic carbon, and the corresponding increase in infiltration and water holding capacity. The analysis of two years of daily records of rainfall, runoff and soil moisture are intended to establish any influence of management practices on the partitioning of water. Particularly, the so-called "green water" was estimated, i.e. the fraction of rainfall that infiltrates into the soil and will be further available to plants. Soil characteristics such as texture, structure, moisture, infiltration were established. In addition simulated rainfalls carried out in summer and winter over bounded plots having different management practices allowed the record of runoff per minute and further influence in soil moisture. After rainfalls soils were at field capacity and progressively dried in undisturbed conditions. Particle size analysis shows that this soil has 58 % sand, 18% silt and 24% clay, corresponding to a Sandy Clay Loam texture. Total porosity in the topsoil ranges from 49 to 51%, although according to previous studies only the 28% is effective to stock water in their micro and mesopores. In the upper 35 cm these soils are able to store from 0.05 to 0.25 m3 of water per m3 of soil depending on the seasons. At the same time, variations of runoff / infiltration were also noticed depending on the seasons and treatments.
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Comparison of provider and plan-based targeting strategies for disease management.
Annis, Ann M; Holtrop, Jodi Summers; Tao, Min; Chang, Hsiu-Ching; Luo, Zhehui
2015-05-01
We aimed to describe and contrast the targeting methods and engagement outcomes for health plan-delivered disease management with those of a provider-delivered care management program. Health plan epidemiologists partnered with university health services researchers to conduct a quasi-experimental, mixed-methods study of a 2-year pilot. We used semi-structured interviews to assess the characteristics of program-targeting strategies, and calculated target and engagement rates from clinical encounter data. Five physician organizations (POs) with 51 participating practices implemented care management. Health plan member lists were sent monthly to the practices to accept patients, and then the practices sent back data reports regarding targeting and engagement in care management. Among patients accepted by the POs, we compared those who were targeted and engaged by POs with those who met health plan targeting criteria. The health plan's targeting process combined claims algorithms and employer group preferences to identify candidates for disease management; on the other hand, several different factors influenced PO practices' targeting approaches, including clinical and personal knowledge of the patients, health assessment information, and availability of disease-relevant programs. Practices targeted a higher percentage of patients for care management than the health plan (38% vs 16%), where only 7% of these patients met the targeting criteria of both. Practices engaged a higher percentage of their targeted patients than the health plan (50% vs 13%). The health plan's claims-driven targeting approach and the clinically based strategies of practices both provide advantages; an optimal model may be to combine the strengths of each approach to maximize benefits in care management.
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Workplace culture and the practice experience of midwifery students: A meta-synthesis.
Arundell, Fiona; Mannix, Judy; Sheehan, Athena; Peters, Kath
2018-04-01
To describe midwifery students' practice experience and to explore facilitators and barriers to positive clinical learning experiences. Practice experience is a vital component of every midwifery course. Course dissatisfaction and attrition of midwifery students has been attributed to sub-optimal practice experiences. Events or actions experienced by midwifery students that trigger dissatisfaction and attrition need to be identified. A meta-synthesis was based on that developed by Noblit and Hare. Students perceive workplaces as poorly prepared for their arrival and subsequent support. Students' experience in the practice setting is influenced by the existing workplace culture. Workplace culture influences institutional functioning and individuals within the culture. Enculturation of students into the midwifery culture and subsequent learning is affected by the support received. The practice experience of midwifery students was profoundly influenced by workplace culture. Students tended to have polarized accounts of their experience that were predominantly negative. To provide an optimal environment for midwifery students; midwifery managers and individual midwives need to be aware of the facilitators and barriers to midwifery student development in the practice setting. © 2017 John Wiley & Sons Ltd.
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Jones, Jay E; Kroll, Andrew J; Giovanini, Jack; Duke, Steven D; Ellis, Tana M; Betts, Matthew G
2012-01-01
Managers of landscapes dedicated to forest commodity production require information about how practices influence biological diversity. Individual species and communities may be threatened if management practices truncate or simplify forest age classes that are essential for reproduction and survival. For instance, the degradation and loss of complex diverse forest in young age classes have been associated with declines in forest-associated Neotropical migrant bird populations in the Pacific Northwest, USA. These declines may be exacerbated by intensive forest management practices that reduce hardwood and broadleaf shrub cover in order to promote growth of economically valuable tree species in plantations. We used a Bayesian hierarchical model to evaluate relationships between avian species richness and vegetation variables that reflect stand management intensity (primarily via herbicide application) on 212 tree plantations in the Coast Range, Oregon, USA. Specifically, we estimated the influence of broadleaf hardwood vegetation cover, which is reduced through herbicide applications, on bird species richness and individual species occupancy. Our model accounted for imperfect detection. We used average predictive comparisons to quantify the degree of association between vegetation variables and species richness. Both conifer and hardwood cover were positively associated with total species richness, suggesting that these components of forest stand composition may be important predictors of alpha diversity. Estimates of species richness were 35-80% lower when imperfect detection was ignored (depending on covariate values), a result that has critical implications for previous efforts that have examined relationships between forest composition and species richness. Our results revealed that individual and community responses were positively associated with both conifer and hardwood cover. In our system, patterns of bird community assembly appear to be associated with stand management strategies that retain or increase hardwood vegetation while simultaneously regenerating the conifer cover in commercial tree plantations.
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Giebel, Stephen; Kothari, Rashmi; Koestner, Amy; Mohney, Gretchen; Baker, Robert
2011-12-01
Numerous guidelines to grade and manage sports-related concussions have been published. However, little is known about how frequently they are implemented in the emergency department. This study evaluates the current practices of emergency physicians (EPs) in managing sports-related concussions. To evaluate the current practice of EP evaluation and management of sports-related concussions. All EPs and emergency medicine residents in Kalamazoo County were surveyed regarding their management of sports-related concussions. The surveys obtained demographic data, participants' use of guidelines, and the importance of clinical and non-clinical factors in deciding when to allow a player to return to play. Of the 73 EP respondents, only 23% used a nationally recognized guideline, with no significant difference between attending and resident EPs. The symptomatic complaints of loss of consciousness, amnesia of the event, and difficulty concentrating were ranked most important by EPs in assessing patients with sports-related concussions. Among non-clinical factors, residents were significantly more likely than attendings to report that medical-legal, parental, and players' concerns were more likely to influence their decision in allowing a patient to return to play. EPs take into consideration important clinical factors in assessing patients with sports-related concussion. However, almost 75% do not use any nationally recognized guideline in their evaluation. Residents are more likely than attendings to be influenced by non-clinical factors. Copyright © 2011 Elsevier Inc. All rights reserved.
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Decisions about weight management: a synthesis of qualitative studies of obesity.
Brown, I; Gould, J
2011-04-01
There is a high non-attendance and dropout attrition from weight management interventions for adults with obesity. Patient dissatisfaction with consultations involving decisions about interventions may be a factor. A systematic review was undertaken of qualitative studies reporting perceptions, experiences, contexts and influences for adults facing, or reflecting on, weight management. The aim was to synthesize a generic model of influences on decision-making about weight management for adult patients. Electronic database and hand searches identified 29 qualitative studies involving 1387 participants (mean age 45.3 years; mean BMI 37.1 kg m(-2) ; 79.9% women). Seven overarching themes were inductively derived from extracted data spanning: cultural identity; social structures such as gender; responses to obesity stigma; previous weight loss experiences; personal motivators and barriers; social support; and practical resources. A model is presented in the paper. Improving decisions about weight management requires attention to how diffuse cultural and psycho-social factors, such as obesity stigma, influence patient choices. Reflection on experiences of previous attempts at weight loss is also essential, as are practical resource factors - particularly for less affluent groups. Considering these factors along with more established theories of individual psychological motivations and barriers may help to improve initial participation and retention within interventions. © 2011 The Authors. Clinical Obesity © 2011 International Association for the Study of Obesity.
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Gardner, Tania; Refshauge, Kathryn; Smith, Lorraine; McAuley, James; Hübscher, Markus; Goodall, Stephen
2017-07-01
What influence do physiotherapists' beliefs and attitudes about chronic low back pain have on their clinical management of people with chronic low back pain? Systematic review with data from quantitative and qualitative studies. Quantitative and qualitative studies were included if they investigated an association between physiotherapists' attitudes and beliefs about chronic low back pain and their clinical management of people with chronic low back pain. Five quantitative and five qualitative studies were included. Quantitative studies used measures of treatment orientation and fear avoidance to indicate physiotherapists' beliefs and attitudes about chronic low back pain. Quantitative studies showed that a higher biomedical orientation score (indicating a belief that pain and disability result from a specific structural impairment, and treatment is selected to address that impairment) was associated with: advice to delay return to work, advice to delay return to activity, and a belief that return to work or activity is a threat to the patient. Physiotherapists' fear avoidance scores were positively correlated with: increased certification of sick leave, advice to avoid return to work, and advice to avoid return to normal activity. Qualitative studies revealed two main themes attributed to beliefs and attitudes of physiotherapists who have a relationship to their management of chronic low back pain: treatment orientation and patient factors. Both quantitative and qualitative studies showed a relationship between treatment orientation and clinical practice. The inclusion of qualitative studies captured the influence of patient factors in clinical practice in chronic low back pain. There is a need to recognise that both beliefs and attitudes regarding treatment orientation of physiotherapists, and therapist-patient factors need to be considered when introducing new clinical practice models, so that the adoption of new clinical practice is maximised. [Gardner T, Refshauge K, Smith L, McAuley J, Hübscher M, Goodall S (2017) Physiotherapists' beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. Journal of Physiotherapy 63: 132-143]. Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.
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Treiger, Teresa M; Fink-Samnick, Ellen
2013-01-01
The purpose of this second article of a 3-article series is to clarify the competencies for a new paradigm of case management built upon a value-driven foundation that : Applicable to all health care sectors where case management is practiced. In moving forward, the one fact that rings true is that there will be a constant change in our industry. As the health care terrain shifts and new influences continually surface, there will be consequences for case management practice. These impacts require nimble clinical professionals in possession of recognized and firmly established competencies. They must be agile to frame (and reframe) their professional practice to facilitate the best possible outcomes for their patients. Case managers can choose to be Gumby™ or Pokey™. This is exactly the time to define a competency-based case management model, highlighting one sufficiently fluid to fit into any setting of care. The practice of case management transcends the vast array of representative professional disciplines and educational levels. A majority of current models are driven by business priorities rather than the competencies critical to successful practice and quality patient outcomes. This results in a fragmented professional case management identity. Although there is an inherent value in what each discipline brings to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities, including a reflective clinical ladder.
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Gu, Lingli; Li, Jing
2016-03-01
Chemotherapy-induced nausea and vomiting (CINV) are considered to be two of the most distressing side-effects of chemotherapy. They have a negative impact on a patient's quality of life and can influence the continuance of treatment. Owing to the lack of effective management of CINV, regular assessment and management of CINV is recommended for patients undergoing chemotherapy. The aim of this project was to integrate the available evidence on the assessment and management of CINV into practice, and implement strategies to improve compliance with evidence-based practice. The project carried out a pre- and post-implementation audit procedure using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. Five audit criteria were established according to the best available evidence on the assessment and management of CINV. The program was divided into three phases and conducted over four months in the chemotherapy ward, Fudan University Shanghai Cancer Center, Shanghai, China. Sixty patients and 14 oncology nurses were involved in this project. The results of the follow-up cycle showed that the compliance rates regarding patient education, risk factors evaluation and non-pharmacologic managements were 100%, 100% and 80%, respectively. The rate of validated tools being used by patients and nurses improved by 93% and 97%, respectively. This project demonstrated that the use of pre- and post-best practice audits is an effective method for incorporating evidence into practice in a chemotherapy ward. The practice of assessing and managing CINV was significantly improved. The next step is to develop strategies for sustaining the new procedures of CINV assessment and management.
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Walshe, Catherine; Todd, Chris; Caress, Ann-Louise; Chew-Graham, Carolyn
2008-01-01
Background Policies emphasise the importance of collaborative working in community palliative care. Collaborations are generally formed through formal and informal referral processes, but little is known about what influences professionals' decisions to refer to such services. Aim To explore the influences on referrals within general and specialist community palliative care services. Design of study Qualitative, multiple-case study. Setting Three primary care trusts in the north-west of England. Method Multiple data collection methods were employed, including documentary analysis, observation of referral team meetings and interviews. This paper primarily reports data from interviews with 47 health professionals, including GPs, district nurses, and specialist palliative care professionals. Results Judgements — positive and negative — about aspects of fellow professionals' performances appeared to influence referral decisions and ongoing collaboration and care. Attributes upon which these judgements were based included professional responsiveness and communication, respect, working and workload management practices, perceived expertise, and notions of elite practice. The effects of such judgements on referral and healthcare practices were altered by professional ‘game playing’ to achieve professionals' desired outcomes. Conclusion Palliative care policies and protocols need to take account of these complex and subtle influences on referrals and collaboration. In particular, teamwork and partnership are encouraged within palliative care work, but critical judgements indicate that such partnerships may be difficult or fragile. It is likely that such judgemental attitudes and practices affect many aspects of primary care, not just palliative care. PMID:18494176
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Structural and Process Factors That Influence Clinical Nurse Specialist Role Implementation.
Kilpatrick, Kelley; Tchouaket, Eric; Carter, Nancy; Bryant-Lukosius, Denise; DiCenso, Alba
2016-01-01
The aim of this study was to examine the influence of structure and process on clinical nurse specialist (CNS) role implementation. We conducted a secondary analysis of cross-sectional survey data. The study was performed in Canada. The authors included 445 of 471 questionnaires (94.5%) of graduate-prepared CNSs. Based on Donabedian's framework, we conducted a secondary analysis of CNS responses using hierarchical regression. The internal consistency of the 6 CNS role dimensions and team dynamics subscales was excellent. The use of a framework to guide CNS role implementation influences all the role dimensions. Employer understanding of the CNS role, working in an urban catchment area, specialty certification, and more years in a CNS role had a direct positive influence on team dynamics. Full-time employment exerted a direct negative influence on this dimension. Furthermore, team dynamics (as a mediator variable), seeing patients in practice, and having an office in the clinical unit exerted a direct positive influence on the clinical dimension. Having an annual performance appraisal and a job description exerted a direct negative influence on the clinical dimension. Employer understanding, working in an urban area, full-time employment, and specialty certification had an indirect effect on the clinical dimension. Accountability to a nonnurse manager exerted a direct negative influence on the education dimension. The research and scholarly/professional development dimensions were influenced by more years in a CNS role. Accountability to a nurse manager exerted a direct positive influence on the organizational leadership dimension; unionization and seeing patients in practice had a direct negative influence on this dimension. Seeing patients in practice and full-time employment exerted a direct positive influence on the consultation dimension. The identification of structures and processes that influence CNS role implementation may inform strategies used by providers and decision makers to optimize these roles across healthcare settings and support the delivery of high-quality care.
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USDA-ARS?s Scientific Manuscript database
Because Varroa mites may cause devastating losses of honey bees through direct feeding, transmitting diseases, and increasing pathogen susceptibility, chemical and mechanical practices commonly are used to reduce mite infestation. While miticide applications are typically the most consistent and eff...
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Children's Mental Health: The Changing Interface between Primary and Specialty Care. Reprint.
ERIC Educational Resources Information Center
Steinberg, A. G.; Gadomski, A.; Wilson, M. D.
The landscape for children's mental health services has changed dramatically due to the confluence of several factors. The emergence of managed care has influenced access to as well as the scope of primary care practice. Evidence-based medicine is steadily emerging and driving practice guideline development. In the rapidly changing and…
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The Rapid Adjustment Farm Program's Influence on Other Farms in the Community.
ERIC Educational Resources Information Center
Simeral, Kenneth D.
The study investigated the diffusion of innovative farming practices from Rapid Adjustment Farms (RAF) to other farms in southeast Ohio. The RAF program, begun in 1968, introduced new technology and management practices to its participant farmers. After reviewing literature of farming programs' information diffusion, a descriptive survey was made…
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Hillebregt, Chantal F; Vlonk, Auke J; Bruijnzeels, Marc A; van Schayck, Onno Cp; Chavannes, Niels H
2017-01-01
Self-management is becoming increasingly important in COPD health care although it remains difficult to embed self-management into routine clinical care. The implementation of self-management is understood as a complex interaction at the level of patient, health care provider (HCP), and health system. Nonetheless there is still a poor understanding of the barriers and effective facilitators. Comprehension of these determinants can have significant implications in optimizing self-management implementation and give further directions for the development of self-management interventions. Data were collected among COPD patients (N=46) and their HCPs (N=11) in three general practices and their collaborating affiliated hospitals. Mixed methods exploration of the data was conducted and collected by interviews, video-recorded consultations (N=50), and questionnaires on consultation skills. Influencing determinants were monitored by 1) interaction and communication between the patient and HCP, 2) visible and invisible competencies of both the patient and the HCP, and 3) degree of embedding self-management into the health care system. Video observations showed little emphasis on effective behavioral change and follow-up of given lifestyle advice during consultation. A strong presence of COPD assessment and monitoring negatively affects the patient-centered communication. Both patients and HCPs experience difficulties in defining personalized goals. The satisfaction of both patients and HCPs concerning patient centeredness during consultation was measured by the patient feedback questionnaire on consultation skills. The patients scored high (84.3% maximum score) and differed from the HCPs (26.5% maximum score). Although the patient-centered approach accentuating self-management is one of the dominant paradigms in modern medicine, our observations show several influencing determinants causing difficulties in daily practice implementation. This research is a first step unravelling the determinants of self-management leading to a better understanding.
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Influence of schizophrenia diagnosis on providers' practice decisions.
Sullivan, Greer; Mittal, Dinesh; Reaves, Christina M; Haynes, Tiffany F; Han, Xiaotong; Mukherjee, Snigdha; Morris, Scott; Marsh, Laura; Corrigan, Patrick W
2015-08-01
Persons with schizophrenia often receive suboptimal physical health care, but the reasons are poorly understood. Vignettes have been used to examine how a patient's race, gender, or physical health influences a provider's practice; in this study, we used vignettes to examine the effect of a mental health diagnosis (schizophrenia) on providers' clinical expectations and decision making regarding physical health care. A cross-sectional survey was administered from August 2011 to April 2012 to 275 primary care and mental health providers in 5 US Department of Veterans Affairs medical centers. Vignettes described identical scenarios for patients with and without schizophrenia. The survey assessed providers' clinical expectations of patients (adherence, competence, ability to read and understand health education materials) and practice behaviors (referrals to weight reduction, pain management, and sleep study). Clinicians expected persons with schizophrenia would be less adherent to treatment (P = .04), less able to read and understand educational materials (P = .03), and less capable of managing their health and personal affairs (P < .01). Providers were less likely to refer a patient with schizophrenia to a weight-reduction program (P = .03). Other types of referral decisions (for pain management and sleep study) were not influenced by a schizophrenia diagnosis. For both mental health and primary care providers, a history of schizophrenia was found to negatively affect provider expectations of patients' adherence to treatment, ability to understand educational materials, and capacity to manage their treatment and financial affairs as well as some treatment decisions, such as referral to a weight-reduction program. © Copyright 2015 Physicians Postgraduate Press, Inc.
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Weed management practices affect the diversity and relative abundance of physic nut mites.
Saraiva, Althiéris de Sousa; Sarmento, Renato A; Erasmo, Eduardo A L; Pedro-Neto, Marçal; de Souza, Danival José; Teodoro, Adenir V; Silva, Daniella G
2015-03-01
Crop management practices determine weed community, which in turn may influence patterns of diversity and abundance of associated arthropods. This study aimed to evaluate whether local weed management practices influence the diversity and relative abundance of phytophagous and predatory mites, as well as mites with undefined feeding habits--of the families Oribatidae and Acaridae--in a physic nut (Jatropha curcas L.) plantation subjected to (1) within-row herbicide spraying and between-row mowing; (2) within-row herbicide spraying and no between-row mowing; (3) within-row weeding and between-row mowing; (4) within-row weeding and no between-row mowing; and (5) unmanaged (control). The herbicide used was glyphosate. Herbicide treatments resulted in higher diversity and relative abundance of predatory mites and mites with undefined feeding habit on physic nut shrubs. This was probably due to the toxic effects of the herbicide on mites or to removal of weeds. Within-row herbicide spraying combined with between-row mowing was the treatment that most contributed to this effect. Our results show that within-row weeds harbor important species of predatory mites and mites with undefined feeding habit. However, the dynamics of such mites in the system can be changed according to the weed management practice applied. Among the predatory mites of the family Phytoseiidae Amblydromalus sp. was the most abundant, whereas Brevipalpus phoenicis was the most frequent phytophagous mite and an unidentified oribatid species was the most frequent mite with undefined feeding habit.
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Scott, Vera; Gilson, Lucy
2017-09-15
Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers' use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. Central governance shaped what information and knowledge was valued - and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the subdistrict level had influence over what information was valued, generated and used locally. Strengthening local level managers' ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices.
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Quality pain management outcomes: the power of place.
Wild, L R; Mitchell, P H
2000-01-01
This study explores how an organization, as the context of care, influences nursing practice and a nursing-sensitive, quality health outcome-pain management. The results provide important insights into organizational patterns associated with favorable pain management-related outcomes as well as the congruence between and among subunits within the organization. Outcomes were most favorable on units where nurses had attitudes supportive of aggressive pain management and higher levels of coordination and discretion.
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Ledoux, Elise; Cloutier, Esther; Fournier, Pierre-Sébastien
2012-01-01
Previous studies have shown that the job knowledge and prudent knowledge of experienced workers constitute a wealth that needs to be shared in workplaces to promote worker integration, job retention and occupational health and safety. It appears, however, that certain management practices undermine this knowledge sharing process. This case study of food service helpers in institutional food service departments is part of a research project aimed at comparing the impact of different work organization methods on knowledge sharing in the workplace on the basis of case studies carried out in several organizations. The results of this case study reveal that by destabilizing and weakening the work teams, flexible management practices create an environment that is not conducive to experiential knowledge sharing.
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Emma L. Witt; Christopher D. Barton; Jeffrey W. Stringer; Randy Kolka; Mac A. Cherry
2016-01-01
Streamside management zones (SMZs) are a common best management practice (BMP) used to reduce water quality impacts from logging. The objective of this research was to evaluate the impact of varying SMZ configurations on water quality. Treatments (T1, T2, and T3) that varied in SMZ width, canopy retention within the SMZ, and BMP utilization were applied at the...
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ERIC Educational Resources Information Center
Carey, Christopher G.
2016-01-01
Synergistic supervision has been commonly utilized as a foundation for practice in the field of student affairs. Numerous studies focus on the use of synergistic supervision with new professionals, but there is limited research on how it influences the supervision of mid-level managers. The role of the mid-level manager is important because of its…
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Robert A., II Pierce; D. Todd Farrand; William B. Kurtz; Jim Brandle; Ron Johnson
2003-01-01
Evolving agricultural policies and technologies have influenced land management practices within agroecosystems, impacting available habitats for many species of wildlife. Increasing available wildlife habitat and enhancing habitat quality have become an explicit objective of existing agricultural policy. Thus, there is renewed focus on utilizing shelterbelt...
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Public and private forest ownership in the conterminous United States. Chapter 6.
Greg C. Liknes; Mark D. Nelson; Brett J. Butler
2010-01-01
Forests and the goods and services they provide are influenced by both the biophysical and human environments. To fully understand forest ecosystems, we need to understand the social context in which forests exist because landowners determine land use and management practice. To influence decisions related to the forests, we need to...
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Clinoptilolite zeolite influence on inorganic nitrogen in silt loam and sandy agricultural soils
USDA-ARS?s Scientific Manuscript database
Development of best management practices can help improve inorganic nitrogen (N) availability to plants and reduce nitrate-nitrogen (NO3-N) leaching in soils. This study was conducted to determine the influence of the zeolite mineral Clinoptilolite (CL) additions on NO3-N and ammonium-nitrogen (NH4...
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Clinoptilolite Zeolite Influence on Inorganic Nitrogen in Silt Loam and Sandy Agricultural Soils
USDA-ARS?s Scientific Manuscript database
Development of best management practices can help improve inorganic nitrogen (N) availability to plants and reduce nitrate-nitrogen (NO3-N) leaching in soils. This study was conducted to determine the influence of the zeolite mineral Clinoptilolite (CL) additions on NO3-N and ammonium-nitrogen (NH4...
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Clinoptilolite zeolite influence on nitrogen in a manure-amended sandy agricultural soil
USDA-ARS?s Scientific Manuscript database
Development of best management practices can help improve inorganic nitrogen (N) availability to plants and reduce nitrate-nitrogen (NO3-N) leaching in soils. This study was conducted to determine the influence of the zeolite mineral clinoptilolite (CL) additions on NO3-N and ammonium-nitrogen (NH4-...
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Hayes, Eileen F
2007-03-01
To explore the attitudes of nurse practitioners (NPs) toward managed care and to identify the sources of negative attitudes and the factors that may ameliorate them. NPs, members of the Massachusetts Coalition of NPs, participated in in-depth interviews about the impact of managed care on their practice. The sources of NP negativity about managed care for many study participants lay in their not appreciating the importance of the business aspects of practice and the provider's role in controlling healthcare costs, reluctance to work with what they perceived as a rigid "system," and lack of support for them to navigate it. They felt pressured by productivity issues, time constraints, practice restrictions, and documentation demands associated with reimbursement. Those who sustained a more positive attitude were realistic about healthcare economics, were willing and able to negotiate the system, were creative and flexible, and felt empowered by knowledge of the business of practice. Some NPs, however, chose to work in practices where they did not feel as pressured as their counterparts in large, busy primary care practices. IMPLICATIONS FOR NP PRACTICE AND EDUCATION: Understanding experiences that have influenced NP attitudes regarding managed care may assist NP faculty to better prepare NP students for their future roles. NPs must be able to challenge, yet be part of, an evolving system that promotes cost-effective health care for everyone, which was what managed care originally was intended to do.
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Using Benchmarking To Influence Tuition and Fee Decisions.
ERIC Educational Resources Information Center
Hubbell, Loren W. Loomis; Massa, Robert J.; Lapovsky, Lucie
2002-01-01
Discusses the use of benchmarking in managing enrollment. Using a case study, illustrates how benchmarking can help administrators develop strategies for planning and implementing admissions and pricing practices. (EV)
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Self-Assessment of Competences in Management Education
ERIC Educational Resources Information Center
Hernández López, Lidia; de Saá Pérez, Petra; Ballesteros Rodríguez, Jose Luis; García Almeida, Desiderio
2015-01-01
Purpose: The purpose of this paper is to discuss the theoretical and practical need for research into the learning conditions that influence a student's self-assessment of their competences in management education. By means of a theoretical review, the paper introduces a model that integrates various learning conditions related to a student's…
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USDA-ARS?s Scientific Manuscript database
Vigor and crop level management are important practices for premium wine grape production. The implications of crop thinning ‘Pinot noir’ (Vitis vinifera L.) vines of varying vigor were investigated in the Willamette Valley of Oregon in 2011 to 2013, to better understand the relationship between can...
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Some references on watershed management.
W.E. Bullard
1950-01-01
Several of you in the field administrative jobs have asked for a summary of available information from forest influences studies relating to watershed management practices. This paper hits some of the high spots, giving a brief survey of European and American studies and recommendations that may be applicable within our region. Further, it contains a few pertinent...
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ERIC Educational Resources Information Center
Vonderau, Asta
2015-01-01
Drawing upon ethnographic data, this article investigates the effects of a new online campus management system in one of the largest universities in Germany. It shows the various ways in which this technological innovation influenced students', teachers' and administrative personnel's relations and everyday working practices and how it is…
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Impacts and management implications of ice storms on forests in the southern United States
Don C. Bragg; Michael G Shelton; Boris Zeide
2003-01-01
Abstract: This review explores the ecological and silvicultural impacts of ice storms on forests in the southern United States. Different environmental factors like weather conditions, topography, vegetation, stand density, and management practices influence the degree of glaze damage a particular forest may experience. Additionally, the frequent...
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Managing the Primary Curriculum: Policy into Practice in England
ERIC Educational Resources Information Center
Gillard, Linda; Whitby, Virginia
2007-01-01
This paper reports on research into how effective non-statutory guidance has been in managing the primary science curriculum in England. A small-scale qualitative study was used to elicit the views of teachers, local education authority advisors, an Ofsted inspector and a policy-maker. The findings indicate that the guidance is influencing the…
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Primary care practice organization influences colorectal cancer screening performance.
Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A
2007-06-01
To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (p<.04), more clinical support arrangements (p<.03), and smaller size (p<.001). Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.
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NASA Astrophysics Data System (ADS)
Patil, Sameer; Kobsa, Alfred; John, Ajita; Brotman, Lynne S.; Seligmann, Doree
To understand how collaborators reconcile the often conflicting needs of awareness and privacy, we studied a large software development project in a multinational corporation involving individuals at sites in the U.S. and India. We present a theoretical framework describing privacy management practices and their determinants that emerged from field visits, interviews, and questionnaire responses. The framework identifies five relevant situational characteristics: issue(s) under consideration, physical place(s) involved in interaction(s), temporal aspects, affordances and limitations presented by technology, and nature of relationships among parties. Each actor, in turn, interprets the situation based on several simultaneous influences: self, team, work site, organization, and cultural environment. This interpretation guides privacy management action(s). Past actions form a feedback loop refining and/or reinforcing the interpretive influences. The framework suggests that effective support for privacy management will require that designers follow a socio-technical approach incorporating a wider scope of situational and interpretive differences.
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Lee, Jihyoun; Kang, Eunyoung; Park, Suyeon; Kim, Zisun; Lee, Min Hyuk
2017-01-01
Lack of awareness, the stigma of carrying a genetic mutation, and economic factors are barriers to acceptance of BRCA genetic testing or appropriate risk management. We aimed to investigate the influence of Angelina Jolie's announcement of her medical experience and also health insurance reimbursement for BRCA gene testing on practice patterns for hereditary breast and ovarian cancer (HBOC). A survey regarding changes in practice patterns for HBOC before and after the announcement was conducted online. The rate of BRCA gene testing was obtained from the National Health Insurance Review and Assessment Service database. From May to August 2016, 70 physicians responded to the survey. Genetic testing recommendations and prophylactic management were increased after the announcement. Risk-reducing salpingo-oophorectomy and contralateral prophylactic mastectomy was significantly increased in BRCA carriers with breast cancer. The BRCA testing rate increased annually. Health insurance and a celebrity announcement were associated with increased genetic testing. PMID:28690658
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Shimizu, Motoko; Tanaka, Katsuaki; Hagiwara, Chie; Ikenaga, Kazutake; Yoshioka, Miwako; Asada, Akira
2011-06-01
Recently, the hospital information systems (HIS) and anesthesia information management systems (AIMS) have been rapidly improved and have been introduced into the clinical practice in Japan drastically; however, few reports have detailed their influences on clinical practice. We here report our experience. We introduced HIS (EGMAIN-EX, Fujitsu Co., Ltd.) in our preoperative evaluation clinic and in the postoperative care unit. AIMS (ORSYS, Philips Electronics Japan) was introduced almost only to the intraoperative management. It became easy for us to acquire patient's information and to share it with the medical staffs in the other departments. However, we had to invest large human resources for the introduction and maintenance of the HIS and the AIMS. Though AIMS is more useful in anesthetic management than HIS, it seems to be more suitable for coordination with the medical staffs in the other departments to use HIS for perioperative management than to use AIMS.
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Legaard, Kasey R; Sader, Steven A; Simons-Legaard, Erin M
2015-01-01
Sustainable forest management is based on functional relationships between management actions, landscape conditions, and forest values. Changes in management practices make it fundamentally more difficult to study these relationships because the impacts of current practices are difficult to disentangle from the persistent influences of past practices. Within the Atlantic Northern Forest of Maine, U.S.A., forest policy and management practices changed abruptly in the early 1990s. During the 1970s-1980s, a severe insect outbreak stimulated salvage clearcutting of large contiguous tracts of spruce-fir forest. Following clearcut regulation in 1991, management practices shifted abruptly to near complete dependence on partial harvesting. Using a time series of Landsat satellite imagery (1973-2010) we assessed cumulative landscape change caused by these very different management regimes. We modeled predominant temporal patterns of harvesting and segmented a large study area into groups of landscape units with similar harvest histories. Time series of landscape composition and configuration metrics averaged within groups revealed differences in landscape dynamics caused by differences in management history. In some groups (24% of landscape units), salvage caused rapid loss and subdivision of intact mature forest. Persistent landscape change was created by large salvage clearcuts (often averaging > 100 ha) and conversion of spruce-fir to deciduous and mixed forest. In groups that were little affected by salvage (56% of landscape units), contemporary partial harvesting caused loss and subdivision of intact mature forest at even greater rates. Patch shape complexity and edge density reached high levels even where cumulative harvest area was relatively low. Contemporary practices introduced more numerous and much smaller patches of stand-replacing disturbance (typically averaging <15 ha) and a correspondingly large amount of edge. Management regimes impacted different areas to different degrees, producing different trajectories of landscape change that should be recognized when studying the impact of policy and management practices on forest ecology.
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Legaard, Kasey R.; Sader, Steven A.; Simons-Legaard, Erin M.
2015-01-01
Sustainable forest management is based on functional relationships between management actions, landscape conditions, and forest values. Changes in management practices make it fundamentally more difficult to study these relationships because the impacts of current practices are difficult to disentangle from the persistent influences of past practices. Within the Atlantic Northern Forest of Maine, U.S.A., forest policy and management practices changed abruptly in the early 1990s. During the 1970s-1980s, a severe insect outbreak stimulated salvage clearcutting of large contiguous tracts of spruce-fir forest. Following clearcut regulation in 1991, management practices shifted abruptly to near complete dependence on partial harvesting. Using a time series of Landsat satellite imagery (1973-2010) we assessed cumulative landscape change caused by these very different management regimes. We modeled predominant temporal patterns of harvesting and segmented a large study area into groups of landscape units with similar harvest histories. Time series of landscape composition and configuration metrics averaged within groups revealed differences in landscape dynamics caused by differences in management history. In some groups (24% of landscape units), salvage caused rapid loss and subdivision of intact mature forest. Persistent landscape change was created by large salvage clearcuts (often averaging > 100 ha) and conversion of spruce-fir to deciduous and mixed forest. In groups that were little affected by salvage (56% of landscape units), contemporary partial harvesting caused loss and subdivision of intact mature forest at even greater rates. Patch shape complexity and edge density reached high levels even where cumulative harvest area was relatively low. Contemporary practices introduced more numerous and much smaller patches of stand-replacing disturbance (typically averaging <15 ha) and a correspondingly large amount of edge. Management regimes impacted different areas to different degrees, producing different trajectories of landscape change that should be recognized when studying the impact of policy and management practices on forest ecology. PMID:26106893
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Schulz, Elke; Schloter, Michael; Buscot, François; Hofrichter, Martin; Krüger, Dirk
2014-01-01
Leaf litter decomposition is the key ecological process that determines the sustainability of managed forest ecosystems, however very few studies hitherto have investigated this process with respect to silvicultural management practices. The aims of the present study were to investigate the effects of forest management practices on leaf litter decomposition rates, nutrient dynamics (C, N, Mg, K, Ca, P) and the activity of ligninolytic enzymes. We approached these questions using a 473 day long litterbag experiment. We found that age-class beech and spruce forests (high forest management intensity) had significantly higher decomposition rates and nutrient release (most nutrients) than unmanaged deciduous forest reserves (P<0.05). The site with near-to-nature forest management (low forest management intensity) exhibited no significant differences in litter decomposition rate, C release, lignin decomposition, and C/N, lignin/N and ligninolytic enzyme patterns compared to the unmanaged deciduous forest reserves, but most nutrient dynamics examined in this study were significantly faster under such near-to-nature forest management practices. Analyzing the activities of ligninolytic enzymes provided evidence that different forest system management practices affect litter decomposition by changing microbial enzyme activities, at least over the investigated time frame of 473 days (laccase, P<0.0001; manganese peroxidase (MnP), P = 0.0260). Our results also indicate that lignin decomposition is the rate limiting step in leaf litter decomposition and that MnP is one of the key oxidative enzymes of litter degradation. We demonstrate here that forest system management practices can significantly affect important ecological processes and services such as decomposition and nutrient cycling. PMID:24699676
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Purahong, Witoon; Kapturska, Danuta; Pecyna, Marek J; Schulz, Elke; Schloter, Michael; Buscot, François; Hofrichter, Martin; Krüger, Dirk
2014-01-01
Leaf litter decomposition is the key ecological process that determines the sustainability of managed forest ecosystems, however very few studies hitherto have investigated this process with respect to silvicultural management practices. The aims of the present study were to investigate the effects of forest management practices on leaf litter decomposition rates, nutrient dynamics (C, N, Mg, K, Ca, P) and the activity of ligninolytic enzymes. We approached these questions using a 473 day long litterbag experiment. We found that age-class beech and spruce forests (high forest management intensity) had significantly higher decomposition rates and nutrient release (most nutrients) than unmanaged deciduous forest reserves (P<0.05). The site with near-to-nature forest management (low forest management intensity) exhibited no significant differences in litter decomposition rate, C release, lignin decomposition, and C/N, lignin/N and ligninolytic enzyme patterns compared to the unmanaged deciduous forest reserves, but most nutrient dynamics examined in this study were significantly faster under such near-to-nature forest management practices. Analyzing the activities of ligninolytic enzymes provided evidence that different forest system management practices affect litter decomposition by changing microbial enzyme activities, at least over the investigated time frame of 473 days (laccase, P<0.0001; manganese peroxidase (MnP), P = 0.0260). Our results also indicate that lignin decomposition is the rate limiting step in leaf litter decomposition and that MnP is one of the key oxidative enzymes of litter degradation. We demonstrate here that forest system management practices can significantly affect important ecological processes and services such as decomposition and nutrient cycling.
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NASA Astrophysics Data System (ADS)
Ifejika Speranza, Chinwe; Kiteme, Boniface; Kimathi Mbae, John; Schmude, Miron
2015-04-01
Social-ecological change is resulting in various risks and opportunities to farmers, which they address through complex multi-strategies to sustain their agricultural-based livelihoods and agricultural landscapes. This paper examines how various stakeholders such as research and government organisations, local and international non-governmental organisations, private companies, farmer groups, individual actors and farmers draw on scientific, external and localised knowledge to address the needs of farmers in sustainable land management and food production. What is the structure of collaboration between the various actors and how does this influence the potential for learning, not only for the farmers but also for other stakeholders? How does the supplied knowledge meet farmers' knowledge needs and demands for sustainable land management and food production? To what extent and how is knowledge co-produced among the various stakeholders? What different types of learning can be identified and what are their influences on farmers' sustainable land management practices? How does farmer learning foster the resilience of agricultural landscapes? Answers to these questions are sought through a case study in the semi-arid areas of Makueni County, Kenya. Particular environmental risks in the study area relate to recurrent droughts and flooding, soil erosion and general land degradation. Opportunities in the study area arise short-term due to more conducive rainfall conditions for crop and vegetation growth, institutional arrangements that foster sustainable land management such as agroforestry programmes and conservation agriculture projects. While farmers observe changes in their environment, they weigh the various risks and opportunities that arise from their social-ecological context and their own capacity to respond leading to the prioritization of certain adaptations relative to others. This can mean that while certain farmers may have knowledge on sustainable land management practices, their capacity to act can be constrained by various factors. Through learning about new land management technologies and adaptation practices, and adapting these to their local contexts, farmers attempt to balance the risks and opportunities arising from social-ecological change. They share and transfer the acquired knowledge to other farmers. While success has been achieved in adoption of sustainable land management practices by many farmers, adoption by other farmers and practice by all farmers remain constrained by various social-ecological factors. The implications of the research findings for interventions and policies aimed at sustainable land management and improved food production are discussed.
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Factors influencing healthcare service quality
Mosadeghrad, Ali Mohammad
2014-01-01
Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality. PMID:25114946
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Lavoie-Tremblay, Mélanie; Fernet, Claude; Lavigne, Geneviève L; Austin, Stéphanie
2016-03-01
To investigate the impact of nurse managers exercising transformational vs. abusive leadership practices with novice nurses. In a nursing shortage context, it is important to understand better the factors that potentially influence the retention of nurses in the early stages of their career. A large body of research has found that transformational leadership practices have a positive influence on employee functioning. However, very little research exists about the detrimental impact of abusive leadership practices, much less in a nursing context. A cross-sectional design where 541 nurses from the province of Quebec (Canada) were questioned in the fall of 2013. A self-administered questionnaire was completed by nurses with less than five years of nursing experience. Results from three linear regression analysis indicated that transformational leadership practices potentially lead to high quality care and weak intention to quit the healthcare facilities. Conversely, abusive leadership practices potentially lead to poorer quality care and to strong intention to quit the healthcare facilities and the nursing profession. Paying close attention to the leadership practices of nurse managers could prove effective in improving patient care and increasing the retention of new nurses, which is helpful in resolving the nursing shortage. Our results specifically suggest not only that we promote supportive leadership practices (transformational leadership) but, most of all, that we spread the word that abusive leadership creates working conditions that could be detrimental to the practice of nursing at career start. © 2015 John Wiley & Sons Ltd.
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NASA Astrophysics Data System (ADS)
Koal, Philipp; Schilling, Rolf; Gerl, Georg; Pritsch, Karin; Munch, Jean Charles
2015-04-01
In order to achieve a reduction of greenhouse gas emissions, modern agronomic management practices need to be established. Therefore, to assess the effect of different farming practices on greenhouse gas emissions, reliable data are required. The experiment covers and compares two main aspects of agricultural management for a better implementation of sustainable land use. The focus lies on the determination and interpretation of greenhouse gas emissions, however, regarding in each case a different agricultural management system, namely an organic farming system and an integrated farming system where the effect of diverse tillage systems and fertilisation practices are observed. In addition, with analysis of the alterable biological, physical and chemical soil properties a link between the impact of different management systems on greenhouse gas emissions and the observed cycle of matter in the soil, especially the nitrogen and carbon cycle, will be enabled. Measurements have been carried out on long-term field trials at the Research Farm Scheyern located in a Tertiary hilly landscape approximately 40 km north of Munich (South Germany). The long-term field trials of the organic and integrated farming system were started in 1992. Since then parcels of land (each around 0.2-0.4 ha) with a particular interior plot set-up have been conducted with the same crop rotation, tillage and fertilisation practice referring to organic and integrated farming management. Thus, the management impacts on the soil of more than 20 years are being examined. Fluxes of CH4, N2O and CO2 have been monitored since 2007 for the integrated farming system trial and since 2012 for the organic farming system trial using an automated system which consists of chambers (0.4 m2 area) with a motor-driven lid, an automated gas sampling unit, an on-line gas chromatographic analysis system, and a control and data logging unit. Precipitation and temperature data have been observed for each experimental field to include weather effects. The main outcomes are the analysis of temporal and spatial dynamics of greenhouse gas emissions influenced by management practice events (i.a. fertilisation, crop incorporation and tillage) and weather effects (drying-rewetting, freezing-thawing, intense rainfall and dry periods) and the creation of impact studies comparing the farming systems (organic vs integrated) and the management practices (minimum tillage vs conventional tillage; high vs low fertilisation). Physical, chemical and biological soil properties (i.a. texture, mineral nitrogen, soil organic carbon and microbial biomass) have been examined in short time intervals to aggregate the parameters and processes influencing the greenhouse gas emissions and to build a linkage between soil organic matter and greenhouse gas emissions. Moreover, with the comparison of the investigated similar long-term field experiments and the collected agronomic data (harvest, tillage and fertilisation practices) the study could contribute to a contemporary set of "best management practices" and could provide a help to create decision tools for stakeholders such as farmers.
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R. A., II Pierce; D. T. Farrand; W. B. Kurtz
2001-01-01
Evolving agricultural policies have influenced management practices within agroecosystems, impacting available habitats for many species of wildlife. Enhancing wildlife habitat has become an explicit objective of existing agricultural policy. Thus, there is renewed focus on field borders and the use of shelterbelt agroforestry systems to achieve conservation goals in...
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Effects of timber harvests on invertebrate biomass and avian nest success
Jeffrey P. Duguay; Petra Bohall Wood; Gary W. Miller
2000-01-01
Concerns over declining songbird populations have led to investigations of effects of various timber management practices on breeding songbirds. We assessed the influence of 2 types of practices, two-age and clearcutting, on invertebrate biomass and avian daily nest survival in the Monongahela National Forest of West Virginia during summers of 1995 and 1996. We also...
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ERIC Educational Resources Information Center
Ismail, Roqia; Ali, Muhammad
2016-01-01
The basic purpose of the study was to explore the influence of workplace incivility on the total quality management practices implementation in higher education institutes of balochistan. The data was collected through questionnaire and the sample size of the study was 381. The reliability and validity of the questionnaire was checked through…
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Potential contributions of figured wood to the practice of sustainable forestry
Don C. Bragg
2006-01-01
The birdseye grain of sugar maple (Acer saccharum Marsh.) can showcase the potential of figured wood in sustainable forestry. This poorly understood but valuable grain abnormality commands such a premium that its presence alone can influence timber management. Good forestry and logging practices can help assure that quality birdseye maple logs are not relegated to low-...
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Management Practices of Cotton Producers in Lauderdale County, Tennessee.
ERIC Educational Resources Information Center
Peal, Charles T.; Dotson, Robert S.
Eighty-one randomly selected cotton producers in Lauderdale County were interviewed for the purposes of: (1) characterizing those in different cotton yield groups, (2) determining which practices were being used by those in different yield groups, and (3) identifying some of the factors influencing the farmers to use or not to use the 12 practices…
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ERIC Educational Resources Information Center
Nicholas, George P.
2006-01-01
In British Columbia, Canada, the practice of archaeology has been strongly influenced by issues of First Nations rights and the ways government and industry have chosen to address them. In turn, this situation has affected academic (i.e., research-based) and consulting (i.e., cultural resource management) archaeology, which have had to respond to…
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Treiger, Teresa M; Fink-Samnick, Ellen
2013-01-01
The purpose of this first of a three-article series is to provide context and justification for a new paradigm of case management built upon a value-driven foundation that Applicable to all health care sectors where case management is practiced. In moving forward, the one fact that rings true is there will be constant change in our industry. As the health care terrain shifts and new influences continually surface, there will be consequences for case management practice. These impacts require nimble clinical professionals in possession of recognized and firmly established competencies. They must be agile to frame (and reframe) their professional practice to facilitate the best possible outcomes for their patients. Case managers can choose to be Gumby or Pokey. This is exactly why the definition of a competency-based case management model's time has come, one sufficiently fluid to fit into any setting of care. The practice of case management transcends the vast array of representative professional disciplines and educational levels. A majority of current models are driven by business priorities rather than by the competencies critical to successful practice and quality patient outcomes. This results in a fragmented professional case management identity. While there is inherent value in what each discipline brings to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities, including a reflective clinical ladder.
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Eh, Kexin; McGill, Margaret; Wong, Jencia; Krass, Ines
2016-09-01
To investigate the influence of cultural and other factors on diabetes self-management behaviors among Australian Chinese immigrants with T2D. A cross-sectional survey was conducted between June and October 2015. The questionnaire comprised several validated scales examining aspects of self-management practice including medication adherence, acculturation and demographics. Participants were recruited from the community and Diabetes Center of the Royal Prince Alfred Hospital (RPAH), Sydney, Australia. Of the 139 participants, a majority were female, from mainland China, with high school level education and a mean age of 64 (SD±12) years. Participants were found to have poor self-management practices generally but moderate medication adherence. 13.7% of participants reported incorporating TCM into their diabetes treatment and 24% reported a cultural shame surrounding a diabetes diagnosis. Higher levels of acculturation predicted better medication adherence, whereas stronger beliefs in TCM predicted poorer medication adherence. Gender, education level and duration of diabetes were also predictors of diabetes self-management behaviors. This study provided insight into cultural influences on diabetes self-management and medication taking among Chinese immigrants in Australia. Health care providers should take these into account in delivering culturally sensitive care and advice to achieve better health outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Wilson, H. F.; Elliott, J. A.; Glenn, A. J.
2017-12-01
Runoff generation and the associated export of nitrogen, phosphorus, and organic carbon on the Northern Great Plains have historically been dominated by snowmelt runoff. In this region the transport of elements primarily occurs in dissolved rather than particulate forms, so cropland management practices designed to reduce particulate losses tend to be ineffective in reducing nutrient runoff. Over the last decade a higher frequency of high volume and intensity rainfall has been observed, leading to rainfall runoff and downstream flooding. To evaluate interactions between tillage, crop residue management, fertilization practices, weather, and runoff biogeochemistry a network of 18 single field scale watersheds (2-6 ha.) has been established in Manitoba, Canada over a range of fertilization (no input to high input) and tillage (zero tillage to frequent tillage). Soils in this network are typical of cropland in the region with clay or clay loam textures, but soil phosphorus differs greatly depending on input practices (3 to 25 mg kg-1 sodium bicarbonate extractable P). Monitoring of runoff chemistry and hydrology at these sites was initiated in 2013 and over the course of 5 years high volume snowmelt runoff from deep snowpack (125mm snow water equivalent), low volume snowmelt from shallow snowpack (25mm snow water equivalent) and extreme rainfall runoff events in spring have all been observed. Event based analyses of the drivers of runoff chemistry indicate that spring fertilization practices (depth, amount, and timing) influence concentrations of N and P in runoff during large rainfall runoff events, but for snowmelt runoff the near surface soil chemistry, tillage, and crop residue management are of greater importance. Management recommendations that might be suggested to reduce nutrient export and downstream eutrophication in the region differ for snowmelt and rainfall, but are not mutually exclusive.
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Mackintosh, Nicola; Sandall, Jane
2016-02-01
The normative position in acute hospital care when a patient is seriously ill is to resuscitate and rescue. However, a number of UK and international reports have highlighted problems with the lack of timely recognition, treatment and referral of patients whose condition is deteriorating while being cared for on hospital wards. This article explores the social practice of rescue, and the structural and cultural influences that guide the categorisation and ordering of acutely ill patients in different hospital settings. We draw on Strauss et al.'s notion of the patient trajectory and link this with the impact of categorisation practices, thus extending insights beyond those gained from emergency department triage to care management processes further downstream on the hospital ward. Using ethnographic data collected from medical wards and maternity care settings in two UK inner city hospitals, we explore how differences in population, cultural norms, categorisation work and trajectories of clinical deterioration interlink and influence patient safety. An analysis of the variation in findings between care settings and patient groups enables us to consider socio-political influences and the specifics of how staff manage trade-offs linked to the enactment of core values such as safety and equity in practice. © 2015 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
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Nest survival of American Coots relative to grazing, burning, and water depths
Austin, Jane E.; Buhl, Deborah A.
2011-01-01
Water and emergent vegetation are key features influencing nest site selection and success for many marsh-nesting waterbirds. Wetland management practices such as grazing, burning, and water-level manipulations directly affect these features and can influence nest survival. We used model selection and before-after-control-impact approaches to evaluate the effects of water depth and four common land-management practices or treatments, i.e., summer grazing, fall grazing, fall burning, and idle (no active treatment) on nest survival of American coots (Fulica americana) nesting at Grays Lake, a large montane wetland in southeast Idaho. The best model included the variables year × treatment, and quadratic functions of date, water depth, and nest age; height of vegetation at the nest did not improve the best model. However, results from the before-after-control-impact analysis indicate that management practices affected nest success via vegetation and involved interactions of hydrology, residual vegetation, and habitat composition. Nest success in idled fields changed little between pre- and post-treatment periods, whereas nest success declined in fields that were grazed or burned, with the most dramatic declines the year following treatments. The importance of water depth may be amplified in this wetland system because of rapid water-level withdrawal during the nesting season. Water and land-use values for area ranchers, management for nesting waterbirds, and long-term wetland function are important considerations in management of water levels and vegetation.
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Williams, Shawn
2016-01-01
Job stress and emotional exhaustion have been shown to have a negative impact on the helping professional. The development and causal relations of job stress and emotional exhaustion are rather unclear in the chiropractic profession. The objective of this study is to understand the main sources of occupational stress and emotional exhaustion among doctors of chiropractic. Analysis of the written responses to web-based open-ended questionnaire was performed using an interpretive research methodology. Additionally, cross tabulation and Chi square statistical tests were conducted to match and couple the demographic data with the categorical themes. Fourteen professional stress categories emerged from the 970 completed surveys. "Managed Care Organization regulation", "Managed Care reimbursement" and "Scope of Practice Issues" were the most common stressors that negatively influenced chiropractors' professional and personal lives. The results of the categorical analysis suggests that age, marital status, number of years in practice and location of practice may have an influence on the category of stress reported by chiropractors. The qualitative approach revealed common, conventional and culture-specific job stressors in doctors of chiropractic. Notably, these findings suggest an association between third-party payer influences (increased regulation/decreased reimbursement) with that of increased job stress. Further research will be undertaken to refine the stress and satisfaction parameters and address stress interventions.
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Sediment deposition from forest roads at stream crossings as influenced by road characteristics
A.J. Lang; W.M. Aust; M.C. Bolding; K.J. McGuire
2015-01-01
Recent controversies associated with ditched forest roads and stream crossings in the Pacific Northwest have focused national attention on sediment production and best management practices (BMPs) at stream crossings. Few studies have quantified soil erosion rates at stream crossings as influenced by road characteristics and compared them to modeled rates. Soil erosion...
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Ned B. Klopfenstein; Mee-Sook Kim; John W. Hanna; Bryce A. Richardson; John E. Lundquist
2009-01-01
Predicting climate change influences on forest diseases will foster forest management practices that minimize adverse impacts of diseases. Precise locations of accurately identified pathogens and hosts must be documented and spatially referenced to determine which climatic factors influence species distribution. With this information, bioclimatic models can predict the...
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Improving Child Management Practices of Parents and Teachers. Maxi I Practicum. Final Report.
ERIC Educational Resources Information Center
Adreani, Arnold J.; McCaffrey, Robert
The practicum design reported in this document was based on one basic assumption, that the adult perceptions of children influence adult behavior toward children which in turn influences the child's behavior. Therefore, behavior changes by children could best be effected by changing the adult perception of, and behavior toward, the child.…
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2011-01-01
Background More than 20% of US children ages 2-5 yrs are classified as overweight or obese. Parents greatly influence the behaviors their children adopt, including those which impact weight (e.g., diet and physical activity). Unfortunately, parents often fail to recognize the risk for excess weight gain in young children, and may not be motivated to modify behavior. Research is needed to explore intervention strategies that engage families with young children and motivate parents to adopt behaviors that will foster healthy weight development. Methods This study tests the efficacy of the 35-week My Parenting SOS intervention. The intervention consists of 12 sessions: initial sessions focus on general parenting skills (stress management, effective parenting styles, child behavior management, coparenting, and time management) and later sessions apply these skills to promote healthier eating and physical activity habits. The primary outcome is change in child percent body fat. Secondary measures assess parent and child dietary intake (three 24-hr recalls) and physical activity (accelerometry), general parenting style and practices, nutrition- and activity-related parenting practices, and parent motivation to adopt healthier practices. Discussion Testing of these new approaches contributes to our understanding of how general and weight-specific parenting practices influence child weight, and whether or not they can be changed to promote healthy weight trajectories. Trial Registration ClinicalTrials.gov: NCT00998348 PMID:21639940
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Ward, Dianne S; Vaughn, Amber E; Bangdiwala, Kant I; Campbell, Marci; Jones, Deborah J; Panter, Abigail T; Stevens, June
2011-06-05
More than 20% of US children ages 2-5 yrs are classified as overweight or obese. Parents greatly influence the behaviors their children adopt, including those which impact weight (e.g., diet and physical activity). Unfortunately, parents often fail to recognize the risk for excess weight gain in young children, and may not be motivated to modify behavior. Research is needed to explore intervention strategies that engage families with young children and motivate parents to adopt behaviors that will foster healthy weight development. This study tests the efficacy of the 35-week My Parenting SOS intervention. The intervention consists of 12 sessions: initial sessions focus on general parenting skills (stress management, effective parenting styles, child behavior management, coparenting, and time management) and later sessions apply these skills to promote healthier eating and physical activity habits. The primary outcome is change in child percent body fat. Secondary measures assess parent and child dietary intake (three 24-hr recalls) and physical activity (accelerometry), general parenting style and practices, nutrition- and activity-related parenting practices, and parent motivation to adopt healthier practices. Testing of these new approaches contributes to our understanding of how general and weight-specific parenting practices influence child weight, and whether or not they can be changed to promote healthy weight trajectories. ClinicalTrials.gov: NCT00998348.
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Li, Siqi; Zheng, Xunhua; Liu, Chunyan; Yao, Zhisheng; Zhang, Wei; Han, Shenghui
2018-08-01
Quantifications of soil dissolvable organic carbon concentrations, together with other relevant variables, are needed to understand the carbon biogeochemistry of terrestrial ecosystems. Soil dissolvable organic carbon can generally be grouped into two incomparable categories. One is soil extractable organic carbon (EOC), which is measured by extracting with an aqueous extractant (distilled water or a salt solution). The other is soil dissolved organic carbon (DOC), which is measured by sampling soil water using tension-free lysimeters or tension samplers. The influences of observation methods, natural factors and management practices on the measured concentrations, which ranged from 2.5-3970 (mean: 69) mg kg -1 of EOC and 0.4-200 (mean: 12) mg L -1 of DOC, were investigated through a meta-analysis. The observation methods (e.g., extractant, extractant-to-soil ratio and pre-treatment) had significant effects on EOC concentrations. The most significant divergence (approximately 109%) occurred especially at the extractant of potassium sulfate (K 2 SO 4 ) solutions compared to distilled water. As EOC concentrations were significantly different (approximately 47%) between non-cultivated and cultivated soils, they were more suitable than DOC concentrations for assessing the influence of land use on soil dissolvable organic carbon levels. While season did not significantly affect EOC concentrations, DOC concentrations showed significant differences (approximately 50%) in summer and autumn compared to spring. For management practices, applications of crop residues and nitrogen fertilizers showed positive effects (approximately 23% to 91%) on soil EOC concentrations, while tillage displayed negative effects (approximately -17%), compared to no straw, no nitrogen fertilizer and no tillage. Compared to no nitrogen, applications of synthetic nitrogen also appeared to significantly enhance DOC concentrations (approximately 32%). However, further studies are needed in the future to confirm/investigate the effects of ecosystem management practices using standardized EOC measurement protocols or more DOC cases of field experiments. Copyright © 2018 Elsevier B.V. All rights reserved.
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Jenkins, Kurt J.; Starkey, Edward E.
1996-01-01
Modern timber management practices often influence forage production for elk (Cervus elaphus) on broad temporal and spatial scales in forested landscapes. We incorporated site-specific information on postharvesting forest succession and forage characteristics in a simulation model to evaluate past and future influences of forest management practices on forage values for elk in a commercially managed Douglas fir (Pseudotsuga menziesii, PSME)-western hemlock (Tsuga heterophylla, TSHE) forest in western Washington. We evaluated future effects of: (1) clear-cut logging 0, 20, and 40% of harvestable stands every five years; (2) thinning 20-year-old Douglas fir forests; and (3) reducing the harvesting cycle from 60 to 45 years. Reconstruction of historical patterns of vegetation succession indicated that forage values peaked in the 1960s and declined from the 1970s to the present, but recent values still were higher than may have existed in the unmanaged landscape in 1945. Increased forest harvesting rates had little short-term influence on forage trends because harvestable stands were scarce. Simulations of forest thinning also produced negligible benefits because thinning did not improve forage productivity appreciably at the stand level. Simulations of reduced harvesting cycles shortened the duration of declining forage values from approximately 30 to 15 years. We concluded that simulation models are useful tools for examining landscape responses of forage production to forest management strategies, but the options examined provided little potential for improving elk forages in the immediate future.
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Physical space and its impact on waste management in the neonatal care setting
Manzi, Sean
2014-01-01
This paper reports an investigation intended to obtain some understanding of how the working environment might influence the practice and knowledge of those involved in the management of healthcare waste. The National Health Service (NHS) has a continuing waste problem, and the way it manages waste harms the environment and consumes resources. It has been estimated that the carbon footprint of the NHS in England is approximately 20 million tons of CO2e. It has been suggested that better waste segregation could lead to more effective recycling, saving up to 42,000 tonnes of CO2. This qualitative study employed non-participant observation and semi-structured interviews. The interviews were carried out with the key informants within the participating neonatal intensive care unit. Findings from this study indicate that space and the physical arrangement of the environment are significant and influential factors in clinical practice. Where the clinical environment is not supportive, poor infection control and waste management practice is likely to occur. However, proximity of staff caused by a lack of physical space might facilitate situated learning and a collective development of knowledge in practice. The implementation of sustainable waste management practices would be more likely to succeed in an environment that facilitates correct waste segregation. PMID:28989373
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Racial/ethnic differences in the etiology of alcohol use among urban adolescents.
Tobler, Amy L; Livingston, Melvin D; Komro, Kelli A
2011-09-01
We examined relations between neighborhood context, home and family management practices, deviant peer affiliations, beliefs favorable to use, and alcohol use among urban African American and Hispanic adolescents. The sample comprised 4,027 African American and Hispanic adolescents who were 50% boys and 75% low income. Participants completed surveys in 2002-2005 and 2008-2009. Structural equation modeling assessed direct and indirect relations between neighborhood context in 6th grade, home and family management practices in 7th grade, deviant peer affiliations and beliefs favorable to use in 8th grade, and alcohol use in 12th grade. There was significant variation in structural models across race/ethnicity but not gender. Differences included the influence of neighborhood and school strength and, where similarities existed, differences in effect magnitude. Similarities included significant correlations among measurement components; the indirect influence of alcohol advertisement exposure, gender, area deprivation, and home alcohol access on alcohol use; direct influence of deviant peer affiliations and beliefs favorable to use on alcohol use; and indirect effects highlighting the importance of preventing home alcohol access, deviant peer affiliations, and beliefs favorable to use and promoting protective family management practices. Neighborhood and school strength may be particularly important in preventing alcohol use among African Americans, whereas preventing early onset of alcohol use among Hispanics remains important. Preventive efforts may wish to focus on neighborhood deprivation, exposure to alcohol advertisements, and home risks and protective factors because they have direct and indirect effects on intrapersonal factors and alcohol use.
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Fielding, Kelly S; Terry, Deborah J; Masser, Barbara M; Bordia, Prashant; Hogg, Michael A
2005-10-01
Water quality is a key concern in the current global environment, with the need to promote practices that help to protect water quality, such as riparian zone management, being paramount. The present study used the theory of planned behaviour as a framework for understanding how beliefs influence decisions about riparian zone management. Respondents completed a survey that assessed their behavioural, normative, and control beliefs in relation to intentions to manage riparian zones on their property. The results of the study showed that, overall, landholders with strong intentions to manage their riparian zones differed significantly in terms of their beliefs compared to landholders who had weak intentions to manage their riparian zones. Strong intentions to manage riparian zones were associated with a favourable cost-benefit analysis, greater perceptions of normative support for the practice and lower perceptions of the extent to which barriers would impede management of riparian zones. It was also evident that willingness to comply with the recommendations of salient referents, beliefs about the benefits of riparian zone management and perceptions of the extent to which barriers would impede riparian zone management were most important for determining intentions to manage riparian zones. Implications for policy and extension practice are discussed.
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Dietitians' views of overweight and obese people and reported management practices.
Harvey, E L; Summerbell, C D; Kirk, S F L; Hill, A J
2002-10-01
To examine dietitians' views of overweight and obese people, to explore the role of level of severity on these perceptions (overweight vs. obesity), and to explore the relationship between dietitians' views and their reported weight management practices. An independent measures survey, questioning dietitians about either overweight or obese people. One-hundred and eighty-seven members of the British Dietetic Association. A questionnaire exploring beliefs about the causes, attitudes, perceptions of responsibility and reported weight management practices. Physical inactivity was identified as an important causative factor for both overweight and obesity. Mood, eating too much of the wrong foods, repeated dieting and interpersonal factors were also seen as relatively important for both groups. Attitudes were mixed, but were generally neutral to positive. The most negative attitudes were described in terms of perceived reduced self-esteem, sexual attractiveness and health. Dietitians rated obese people more negatively than overweight people. They viewed both overweight and obese people as being responsible for their excess weight. They also reported very similar management practices for overweight and obese people. Beliefs about the causes of overweight explained more of the variance in practice than dietitians' attitudes towards or perceived responsibility of overweight and obese people. However, these associations were not consistent and strong, and other factors not investigated here are likely to have a greater influence on weight management practices.
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Case Report: Activity Diagrams for Integrating Electronic Prescribing Tools into Clinical Workflow
Johnson, Kevin B.; FitzHenry, Fern
2006-01-01
To facilitate the future implementation of an electronic prescribing system, this case study modeled prescription management processes in various primary care settings. The Vanderbilt e-prescribing design team conducted initial interviews with clinic managers, physicians and nurses, and then represented the sequences of steps carried out to complete prescriptions in activity diagrams. The diagrams covered outpatient prescribing for patients during a clinic visit and between clinic visits. Practice size, practice setting, and practice specialty type influenced the prescribing processes used. The model developed may be useful to others engaged in building or tailoring an e-prescribing system to meet the specific workflows of various clinic settings. PMID:16622168
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Brooke Baldauf McBride; Anne E. Black
2012-01-01
This study examined the effects of organizational, environmental, group and individual characteristics on five components of safety climate in the US federal fire management community (HRO Practices, Leadership, Group Culture, Learning Orientation and Mission Clarity). Multiple analyses of variance revealed that all types of characteristics had a significant effect on...
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Anne E. Black; Brooke Baldauf McBride
2013-01-01
This study examined the effects of organisational, environmental, group and individual characteristics on five components of safety climate (High Reliability Organising Practices, Leadership, Group Culture, Learning Orientation and Mission Clarity) in the US federal wildland fire management community. Of particular interest were differences between perceptions based on...
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A Conceptual Model for Analysing Management Development in the UK Hospitality Industry
ERIC Educational Resources Information Center
Watson, Sandra
2007-01-01
This paper presents a conceptual, contingent model of management development. It explains the nature of the UK hospitality industry and its potential influence on MD practices, prior to exploring dimensions and relationships in the model. The embryonic model is presented as a model that can enhance our understanding of the complexities of the…
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Rating spruce-fir silviculture for wildlife and forestry
H.S. Crawford; R.M. Frank
1985-01-01
Forest managers face a wide array of potential choices when they consider all of the products derived from woodlands. Many of these products compete with one another to some degree. For instance, hardwood regeneration may be removed in thinnings to favor softwood growth. Forest wildlife-is also influenced by silvicultural practice and the manager must decide whether to...
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Predicting forest road surface erosion and storm runoff from high-elevation sites
J. M. Grace III
2017-01-01
Forest roads are a concern in management because they represent areas of elevated risks associated with soil erosion and storm runoff connectivity to stream systems. Storm runoff emanating from forest roads and their connectivity to downslope resources can be influenced by a myriad of factors, including storm characteristics, management practices, and the interaction...
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Principles of Classroom Management: A Professional Decision-Making Model, 7th Edition
ERIC Educational Resources Information Center
Levin, James; Nolan, James F.
2014-01-01
This text takes a decision-making model approach to classroom management. It provides teachers with a very practical system to influence students to choose to behave productively and to strive for academic success. This widely used text presents an array of decision-making options that guide teachers in developing positive, pro-social classroom…
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Gillian L. Holloway; Winston P. Smith; Charles B. Halpern; Robert A. Gitzen; Christine C. Maguire; Stephen D. West
2012-01-01
In many regions of the world, forest management has shifted from practices emphasizing timber production to more sustainable harvesting that integrates ecological values, including maintenance of biodiversity, wildlife habitat, and ecological goods and services. To this end, management strategies emphasize retention of stand structures that meet the needs of forest-...
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Sourcing the Imagination: Ta-Nehisi Coates's Work as a Praxis of Decolonization (2017)
ERIC Educational Resources Information Center
Gibson, Stacey A.
2017-01-01
A teacher's practice is influenced by personal, institutional, historical, and societal experiences. Teachers are expected to manage how content is delivered in a classroom setting. As well a teacher is managing their own emotional and internal narratives around complex issues such as race, racism, and oppression in the classroom. By exploring the…
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ERIC Educational Resources Information Center
Kumar, G. D. S.; Popat, M. N.
2010-01-01
One of the major impediments for diversification of groundnut ("Arachis Hypogaea" L.) as food crop is aflatoxin contamination. The study was conducted with an objective to assess the adoption gaps in aflatoxin management practices of groundnut (AMPG) and the farmer's characteristics influencing these gaps. The study used an expost-facto…
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Caring for 'Very Important Patients'--Ethical Dilemmas and Suggestions for Practical Management.
Alfandre, David; Clever, Sarah; Farber, Neil J; Hughes, Mark T; Redstone, Paul; Lehmann, Lisa Soleymani
2016-02-01
The care of Very Important Patients (VIPs) is different from other patients because they may receive greater access, attention, and resources from health care staff. Although the term VIP is used regularly in the medical literature and is implicitly understood, in practice it constitutes a wide and heterogeneous group of patients that have a strong effect on health care providers. We define a VIP as a very influential patient whose individual attributes and characteristics (eg, social status, occupation, position), coupled with their behavior, have the potential to significantly influence a clinician's judgment or behavior. Physicians, celebrities, the politically powerful, and philanthropists, may all become VIPs in the appropriate context. The quality of care may be inferior because health care professionals may deviate from standard practices when caring for them. Understanding the common features among what may otherwise be very different groups of patients can help health care providers manage ethical concerns when they arise. We use a series of vignettes to demonstrate how VIPs behavior and status can influence a clinician's judgment or actions. Appreciating the ethical principles in these varied circumstances provides health care professionals with the tools to manage ethical conflicts that arise in the care of VIPs. We conclude each vignette with guidance for how health care providers and administrators can manage the ethical concern. Published by Elsevier Inc.
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NASA Astrophysics Data System (ADS)
Wee, Seow Ta; Abas, Muhamad Azahar; Chen, Goh Kai; Mohamed, Sulzakimin
2017-10-01
Nowadays, international donors have emphasised on the adoption of good governance practices in solid waste management which include policy implementation. In Malaysia, the National Solid Waste Management Policy (NSWMP) was introduced as the main guideline for its solid waste management and the Malaysian government has adopted good governance practice in the NSMWP implementation. However, the good governance practices implemented by the Malaysian government encountered several challenges. This study was conducted to explore the good governance constraints experienced by stakeholders in the NSWMP implementation. An exploratory research approach is applied in this study through in-depth interviews with several government agencies and concessionaires that involved in the NSWMP implementation in Malaysia. A total of six respondents took part in this study. The findings revealed three main good governance constraints in the NSWMP implementation, namely inadequate fund, poor staff's competency, and ambiguity of policy implementation system. Moreover, this study also disclosed that the main constraint influenced the other constraints. Hence, it is crucial to identify the main constraint in order to minimise its impact on the other constraints.
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Probandari, Ari; Widjanarko, Bagoes; Mahendradhata, Yodi; Sanjoto, Hary; Cerisha, Ancila; Nungky, Saverina; Riono, Pandu; Simon, Sumanto; Farid, Muhammad Noor; Giriputra, Sardikin; Putra, Artawan Eka; Burhan, Erlina; Wahyuni, Chatarina U.; Mustikawati, Dyah; Widianingrum, Christina; Tiemersma, Edine W.; Alisjahbana, Bachti
2016-01-01
Background Operational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices. Objective We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Design Using a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis. Results Operational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process. Conclusions Operational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored. PMID:26928217
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Probandari, Ari; Widjanarko, Bagoes; Mahendradhata, Yodi; Sanjoto, Hary; Cerisha, Ancila; Nungky, Saverina; Riono, Pandu; Simon, Sumanto; Farid, Muhammad Noor; Giriputra, Sardikin; Putra, Artawan Eka; Burhan, Erlina; Wahyuni, Chatarina U; Mustikawati, Dyah; Widianingrum, Christina; Tiemersma, Edine W; Alisjahbana, Bachti
2016-01-01
Operational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices. We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Using a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis. Operational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process. Operational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored.
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Chakraborty, Sarbani; Frick, Kevin
2002-11-01
In many developing countries, private health practitioners provide a significant portion of curative care for diseases which are of public health importance. Currently, health sector reform efforts in these countries are fostering increased participation of private providers in the delivery of health services, including those of public health importance. Guaranteeing good technical quality of care is critical to the process. However, little is known about private providers' technical quality of care (disease management practices) and the factors influencing these services. The purpose of this study was to contribute information on this topic. The study was conducted among private providers in rural West Bengal, India and focused on providers' disease management practices for acute respiratory infections (ARI) among under-five children. World Health Organization (WHO) guidelines for ARI case management were used as the expected standard of care. Observations of patient-provider encounters and interviews with the providers and mothers were the main sources of data. The study found that private health providers in rural West Bengal have inadequate technical quality of care. The problem was related both to low levels of performance (limited potential) and inconsistency in performance (within-provider variation). Limited potential for good technical quality for ARI among the providers was related to lack of knowledge (technical incompetence). One of the important factors influencing within-provider variation was patient load. Since rural private providers operate on a fee-for-service payment system, there are incentives related to seeing many patients. The study concluded that to bring about sustainable improvements in private providers' ARI disease management practices, training programs and interventions that improved compliance were necessary.
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Sveinsdóttir, Herdís; Ragnarsdóttir, Erla Dögg; Blöndal, Katrín
2016-03-01
The aim of this study was to investigate the associations between praise from nurse unit managers and job satisfaction, professional practice, workload, work climate and organizational commitment of nurses caring for surgical patients. Praise influences experiences of employees. Web-based, cross-sectional explorative survey design. A structured questionnaire was used to measure praise given by nurse unit managers as perceived by nurses (n = 383; 49% response rate) working with surgical patients. Data were collected between December 2009-January 2010. Several variables assessed the major concepts under study. Binary logistic regression analysis was employed to compare nurses who receive praise very rarely/rarely as compared with very often/rather often. Praise was received often/very often by 31·6% of participants. Compared with nurses receiving praise rarely/very rarely those who received it often/rather showed more job satisfaction, stated they had more opportunities to practice professionally, described a more positive work climate and were more committed to the organization such as being proud to work at and willing to make effort for the unit and hospital. There was no difference between the groups regarding workload. Main findings of the regression analysis were that nurses display their organizational commitment by not thinking about leaving the current workplace and those who value professional recognition are likelier to receive praise than their counterparts. Nurse unit managers should praise their staff in a realistic fashion. Such praise is cost-effective, takes short time, produces positive influences on members of their staff and may improve patient safety. © 2015 John Wiley & Sons Ltd.
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Access to laboratory testing: the impact of managed care in the Pacific Northwest.
LaBeau, K M; Simon, M; Steindel, S J
1999-01-01
Patient access to health-care services has become an important issue owing to the growth of managed care organizations and the number of patients enrolled. To better understand the current issues related to access to laboratory testing, with a particular focus on the impact of managed care, we gathered information from a network of clinical laboratories in the Pacific Northwest. Two questionnaires were sent to the 257 Laboratory Medicine Sentinel Monitoring Network participants in November 1995 and March 1996 to investigate trends in the availability and utilization of laboratory testing services and changes in onsite testing menus. Although laboratories reported that managed care was a factor in their decisions about laboratory practices, testing decisions were more likely made for business reasons, based on medical practice changes and marketplace influences not associated with managed care.
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McEvoy, Phil; Escott, Diane; Bee, Penny
2011-01-01
This study is based on a formative evaluation of a case management service for high-intensity service users in Northern England. The evaluation had three main purposes: (i) to assess the quality of the organisational infrastructure; (ii) to obtain a better understanding of the key influences that played a role in shaping the development of the service; and (iii) to identify potential changes in practice that may help to improve the quality of service provision. The evaluation was informed by Gittell's relational co-ordination theory, which focuses upon cross-boundary working practices that facilitate task integration. The Assessment of Chronic Illness Care Survey was used to assess the organisational infrastructure and qualitative interviews with front line staff were conducted to explore the key influences that shaped the development of the service. A high level of strategic commitment and political support for integrated working was identified. However, the quality of care co-ordination was variable. The most prominent operational factor that appeared to influence the scope and quality of care co-ordination was the pattern of interaction between the case managers and their co-workers. The co-ordination of patient care was much more effective in integrated co-ordination networks. Key features included clearly defined, task focussed, relational workspaces with interactive forums where case managers could engage with co-workers in discussions about the management of interdependent care activities. In dispersed co-ordination networks with fewer relational workspaces, the case managers struggled to work as effectively. The evaluation concluded that the creation of flexible and efficient task focused relational workspaces that are systemically managed and adequately resourced could help to improve the quality of care co-ordination, particularly in dispersed networks. © 2010 Blackwell Publishing Ltd.
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Petrakis, Roy; van Leeuwen, Willem J.D.; Villarreal, Miguel; Tashjian, Paul; Dello Russo, Regina; Scott, Christopher A.
2017-01-01
Riparian ecosystems are valuable to the ecological and human communities that depend on them. Over the past century, they have been subject to shifting management practices to maximize human use and ecosystem services, creating a complex relationship between water policy, management, and the natural ecosystem. This has necessitated research on the spatial and temporal dynamics of riparian vegetation change. The San Acacia Reach of the Middle Rio Grande has experienced multiple management and river flow fluctuations, resulting in threats to its riparian and aquatic ecosystems. This research uses remote sensing data, GIS, a review of management decisions, and an assessment of climate to both quantify how riparian vegetation has been altered over time and provide interpretations of the relationships between riparian change and shifting climate and management objectives. This research focused on four management phases from 1935 to 2014, each highlighting different management practices and climate-driven river patterns, providing unique opportunities to observe a direct relationship between river management, climate, and riparian response. Overall, we believe that management practices coupled with reduced surface river-flows with limited overbank flooding influenced the compositional and spatial patterns of vegetation, including possibly increasing non-native vegetation coverage. However, recent restoration efforts have begun to reduce non-native vegetation coverage.
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Garforth, C J; Bailey, A P; Tranter, R B
2013-07-01
The UK Department for Environment, Food and Rural Affairs (Defra) identified practices to reduce the risk of animal disease outbreaks. We report on the response of sheep and pig farmers in England to promotion of these practices. A conceptual framework was established from research on factors influencing adoption of animal health practices, linking knowledge, attitudes, social influences and perceived constraints to the implementation of specific practices. Qualitative data were collected from nine sheep and six pig enterprises in 2011. Thematic analysis explored attitudes and responses to the proposed practices, and factors influencing the likelihood of implementation. Most feel they are doing all they can reasonably do to minimise disease risk and that practices not being implemented are either not relevant or ineffective. There is little awareness and concern about risk from unseen threats. Pig farmers place more emphasis than sheep farmers on controlling wildlife, staff and visitor management and staff training. The main factors that influence livestock farmers' decision on whether or not to implement a specific disease risk measure are: attitudes to, and perceptions of, disease risk; attitudes towards the specific measure and its efficacy; characteristics of the enterprise which they perceive as making a measure impractical; previous experience of a disease or of the measure; and the credibility of information and advice. Great importance is placed on access to authoritative information with most seeing vets as the prime source to interpret generic advice from national bodies in the local context. Uptake of disease risk measures could be increased by: improved risk communication through the farming press and vets to encourage farmers to recognise hidden threats; dissemination of credible early warning information to sharpen farmers' assessment of risk; and targeted information through training events, farming press, vets and other advisers, and farmer groups, tailored to the different categories of livestock farmer. Copyright © 2013 Elsevier B.V. All rights reserved.
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García-Orenes, Fuensanta; Morugán-Coronado, Alicia; Zornoza, Raul; Cerdà, Artemi; Scow, Kate
2013-01-01
Agricultural practices have proven to be unsuitable in many cases, causing considerable reductions in soil quality. Land management practices can provide solutions to this problem and contribute to get a sustainable agriculture model. The main objective of this work was to assess the effect of different agricultural management practices on soil microbial community structure (evaluated as abundance of phospholipid fatty acids, PLFA). Five different treatments were selected, based on the most common practices used by farmers in the study area (eastern Spain): residual herbicides, tillage, tillage with oats and oats straw mulching; these agricultural practices were evaluated against an abandoned land after farming and an adjacent long term wild forest coverage. The results showed a substantial level of differentiation in the microbial community structure, in terms of management practices, which was highly associated with soil organic matter content. Addition of oats straw led to a microbial community structure closer to wild forest coverage soil, associated with increases in organic carbon, microbial biomass and fungal abundances. The microbial community composition of the abandoned agricultural soil was characterised by increases in both fungal abundances and the metabolic quotient (soil respiration per unit of microbial biomass), suggesting an increase in the stability of organic carbon. The ratio of bacteria:fungi was higher in wild forest coverage and land abandoned systems, as well as in the soil treated with oat straw. The most intensively managed soils showed higher abundances of bacteria and actinobacteria. Thus, the application of organic matter, such as oats straw, appears to be a sustainable management practice that enhances organic carbon, microbial biomass and activity and fungal abundances, thereby changing the microbial community structure to one more similar to those observed in soils under wild forest coverage.
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Li, Hongxia; Di, Hongxi; Tian, Shuicheng; Li, Jian
2015-01-01
The aim of this study is research the impact of management level's charismatic leadership style on miners' unsafe behavior by using the questionnaires on charismatic leadership style, safety attitude and the miners' unsafe behavior measurement to investigate 200 employees in Shen Dong Company. The research results suggest that management level's charismatic leadership style have very important influence on miners' unsafe behavior and the influence is affected by the safety attitude which is the intermediary function. In the end, this study propose advice on how to improve the coal mine enterprise managers charismatic leadership style in the coal mine enterprise's safety management work, including attach great importance to a variety of incentive methods, set up safety moral models, practice of inductive leadership concept, create a good atmosphere of safety, etc for reference for coal mining enterprises.
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Phan, Thanh Nguyet; Baird, Kevin
2015-09-01
This study contributes to the EMS literature by providing a more detailed insight into the comprehensiveness of environmental management systems (EMSs) by focusing on the intensity of use of environmental management practices. In addition, the study examines the influence of institutional pressures (coercive, mimetic and normative) on the comprehensiveness of environmental management systems (EMSs), and the impact of EMS comprehensiveness on environmental performance. A mail survey questionnaire was used to collect data from a random sample of Australian senior managers across various industries. Both coercive and normative pressures were found to influence the comprehensiveness of EMSs. Specifically, the pressure exerted by the government, through the creation of appropriate regulatory pressures and public incentives, and by employees, customers, professional groups, the media, and community, influenced the comprehensiveness of the EMS. In addition, organisations with more comprehensive EMSs were found to experience higher levels of environmental performance. With more than 300,000 organisations worldwide adopting EMSs (ISO, 2013), the findings provide an important insight into the relevance of EMSs. In particular, it is suggested that organisations should endeavour to implement a more comprehensive EMS and be conscious of the role that coercive and normative pressures play in influencing the comprehensiveness of their EMSs. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Influencing prescribing in English primary care: the views of primary care organisations.
Mason, Anne; Drummond, Michael; Towse, Adrian; Cooke, Jonathan
2004-07-01
The rapid rise of prescribing expenditure is a concern in many industrialised countries and methods to manage medicines are widely employed. The purpose of this study was to identify the approaches to improve primary care prescribing by primary care organisations (PCOs) in the National Health Service (NHS) in England. A questionnaire (Management of Medicines, MANMED) was mailed to prescribing advisers and prescribing leads in 332 PCOs. A response rate of 66% (220/332) was achieved. Most PCOs report the improvement of the quality of prescribing as their top priority, followed by budget adherence at both practice and PCO levels. Prescribing advisers typically offer several forms of support: practice visits, prescribing reviews, indicators of prescribing, prescribing newsletters, hands-on support, seminars and local formularies. PCOs are pursuing a wide range of prescribing initiatives, covering, on average, seven different therapeutic areas. National targets are the main driver for prescribing initiatives but other key influences include inappropriate prescribing and clinical governance. Although cost considerations are important, improving the quality of prescribing is perceived as the overriding principle on which PCO prescribing strategy is based. Multifaceted prescribing support is widespread and national targets are the largest single factor influencing choice of therapeutic area for prescribing initiatives. Diversity in approaches presents the opportunity to improve the evidence base for medicines management. Not only could such research inform PCOs in their central aim of improving the quality of prescribing within the NHS, but it may also offer insights of relevance to other countries if the influence of process and context upon the effectiveness of medicines management is systematically explored.
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American Association of Critical-Care Nurses
... Influencing Sleep in the ICU Explore Explore New Nurses Experienced Nurses Educators/Managers Advanced Practice Membership As a new ... More CSI Academy AACN CSI Academy develops staff nurses as leaders and change agents who drive improved ...
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Encouraging Wildland Fire Preparedness: Lessons Learned from Three Wildfire Education Programs
Victoria Sturtevant; Sarah McCaffrey
2006-01-01
Managers may often wonder why some people do not choose to adopt defensible space practices despite understanding the benefits of doing so. Research has sought to understand why a new practice or innovation is or is not adopted. This paper will briefly discuss factors found to influence adoption rates and describe how three different fire education programs - Firewise...
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Humphreys, John; Harvey, Gill; Coleiro, Michelle; Butler, Brook; Barclay, Anna; Gwozdziewicz, Maciek; O'Donoghue, Donal; Hegarty, Janet
2012-08-01
Research has demonstrated a knowledge and practice gap in the identification and management of chronic kidney disease (CKD). In 2009, published data showed that general practices in Greater Manchester had a low detection rate for CKD. A 12-month improvement collaborative, supported by an evidence-informed implementation framework and financial incentives. 19 general practices from four primary care trusts within Greater Manchester. Number of recorded patients with CKD on practice registers; percentage of patients on registers achieving nationally agreed blood pressure targets. The collaborative commenced in September 2009 and involved three joint learning sessions, interspersed with practice level rapid improvement cycles, and supported by an implementation team from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Greater Manchester. At baseline, the 19 collaborative practices had 4185 patients on their CKD registers. At final data collection in September 2010, this figure had increased by 1324 to 5509. Blood pressure improved from 34% to 74% of patients on practice registers having a recorded blood pressure within recommended guidelines. Evidence-based improvement can be implemented in practice for chronic disease management. A collaborative approach has been successful in enabling teams to test and apply changes to identify patients and improve care. The model has proved to be more successful for some practices, suggesting a need to develop more context-sensitive approaches to implementation and actively manage the factors that influence the success of the collaborative.
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NASA Astrophysics Data System (ADS)
Koal, Philipp; Schilling, Rolf; Gerl, Georg; Pritsch, Karin; Munch, Jean Charles
2016-04-01
In order to achieve a reduction of greenhouse gas emissions, modern agronomic management practices need to be established. Therefore, to assess the effect of different farming practices on greenhouse gas emissions, reliable data are required. The experiment covers and compares main aspects of agricultural management for a better implementation of sustainable land use. The focus lies on the determination and interpretation of greenhouse gas emissions, where the effects of diverse tillage systems and fertilisation practices of an integrated farming system as well as the impacts of extreme weather conditions are observed. In addition, with analysis of the alterable biological, physical and chemical soil properties a link between the impact of different management systems on greenhouse gas emissions and the observed cycle of matter in the soil, especially the nitrogen and carbon cycle, is enabled. Measurements have been carried out on long-term field trials at the Research Farm Scheyern located in a Tertiary hilly landscape approximately 40 km north of Munich (South Germany). The long-term integrated farming system trial was started in 1992. Since then parcels of land (each around 0.2-0.4 ha) with a particular interior plot set-up have been conducted with the same crop rotation, tillage and fertilisation practice referring to integrated farming management. Thus, the management impacts on the soil of more than 20 years have been examined. Fluxes of CH4, N2O and CO2 have been monitored since 2007 for the integrated farming system trial using an automated system which consists of chambers (0.4 m2 area) with a motor-driven lid, an automated gas sampling unit, an on-line gas chromatographic analysis system, and a control and data logging unit. Precipitation and temperature data have been observed for the experimental field to include weather effects. The main outcomes are the analysis of temporal and spatial dynamics of greenhouse gas emissions influenced by management practice events (i.a. fertilisation, crop incorporation and tillage) and weather effects (drying-rewetting, freezing-thawing, intense rainfall and dry periods) and the creation of impact studies comparing the management practices (minimum tillage vs conventional tillage; high vs low fertilisation). Physical, chemical and biological soil properties (i.a. texture, mineral nitrogen, soil organic carbon and microbial biomass) have been examined in short time intervals to aggregate the parameters and processes influencing the greenhouse gas emissions and to build a linkage between soil organic matter and greenhouse gas emissions. Moreover, with the collected soil and agronomic data (harvest, tillage and fertilisation practices) the study contributes to a process quantification supporting modelling approaches.
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Mcnaughton, Susan; Barrow, Mark; Bagg, Warwick; Frielick, Stanley
2016-01-01
Practice-based learning integrates the cognitive, psychomotor, and affective domains and is influenced by students' beliefs, values, and attitudes. Concept mapping has been shown to effectively demonstrate students' changing concepts and knowledge structures. This article discusses how concept mapping was modified to capture students' perceptions of the connections between the domains of thinking and knowing, emotions, behavior, attitudes, values, and beliefs and the specific experiences related to these, over a period of eight months of practice-based clinical learning. The findings demonstrate that while some limitations exist, modified concept mapping is a manageable way to gather rich data about students' perceptions of their clinical practice experiences. These findings also highlight the strong integrating influence of beliefs and values on other areas of practice, suggesting that these need to be attended to as part of a student's educational program.
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Mcnaughton, Susan; Barrow, Mark; Bagg, Warwick; Frielick, Stanley
2016-01-01
Practice-based learning integrates the cognitive, psychomotor, and affective domains and is influenced by students’ beliefs, values, and attitudes. Concept mapping has been shown to effectively demonstrate students’ changing concepts and knowledge structures. This article discusses how concept mapping was modified to capture students’ perceptions of the connections between the domains of thinking and knowing, emotions, behavior, attitudes, values, and beliefs and the specific experiences related to these, over a period of eight months of practice-based clinical learning. The findings demonstrate that while some limitations exist, modified concept mapping is a manageable way to gather rich data about students’ perceptions of their clinical practice experiences. These findings also highlight the strong integrating influence of beliefs and values on other areas of practice, suggesting that these need to be attended to as part of a student's educational program. PMID:29349311
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Alignier, Audrey; Aviron, Stéphanie
2017-12-15
Field margins are key features for the maintenance of biodiversity and associated ecosystem services in agricultural landscapes. Little is known about the effects of management practices of old semi-natural field margins, and their historical dimension regarding past management practices and landscape context is rarely considered. In this paper, the relative influence of recent and past management practices and landscape context (during the last five years) were assessed on the local biodiversity (species richness and composition) of carabid assemblages of field margins in agricultural landscapes of northwestern France. The results showed that recent patterns of carabid species richness and composition were best explained by management practices and landscape context measured four or five years ago. It suggests the existence of a time lag in the response of carabid assemblages to past environmental conditions of field margins. The relative contribution of past management practices and past landscape context varied depending on the spatial scale at which landscape context was taken into account. Carabid species richness was higher in grazed or sprayed field margins probably due to increased heterogeneity in habitat conditions. Field margins surrounded by grasslands and crops harbored species associated with open habitats whilst forest species dominated field margins surrounded by woodland. Landscape effect was higher at fine spatial scale, within 50 m around field margins. The present study highlights the importance of considering time-lagged responses of biodiversity when managing environment. It also suggests that old semi-natural field margins should not be considered as undisturbed habitats but more as management units being part of farming activities in agricultural landscapes, as for arable fields. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Fender, Guy R K; Prentice, Andrew; Gorst, Tess; Nixon, Richard M; Duffy, Stephen W; Day, Nicholas E; Smith, Stephen K
1999-01-01
Objective To determine whether an educational package could influence the management of menorrhagia, increase the appropriateness of choice of non-hormonal treatment, and reduce referral rates from primary to secondary care. Design Randomised controlled trial. Setting General practices in East Anglia. Subjects 100 practices (348 doctors) in primary care were recruited and randomised to intervention (54) and control (46). Interventions An educational package based on principles of “academic detailing” with independent academics was given in small practice based interactive groups with a visual presentation, a printed evidence based summary, a graphic management flow chart, and a follow up meeting at 6 months. Outcome measures All practices recorded consultation details, treatments offered, and outcomes for women with regular heavy menstrual loss (menorrhagia) over 1 year. Results 1001 consultation data sheets for menorrhagia were returned. There were significantly fewer referrals (20% v 29%; odds ratio 0.64; 95% confidence interval 0.41 to 0.99) and a significantly higher use of tranexamic acid (odds ratio 2.38; 1.61 to 3.49) in the intervention group but no overall difference in norethisterone treatment compared with controls. There were more referrals when tranexamic acid was given with norethisterone than when it was given alone. Those practices reporting fewer than 10 cases showed the highest increase in prescribing of tranexamic acid. Conclusions The educational package positively influenced referral for menorrhagia and treatment with appropriate non-hormonal drugs. Key messagesMenorrhagia (regular excessive menstruation) affects many women and treatment is a considerable use of resourcesAppropriate non-hormonal treatments are not always offered before referral, which often results in therapeutic surgeryAn educational package with independent academics in small informal groups presenting visual, graphic, and written material can positively influence doctors’ behaviourIncreasing appropriate non-hormonal treatments for menorrhagia results in fewer referrals PMID:10231255
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Lee, Guna; Yang, Sook Ja; Chee, Yeon Kyung
2016-06-18
Since the worldwide incidence of metabolic syndrome (Mets) has rapidly increased, healthy behaviors such as weight control, engaging in physical activity, and healthy diet have been crucial in the management of Mets. The purpose of this study was to examine healthy behaviors practice and factors that affect the practice in relation to Mets on the basis of a modified Information-Motivation-Behavioral skills model (IMB) with psychological distress, which is a well-known factor affecting healthy behaviors among individuals with Mets. Study participants were 267 community dwelling adults (M age: 54.0 ± 8.1 years) with Mets who were attending public health centers located in Seoul, South Korea. A structured questionnaire was administered in the areas of information, motivation, behavioral skills, and practice of Mets healthy behaviors and levels of psychological distress from May 2014 to September 2014. Structural equation modeling was used to test the modified IMB model. The modified IMB model had a good fit with the data, indicating that motivation and behavioral skills directly influenced the practice of Mets healthy behaviors, whereas information and psychological distress directly influenced motivation and influenced the practice of healthy behaviors through behavioral skills. These components of the modified IMB model explained 29.8 % of the variance in healthy behaviors for Mets. Findings suggested that strengthening motivation and behavioral skills for healthy behaviors can directly enhance healthy behavior practice. Providing information about Mets related healthy behaviors and strategies for psychological distress management can be used as the first line evidence based intervention to systemically enhance motivation and behavioral skills among individuals with Mets.
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Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan
2017-02-01
There is a dearth of literature on priority setting and resource allocation (PSRA) practices in hospitals, particularly in low and middle income countries (LMICs). Using a case study approach, we examined PSRA practices in 2 public hospitals in coastal Kenya. We collected data through a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations of PSRA practices in case study hospitals over a period of 7 months. In this paper, we apply complex adaptive system (CAS) theory to examine the factors that influence PSRA practices. We found that PSRA practices in the case hospitals were influenced by, 1) inadequate financing level and poorly designed financing arrangements, 2) limited hospital autonomy and decision space, and 3) inadequate management and leadership capacity in the hospital. The case study hospitals exhibited properties of complex adaptive systems (CASs) that exist in a dynamic state with multiple interacting agents. Weaknesses in system 'hardware' (resource scarcity) and 'software' (including PSRA guidelines that reduced hospitals decision space, and poor leadership skills) led to the emergence of undesired properties. The capacity of hospitals to set priorities should be improved across these interacting aspects of the hospital organizational system. Interventions should however recognize that hospitals are CAS. Rather than rectifying isolated aspects of the system, they should endeavor to create conditions for productive emergence. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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ERIC Educational Resources Information Center
Fernandez, Julie A.
2012-01-01
In the context of a global school reform movement, defining the extent of a principal's influence on teacher effectiveness and student achievement is essential. A principal must be more than a manager, but also a transformational and an instructional leader. This concurrent mix methods study incorporated guided interviews and an online survey…
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Practice recommendations for pain assessment by self-report with African American older adults.
Booker, Staja Star; Pasero, Chris; Herr, Keela A
2015-01-01
Despite decades of education and clinical practice guidelines underscoring disparities in pain management, pain continues to be inadequately managed in older African American adults as a result of patient, provider, and systems factors. Critical factors influencing pain assessment in older African American adults has not been extensively examined, contributing to a lack of data to inform health care providers' knowledge on culturally-responsive pain assessment in older African Americans. Assessing pain in older African Americans is unique because differences in language, cultural beliefs, and practices moderate how they report and express pain. This paper presents an overview of patient-provider factors that affect pain assessment in older African Americans with a focus on this population's unique cultural beliefs and practices. Recommendations for best practices for performance of a culturally-responsive pain assessment with older African Americans are provided. Copyright © 2015 Elsevier Inc. All rights reserved.
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Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.
Roemer, Lorrie K; Rocha, Roberto A; Del Fiol, Guilherme; Bradshaw, Richard L; Hanna, Timothy P; Hulse, Nathan C
2006-01-01
At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.
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Farfán-Heredia, Berenice; Casas, Alejandro; Moreno-Calles, Ana I; García-Frapolli, Eduardo; Castilleja, Aída
2018-01-15
Interactions between societies and nature are regulated by complex systems of beliefs, symbolism, customs, and worldviews (kosmos), ecological knowledge (corpus), and management strategies and practices (praxis), which are constructed as product of experiences and communication of people throughout time. These aspects influence social relations, life strategies, and cultural identity, and all of them in turn influence and are influenced by local and regional patterns of interchange. In this study, we analyze the interchange of wild and weedy plants and mushrooms in traditional markets of the Phurépecha region of Mexico. Particularly, the social relations constructed around the interchange of these products; how knowledge, cultural values, and ecological factors influence and are influenced by interchange; and how all these factors influence the type and intensity of biotic resources management. We studied three main traditional markets of the Phurépecha region of Michoacán, Mexico, through 140 visits to markets and 60 semi-structured interviews to sellers of wild and weedy plants and mushrooms. In nearly 2 years, we carried out 80 visits and 30 interviews in the "Barter Market", 20 visits and 15 interviews in the "Phurépecha Tiánguis", and 40 visits and 15 interviews to the "Municipal Market". We documented information about the spaces of interchange that form the markets, the types of interchange occurring there, the cultural and economic values of the resources studied, the environmental units that are sources of such resources, the activities associated to resources harvesting and, particularly, the management techniques practiced to ensure or increase their availability. We analyzed the relations between the amounts of products interchanged, considered as pressures on the resources; the perception of their abundance or scarcity, considered as the magnitude of risk in relation to the pressures referred to; and the management types as response to pressures and risk. We recorded 38 species of wild and weedy plants and 15 mushroom species interchanged in the markets. We characterized the spaces of interchange, the interchange types, and social relations among numerous Phurépecha communities which maintain the main features of pre-Columbian markets. The products analyzed are differentially valued according to their role in people's life, particularly food, medicine, rituals, and ornamental purposes. The highest cultural values were identified in multi-purpose plant and mushroom resources and, outstandingly, in ornamental and ritual plants. In markets, women are the main actors and connectors of the regional households' activities of use and management of local resources and ecosystems. The interrelationships between worldviews, knowledge, and practices are visible through the interchange of the products analyzed, including the types of environments comprised in communitarian territories, agricultural calendars, and feasts. Those plants and mushrooms are highly valued but relatively scarce according to the demand on them receiving special attention and management practices directed to ensure or increase their availability. With the exception of most mushrooms and ornamental and ritual plants, which have high economic and cultural values, there are those that are relatively scarce and under high risk, but are obtained through simple gathering from the wild. Traditional markets are crucial part of the subsistence strategy of Phurépecha people based on the multiple use of resources and ecosystems at the local and regional levels. The markets influence social relations, cultural identity, and preservation of traditional knowledge and biodiversity. In general, the demand of products in markets enhances innovation and practices for ensuring or increasing their availability, particularly those that are naturally scarce. However, it was notorious that, althoug mushrooms and ritual plants have high demand and value in markets, most of them are obtained by simple gathering.
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Treiger, Teresa M; Fink-Samnick, Ellen
2014-01-01
The purpose of the third of this 3-article series is to provide context and justification for a new paradigm of case management built upon a value-driven foundation that * improves the patient's experience of health care delivery, * provides consistency in approach applicable across health care populations, and * optimizes the potential for return on investment. Applicable to all health care sectors where case management is practiced. In moving forward the one fact that rings true is there will be constant change in our industry. As the health care terrain shifts and new influences continually surface, there will be consequences for case management practice. These impacts require nimble clinical professionals in possession of recognized and firmly established competencies. They must be agile to frame (and reframe) their professional practice to facilitate the best possible outcomes for their patients. Case managers can choose to be Gumby or Pokey. This is exactly why the definition of a competency-based case management model's time has come, one sufficiently fluid to fit into any setting of care. The practice of case management transcends the vast array of representative professional disciplines and educational levels. A majority of current models are driven by business priorities rather than the competencies critical to successful practice and quality patient outcomes. This results in a fragmented professional case management identity. While there is inherent value in what each discipline brings to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities, including a reflective clinical ladder.
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Factors influencing nurses' attitudes toward simulation-based education.
Decarlo, Deborah; Collingridge, Dave S; Grant, Carrie; Ventre, Kathleen M
2008-01-01
To identify barriers to nurses' participation in simulation, and to determine whether prior simulation exposure, professional experience, and practice location influence their tendency to perceive specific issues as barriers. We also sought to identify nurses' educational priorities, and to determine whether these were influenced by years of experience or practice location. We surveyed full-time and part-time nurses in a university-affiliated children's hospital to gather data on professional demographics, simulation exposure, perceived barriers to participation in simulation, and training priorities. A total of 523 of 936 (56%) eligible nurses completed the survey. Binary logistic regression analysis revealed that "simulation is 'not the real thing'" was selected as a barrier more often by nurses with prior simulation experience (P = 0.02), fewer years in practice (P = 0.02), and employment in non-acute care areas of the hospital (P = 0.03). "Unfamiliarity with equipment" was reported more often by nurses with less experience (P = 0.01). "Stressful or intimidating environment" was selected more often by those who work in non-acute care areas (P < 0.01). "Providing opportunities to manage rare events" was suggested as a training priority by nurses with less experience (P = 0.08) and by those practicing in acute care areas (P = 0.03). We identified several barriers to nurses' participation in simulation training. Nurses' tendency to name specific issues as barriers is related to prior simulation exposure, years of experience, and area of hospital practice. Rehearsing rare event management is a priority for less-experienced nurses and those in acute care areas.
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From Observation to Information: Data-Driven Understanding of on Farm Yield Variation
Jiménez, Daniel; Dorado, Hugo; Cock, James; Prager, Steven D.; Delerce, Sylvain; Grillon, Alexandre; Andrade Bejarano, Mercedes; Benavides, Hector; Jarvis, Andy
2016-01-01
Agriculture research uses “recommendation domains” to develop and transfer crop management practices adapted to specific contexts. The scale of recommendation domains is large when compared to individual production sites and often encompasses less environmental variation than farmers manage. Farmers constantly observe crop response to management practices at a field scale. These observations are of little use for other farms if the site and the weather are not described. The value of information obtained from farmers’ experiences and controlled experiments is enhanced when the circumstances under which it was generated are characterized within the conceptual framework of a recommendation domain, this latter defined by Non-Controllable Factors (NCFs). Controllable Factors (CFs) refer to those which farmers manage. Using a combination of expert guidance and a multi-stage analytic process, we evaluated the interplay of CFs and NCFs on plantain productivity in farmers’ fields. Data were obtained from multiple sources, including farmers. Experts identified candidate variables likely to influence yields. The influence of the candidate variables on yields was tested through conditional forests analysis. Factor analysis then clustered harvests produced under similar NCFs, into Homologous Events (HEs). The relationship between NCFs, CFs and productivity in intercropped plantain were analyzed with mixed models. Inclusion of HEs increased the explanatory power of models. Low median yields in monocropping coupled with the occasional high yields within most HEs indicated that most of these farmers were not using practices that exploited the yield potential of those HEs. Varieties grown by farmers were associated with particular HEs. This indicates that farmers do adapt their management to the particular conditions of their HEs. Our observations confirm that the definition of HEs as recommendation domains at a small-scale is valid, and that the effectiveness of distinct management practices for specific micro-recommendation domains can be identified with the methodologies developed. PMID:26930552
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Jones, Jay E.; Kroll, Andrew J.; Giovanini, Jack; Duke, Steven D.; Ellis, Tana M.; Betts, Matthew G.
2012-01-01
Background Managers of landscapes dedicated to forest commodity production require information about how practices influence biological diversity. Individual species and communities may be threatened if management practices truncate or simplify forest age classes that are essential for reproduction and survival. For instance, the degradation and loss of complex diverse forest in young age classes have been associated with declines in forest-associated Neotropical migrant bird populations in the Pacific Northwest, USA. These declines may be exacerbated by intensive forest management practices that reduce hardwood and broadleaf shrub cover in order to promote growth of economically valuable tree species in plantations. Methodology and Principal Findings We used a Bayesian hierarchical model to evaluate relationships between avian species richness and vegetation variables that reflect stand management intensity (primarily via herbicide application) on 212 tree plantations in the Coast Range, Oregon, USA. Specifically, we estimated the influence of broadleaf hardwood vegetation cover, which is reduced through herbicide applications, on bird species richness and individual species occupancy. Our model accounted for imperfect detection. We used average predictive comparisons to quantify the degree of association between vegetation variables and species richness. Both conifer and hardwood cover were positively associated with total species richness, suggesting that these components of forest stand composition may be important predictors of alpha diversity. Estimates of species richness were 35–80% lower when imperfect detection was ignored (depending on covariate values), a result that has critical implications for previous efforts that have examined relationships between forest composition and species richness. Conclusion and Significance Our results revealed that individual and community responses were positively associated with both conifer and hardwood cover. In our system, patterns of bird community assembly appear to be associated with stand management strategies that retain or increase hardwood vegetation while simultaneously regenerating the conifer cover in commercial tree plantations. PMID:22905249
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Bees for development: Brazilian survey reveals how to optimize stingless beekeeping.
Jaffé, Rodolfo; Pope, Nathaniel; Torres Carvalho, Airton; Madureira Maia, Ulysses; Blochtein, Betina; de Carvalho, Carlos Alfredo Lopes; Carvalho-Zilse, Gislene Almeida; Freitas, Breno Magalhães; Menezes, Cristiano; Ribeiro, Márcia de Fátima; Venturieri, Giorgio Cristino; Imperatriz-Fonseca, Vera Lucia
2015-01-01
Stingless bees are an important asset to assure plant biodiversity in many natural ecosystems, and fulfill the growing agricultural demand for pollination. However, across developing countries stingless beekeeping remains an essentially informal activity, technical knowledge is scarce, and management practices lack standardization. Here we profited from the large diversity of stingless beekeepers found in Brazil to assess the impact of particular management practices on productivity and economic revenues from the commercialization of stingless bee products. Our study represents the first large-scale effort aiming at optimizing stingless beekeeping for honey/colony production based on quantitative data. Survey data from 251 beekeepers scattered across 20 Brazilian States revealed the influence of specific management practices and other confounding factors over productivity and income indicators. Specifically, our results highlight the importance of teaching beekeepers how to inspect and feed their colonies, how to multiply them and keep track of genetic lineages, how to harvest and preserve the honey, how to use vinegar traps to control infestation by parasitic flies, and how to add value by labeling honey containers. Furthermore, beekeeping experience and the network of known beekeepers were found to be key factors influencing productivity and income. Our work provides clear guidelines to optimize stingless beekeeping and help transform the activity into a powerful tool for sustainable development.
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Bees for Development: Brazilian Survey Reveals How to Optimize Stingless Beekeeping
Jaffé, Rodolfo; Pope, Nathaniel; Carvalho, Airton Torres; Maia, Ulysses Madureira; Blochtein, Betina; de Carvalho, Carlos Alfredo Lopes; Carvalho-Zilse, Gislene Almeida; Freitas, Breno Magalhães; Menezes, Cristiano; de Fátima Ribeiro, Márcia; Venturieri, Giorgio Cristino; Imperatriz-Fonseca, Vera Lucia
2015-01-01
Stingless bees are an important asset to assure plant biodiversity in many natural ecosystems, and fulfill the growing agricultural demand for pollination. However, across developing countries stingless beekeeping remains an essentially informal activity, technical knowledge is scarce, and management practices lack standardization. Here we profited from the large diversity of stingless beekeepers found in Brazil to assess the impact of particular management practices on productivity and economic revenues from the commercialization of stingless bee products. Our study represents the first large-scale effort aiming at optimizing stingless beekeeping for honey/colony production based on quantitative data. Survey data from 251 beekeepers scattered across 20 Brazilian States revealed the influence of specific management practices and other confounding factors over productivity and income indicators. Specifically, our results highlight the importance of teaching beekeepers how to inspect and feed their colonies, how to multiply them and keep track of genetic lineages, how to harvest and preserve the honey, how to use vinegar traps to control infestation by parasitic flies, and how to add value by labeling honey containers. Furthermore, beekeeping experience and the network of known beekeepers were found to be key factors influencing productivity and income. Our work provides clear guidelines to optimize stingless beekeeping and help transform the activity into a powerful tool for sustainable development. PMID:25826402
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ERIC Educational Resources Information Center
Neves, Celine A.
2012-01-01
The federal government spends much money on information technology (IT) projects each year, yet numerous IT projects continue to underperform. For instance, in Fiscal Year 2008, OMB and federal agencies identified approximately 413 IT projects ($25.2 billion) as being poorly planned, poorly performing, or both. Agencies struggle to implement sound…
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ERIC Educational Resources Information Center
Girardet, Céline; Berger, Jean-Louis
2018-01-01
Two studies were conducted to investigate the evolution of 71 Swiss vocational teachers' classroom management as a result of the inputs of a teacher education program, and to identify the factors that encouraged or impeded teacher change. Study 1 consisted of a longitudinal survey, and Study 2 of interviews. Longitudinal analyses were performed…
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USDA-ARS?s Scientific Manuscript database
Composted dairy manure (CDM) is among the management practices used in transitioning from a conventional to an organic agricultural system. The objectives of this study are to evaluate the impact of several organic nitrogen (N) sources on: (i) soil organic C (SOC) and soil total N (STN) content; (ii...
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Sohanpal, Ratna; Steed, Liz; Mars, Thomas; Taylor, Stephanie J C
2015-09-17
In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in studies of self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as COPD support programmes) is established. Understanding this problem beyond the previously reported socio-demographics and clinical factors is critical. The aim of this study was to explore factors that explain patient participation in studies of COPD support programmes. Thematic 'framework' synthesis was conducted on literature published from 1984 to 1 February 2015. Emergent themes and subthemes were mapped onto the adapted 'attitude-social influence-external barriers' and the 'self-regulation' models to produce analytical themes. Ten out of 12 studies were included: PR (n=9) and SM (n=1). Three descriptive themes with 38 subthemes were mapped onto the models' constructs, and it generated four analytical themes: 'attitude', 'social influences' and 'illness' and 'intervention representations'. The following factors influenced (1) attendance-helping oneself through health improvements, perceived control of worsening condition, perceived benefits and positive past experience of the programme, as well as perceived positive influence of professionals; (2) non-attendance-perceived negative effects and negative past experience of the programme, perceived physical/practical concerns related to attendance, perceived severity of condition/symptoms and perceived negative influence of professionals/friends; (3) dropout-no health improvements perceived after attending a few sessions of the programme, perceived severity of the condition and perceived physical/practical concerns related to attendance. Psychosocial factors including perceived practical/physical concerns related to attendance influenced patients' participation in COPD support programmes. Addressing the negative beliefs/perceptions via behaviour change interventions may help improve participation in COPD support programmes and, ultimately, patient outcomes.
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2013-01-01
Background Although the United Kingdom’s (UK’s) General Medical Council (GMC) recommends that graduating medical students are competent to discuss obesity and behaviour change with patients, it is difficult to integrate this education into existing curricula, and clinicians report being unprepared to support patients needing obesity management in practice. We therefore aimed to identify factors influencing the integration of obesity management education within medical schools. Methods Twenty-seven UK and Irish medical school educators participated in semi-structured interviews. Grounded theory principles informed data collection and analysis. Themes emerging directly from the dataset illustrated key challenges for educators and informed several suggested solutions. Results Factors influencing obesity management education included: 1) Diverse and opportunistic learning and teaching, 2) Variable support for including obesity education within undergraduate medical programmes, and 3) Student engagement in obesity management education. Findings suggest several practical solutions to identified challenges including clarifying recommended educational agendas; improving access to content-specific guidelines; and implementing student engagement strategies. Conclusions Students’ educational experiences differ due to diverse interpretations of GMC guidelines, educators’ perceptions of available support for, and student interest in obesity management education. Findings inform the development of potential solutions to these challenges which may be tested further empirically. PMID:23578257
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Ellinas, A; Jervis, P; Kenyon, G; Flood, L M
2017-04-01
Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.
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Quality of Project Management Education and Training Programmes
NASA Astrophysics Data System (ADS)
Bodea, Constanta-Nicoleta; Dascalu, Maria; Coman, Melania
The paper refers to the factors which influence the quality of training and education on project management. A survey was made and the main results are presented. 81 % of the responses came from China. The rest were professionals of different EU nationalities. The percentage of Project Managers who answered the questions is rather low - 8%. In the "Others" category, we have software developers, financial managers and professors, who are involved in both training on project management, but also as team members or team managers in projects, thus ensuring a balanced overview of both theory and practical issues.
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Factors influencing the implementation of evidence in Chinese nursing practice.
Cheng, Lei; Broome, Marion E; Feng, Sheng; Hu, Yan
2017-12-01
To explore the influencing factors from staff nurses, nurse managers, nursing directors and a physician involved in nursing evidence implementation in Mainland China. Although the need for evidence-based nursing is well recognised, continuous efforts are needed to strive for closing the gap from evidence to action. Previous studies have explored influencing factors from individual and organisational perspectives in Western countries. However, it remains unclear what the influences (i.e., context and culture) in the developing countries as China. A grounded theory design using in-depth individual interviews was conducted. Interviews with 56 participants from 24 evidence-based nursing implementation projects were conducted in Mainland China. Constant comparative analysis was used to discover the concepts describing the influencing factors during the implementation process. Factors that influenced implementation of evidence-based practice in the Chinese context were identified. These included the leaders of the projects, the nature of the evidence, practising nurses, patients involved in the projects, the system where the projects were implemented, as well as the influence from outside of the system. A variety of factors influencing evidence implementation in Chinese nursing context were identified and further explored from the perspective of different project leaders and culture influence. There is apparently a strong demand for a supportive system, targeted strategies to facilitate various evidence implementations and integrated core elements of evidence-based practice at the point care. The blurred boundaries and complexity of influencing factors call for a systematic and dynamic perspective during implementation. The competitive priorities emphasise the importance of integration between clinical nursing care and evidence-based practice. © 2017 John Wiley & Sons Ltd.
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Cavity nesting bird habitat in the oak-hickory forests--a review.
Kimberly I. Hardin; Keith E. Evans
1977-01-01
Summarizes and discusses the literature about the nesting habitat of the 26 cavity-nesting bird species found in the oak-hickory forest. Also discusses the potential influences of silvicultural practices and management alternatives.
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Impressions of defensive medical practice and medical litigation among South African neurosurgeons.
Roytowski, D; Smith, T R; Fieggen, A G; Taylor, A
2014-11-01
From a litigation perspective, neurosurgery is considered a 'super high-risk' field, and this has been associated with rapidly increasing malpractice cover costs. In 2013 the annual Medical Protection Society fee for cover was R250,900. We wished to determine whether high malpractice cover was influencing how neurosurgeons managed patients. A 40-question online survey asking questions on defensive medicine was distributed to determine perceptions around liability risk and whether these influenced how patients were managed. Eighty-four per cent of respondents agreed that a medicolegal crisis existed, and over half (53.8%) had been sued for malpractice during their career. Altering practice behaviour to minimise the risk of a lawsuit is common. The increasing number of legal claims against respondents in this survey has resulted in most neurosurgeons practising defensive medicine. Arguably this will result in increased healthcare costs, inferior patient care and decreased access to skilled surgeons.
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Serrano-Gil, Manuel; Jacob, Stephan
2010-06-01
For over 20 years, the World Health Assembly has recognized diabetes (type 1 and type 2) as a serious threat to national health and economic development and called for action regarding its prevention and control. However, the prevalence of type 2 diabetes continues to rise despite a significant percentage of cases being preventable. Furthermore, data suggest that in many patients diagnosed with type 2 diabetes, glycated hemoglobin (HbA(1c)) levels remain above the agreed international and national target levels, despite the availability of numerous antihyperglycemic agents, the best intentions of both patient and physician, and the support of the wider healthcare team. Part I of this two-part review considers evidence that seems to suggest there is a knowledge, attitude, and practice (KAP) gap in type 2 diabetes, and that although theoretical knowledge of how type 2 diabetes should be managed exists, the attitude of patients and healthcare professionals may influence the practicalities of implementing life-enhancing changes for patients living day-to-day with the condition. Here, we consider why there may be a KAP gap, how type 2 diabetes is currently being assessed and managed, and whether these current management approaches remain valid in the light of recent studies evaluating the impact of lowering current target HbA(1c) levels. This article also explores how encouraging patients to self-manage their disease, as well as engaging all stakeholders in the necessary behavioral changes, can positively influence the long-term treatment outcomes of patients with type 2 diabetes.
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Gabrey, S.W.; Afton, A.D.
2001-01-01
Many marshes in the Gulf Coast Chenier Plain, USA, are managed through a combination of fall or winter burning and structural marsh management (i.e., levees and water control structures; hereafter SMM). The goals of winter burning and SMM include improvement of waterfowl and furbearer habitat, maintenance of historic isohaline lines, and creation and maintenance of emergent wetlands. Although management practices are intended to influence the plant community, effects of these practices on primary productivity have not been investigated. Marsh processes, such as vertical accretion and nutrient cycles, which depend on primary productivity may be affected directly or indirectly by winter burning or SMM. We compared Chenier Plain plant community characteristics (species composition and above- and belowground biomass) in experimentally burned and unburned control plots within impounded and unimpounded marshes at 7 months (1996), 19 months (1997), and 31 months (1998) after burning. Burning and SMM did not affect number of plant species or species composition in our experiment. For all three years combined, burned plots had higher live above-ground biomass than did unburned plots. Total above-ground and dead above-ground biomasses were reduced in burned plots for two and three years, respectively, compared to those in unburned control plots. During all three years, belowground biomass was lower in impounded than in unimpounded marshes but did not differ between burn treatments. Our results clearly indicate that current marsh management practices influence marsh primary productivity and may impact other marsh processes, such as vertical accretion, that are dependent on organic matter accumulation and decay.
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Cairns-Haylor, Theodora; Fordyce, Peter
2017-02-11
This study maps communication between veterinary surgeons and dog owners on obesity management in four first-opinion practices in the UK. A total of 74 dog owners who met the study's inclusion criteria and 24 veterinary surgeons were interviewed using oral questionnaires between November 2013 and May 2014. The dog owner questionnaire was based on potential discussion areas that could influence an owner's intention to act (initiate a weight loss regime) based on Ajzen's Theory of Planned Behaviour. The veterinary surgeons' questionnaires assessed perception of canine obesity, their personal communication strategies and current practice-level interventions. The findings identify opportunities for more proactive approaches to obesity management by veterinary surgeons and their practices. British Veterinary Association.
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Turning men into machines? Scientific management, industrial psychology, and the "human factor".
Derksen, Maarten
2014-01-01
In the controversy that broke out in 1911 over Frederick W. Taylor's scientific management, many critics contended that it ignored "the human factor" and reduced workers to machines. Psychologists succeeded in positioning themselves as experts of the human factor, and their instruments and expertise as the necessary complement of Taylor's psychologically deficient system. However, the conventional view that the increasing influence of psychologists and other social scientists "humanized" management theory and practice needs to be amended. Taylor's scientific management was not less human than later approaches such as Human Relations, but it articulated the human factor differently, and aligned it to its own instruments and practices in such a way that it was at once external to them and essential to their functioning. Industrial psychologists, on the other hand, at first presented themselves as engineers of the human factor and made the human mind an integral part of management. © 2014 Wiley Periodicals, Inc.
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Sound management may sequester methane in grazed rangeland ecosystems
Wang, Chengjie; Han, Guodong; Wang, Shiping; Zhai, Xiajie; Brown, Joel; Havstad, Kris M.; Ma, Xiuzhi; Wilkes, Andreas; Zhao, Mengli; Tang, Shiming; Zhou, Pei; Jiang, Yuanyuan; Lu, Tingting; Wang, Zhongwu; Li, Zhiguo
2014-01-01
Considering their contribution to global warming, the sources and sinks of methane (CH4) should be accounted when undertaking a greenhouse gas inventory for grazed rangeland ecosystems. The aim of this study was to evaluate the mitigation potential of current ecological management programs implemented in the main rangeland regions of China. The influences of rangeland improvement, utilization and livestock production on CH4 flux/emission were assessed to estimate CH4 reduction potential. Results indicate that the grazed rangeland ecosystem is currently a net source of atmospheric CH4. However, there is potential to convert the ecosystem to a net sink by improving management practices. Previous assessments of capacity for CH4 uptake in grazed rangeland ecosystems have not considered improved livestock management practices and thus underestimated potential for CH4 uptake. Optimal fertilization, rest and light grazing, and intensification of livestock management contribute mitigation potential significantly. PMID:24658176
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Sound management may sequester methane in grazed rangeland ecosystems.
Wang, Chengjie; Han, Guodong; Wang, Shiping; Zhai, Xiajie; Brown, Joel; Havstad, Kris M; Ma, Xiuzhi; Wilkes, Andreas; Zhao, Mengli; Tang, Shiming; Zhou, Pei; Jiang, Yuanyuan; Lu, Tingting; Wang, Zhongwu; Li, Zhiguo
2014-03-24
Considering their contribution to global warming, the sources and sinks of methane (CH4) should be accounted when undertaking a greenhouse gas inventory for grazed rangeland ecosystems. The aim of this study was to evaluate the mitigation potential of current ecological management programs implemented in the main rangeland regions of China. The influences of rangeland improvement, utilization and livestock production on CH4 flux/emission were assessed to estimate CH4 reduction potential. Results indicate that the grazed rangeland ecosystem is currently a net source of atmospheric CH4. However, there is potential to convert the ecosystem to a net sink by improving management practices. Previous assessments of capacity for CH4 uptake in grazed rangeland ecosystems have not considered improved livestock management practices and thus underestimated potential for CH4 uptake. Optimal fertilization, rest and light grazing, and intensification of livestock management contribute mitigation potential significantly.
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Walston, S L; Kimberly, J R; Burns, L R
2001-06-01
In the recent past, a number of managerial innovations--including product line management, total quality management, and reengineering--have swept through the hospital industry. Given their pervasiveness and their cost, understanding the mix of factors that influences their adoption is of theoretical interest and practical relevance. The research reported here focuses on this general question by examining influences on the adoption and extensiveness of a particular managerial innovation, hospital reengineering. The results suggest that while economic and institutional factors have influenced the adoption and extensiveness of hospital reengineering, institutional forces play a more important role. The greater influence of institutional forces may be attributed to the high degree of uncertainty in health care, the causal ambiguity of the innovation, and the anticipatory actions of hospitals attempting to position themselves in a rapidly changing environment.
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Critical thinking of nurse managers related to staff RNs' perceptions of the practice environment.
Zori, Susan; Nosek, Laura J; Musil, Carol M
2010-09-01
BACKGROUND INFORMATION AND SIGNIFICANCE: Critical thinking (CT) skills and the inclination to engage in critical thinking are essential for nurse managers to function as transformational leaders capable of influencing staff to align with organizational goals. In an extensive literature review, numerous studies were found examining the concept of CT in students and no studies were found exploring CT in nurse managers. Identifying the attributes, such as CT, that lead to success in the nurse manager role is useful when preparing nurse managers to lead effectively in the current healthcare climate. Is there a difference between nurse managers' CT dispositions and their respective staff nurses' perceptions of the practice environment? A convenience sample of 12 nurse managers and a random sample of 132 of their respective staff registered nurses (RNs) participated in this descriptive study. CT in nurse managers was measured by the California Critical Thinking Disposition Inventory (CCTDI). Staff RNs' perceptions of the practice environment were measured by the Practice Environment Scale (PES). The research question was answered using a t test. Significant (p < .001) differences were found between specific nurse managers' CCTDI scores for open-mindedness, analyticity, and critical thinking confidence, and significant differences (p < .01) were found for systematicity when compared with their respective staff RNs' mean subscale and overall PES scores. Results of the study support the positive relationship between strength in critical thinking dispositions of nurse managers and their respective staff RNs' perceptions of the practice environment. Nurse managers with stronger CT dispositions may be better able to create positive practice environments that are conducive to job satisfaction and thus the retention of staff RNs. Inclusion of strategies to support the development and use of CT in nurse managers is recommended. CT and other leadership attributes and skills including emotional and social intelligence and management of change through an appreciative inquiry process may provide opportunities to improve leadership effectiveness in nurse managers. Enhancing critical thinking skills and dispositions of nurse managers may help to create positive work environments for staff RNs. Staff RNs who work in an environment perceived to be positive may be in a better position to deliver high quality, safe patient care.
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Relating management practices and nutrient export in agricultural watersheds of the United States
Sprague, Lori A.; Gronberg, Jo Ann M.
2012-01-01
Relations between riverine export (load) of total nitrogen (N) and total phosphorus (P) from 133 large agricultural watersheds in the United States and factors affecting nutrient transport were evaluated using empirical regression models. After controlling for anthropogenic inputs and other landscape factors affecting nutrient transport-such as runoff, precipitation, slope, number of reservoirs, irrigated area, and area with subsurface tile drains-the relations between export and the area in the Conservation Reserve Program (CRP) (N) and conservation tillage (P) were positive. Additional interaction terms indicated that the relations between export and the area in conservation tillage (N) and the CRP (P) progressed from being clearly positive when soil erodibility was low or moderate, to being close to zero when soil erodibility was higher, to possibly being slightly negative only at the 90th to 95th percentile of soil erodibility values. Possible explanations for the increase in nutrient export with increased area in management practices include greater transport of soluble nutrients from areas in conservation tillage; lagged response of stream quality to implementation of management practices because of nitrogen transport in groundwater, time for vegetative cover to mature, and/or prior accumulation of P in soils; or limitations in the management practice and stream monitoring data sets. If lags are occurring, current nutrient export from agricultural watersheds may still be reflecting the influence of agricultural land-use practices that were in place before the implementation of these management practices.
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Influence of workplace culture on nursing-sensitive nurse outcomes in municipal primary health care.
Hahtela, Nina; Paavilainen, Eija; McCormack, Brendan; Slater, Paul; Helminen, Mika; Suominen, Tarja
2015-10-01
To explore the influence of workplace culture on sickness absences, overtime work and occupational injuries in municipal primary health care. The need to improve nursing sensitive outcomes has been highlighted. Therefore, an adequate understanding of the influence of workplace culture on nursing-sensitive nurse outcomes is essential for nurse managers to meet the requirements of improving nursing outcomes. A cross-sectional survey design was used to incorporating the data from 21 inpatient acute care units of nine organisations at the Finnish municipal primary health care system from 2011 to 2012. Findings emphasise in particular the importance of the practice environment as being an interpretative factor for nurses' absences owing to sickness, overtime work and occupational injuries. To ensure favourable nursing sensitive outcomes it is essential that there is a shared interest in the unit to invest in the creation of a supportive practice environment. Outcome improvements require a special focus on issues related to nursing management, adequate staffing and resources and intention to leave. © 2014 John Wiley & Sons Ltd.
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Impact of Crop Conversions on Runoff and Sediment Output in the Lower Mississippi River Basin
NASA Astrophysics Data System (ADS)
Momm, H.; Bingner, R. L.; Elkadiri, R.; Yaraser, L.; Porter, W.
2017-12-01
Farming management practices influence sediment and agrochemical loads exiting fields and entering downstream water bodies. These practices impact multiple physical processes responsible for sediment and nutrient detachment, transport, and deposition. Recent changes in farming practices in the Southern United States coincide with increased grain production, replacing traditional crops such as cotton with corn and soybeans. To grow these crops in the South, adapted crop management practices are needed (irrigation, fertilizer, etc.). In this study, the impact of grain crop adoption on hydrologic processes and non-point source pollutant production is quantified. A watershed located in the Big Sunflower River drainage basin (14,179 km2) - a part of the greater Lower Mississippi River basin - was selected due to its economic relevance, historical agricultural output, and depiction of recent farming management trends. Estimates of runoff and sediment loads were produced using the U.S. Department of Agriculture supported Annualized Agriculture Non-Point Source Pollution (AnnAGNPS) watershed pollution and management model. Existing physical conditions during a 16-year period (2000-2015) were characterized using 3,992 sub-catchments and 1,602 concentrated flow paths. Algorithms were developed to integrate continuous land use/land cover information, variable spatio-temporal irrigation practices, and crop output yield in order to generate a total of 2,922 unique management practices and corresponding soil-disturbing operations. A simulation representing existing conditions was contrasted with simulations depicting alternatives of management, irrigation practices, and temporal variations in crop yield. Quantification of anthropogenic impacts to water quality and water availability at a watershed scale supports the development of targeted pollution mitigation and custom conservation strategies.
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Alexander, J A; Vaughn, T E; Burns, L R
2000-11-01
Research to date has documented weak or inconsistent associations between market and organizational factors and the adoption of physician-organization arrangements (POAs) (e.g. physician-hospital organizations, management service organizations and independent practice associations) designed to increase physician integration. We argue that POAs may mask considerable variation in how these entities are operated and governed. Further, because the operating policies and practices of POAs are likely to influence more directly the behaviour of physicians than the structural form of the POA, they may be more sensitive to the market and organizational contingencies that encourage integration. This study attempts to test empirically the relative effects of POA type and market, strategic and organization factors on the operating policies and practices of market-based POAs. Results suggest that type of POA, and market, strategic and organizational factors affect risk sharing, physician selection practices, physician monitoring practices and ways in which monitoring information is used to influence physician behaviour in POAs.
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ERIC Educational Resources Information Center
Brooks, Jeffrey S.; Miles, Mark
2006-01-01
This article presents an historical overview of pedagogical orientations of school leadership in the United States, and then considers issues facing contemporary educational leaders in this context. Our survey begins with a consideration of the early influence of Frederick Taylor and ends in the present day, a time when the fields of practice and…
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Influence of organizational factors on safety
DOE Office of Scientific and Technical Information (OSTI.GOV)
Haber, S.B.; Metlay, D.S.; Crouch, D.A.
There is a need for a better understanding of exactly how organizational management factors at a nuclear power plant (NPP) affect plant safety performance, either directly or indirectly, and how these factors might be observed, measured, and evaluated. The purpose of this research project is to respond to that need by developing a general methodology for characterizing these organizational and management factors, systematically collecting information on their status and integrating that information into various types of evaluative activities. Research to date has included the development of the Nuclear Organization and Management Analysis Concept (NOMAC) of a NPP, the identification ofmore » key organizational and management factors, and the identification of the methods for systematically measuring and analyzing the influence of these factors on performance. Most recently, two field studies, one at a fossil fuel plant and the other at a NPP, were conducted using the developed methodology. Results are presented from both studies highlighting the acceptability, practicality, and usefulness of the methods used to assess the influence of various organizational and management factors including culture, communication, decision-making, standardization, and oversight. 6 refs., 3 figs., 1 tab.« less
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Racial/Ethnic Differences in the Etiology of Alcohol Use Among Urban Adolescents*
Tobler, Amy L.; Livingston, Melvin D.; Komro, Kelli A.
2011-01-01
Objective: We examined relations between neighborhood context, home and family management practices, deviant peer affiliations, beliefs favorable to use, and alcohol use among urban African American and Hispanic adolescents. Method: The sample comprised 4,027 African American and Hispanic adolescents who were 50% boys and 75% low income. Participants completed surveys in 2002–2005 and 2008–2009. Structural equation modeling assessed direct and indirect relations between neighborhood context in 6th grade, home and family management practices in 7th grade, deviant peer affiliations and beliefs favorable to use in 8th grade, and alcohol use in 12th grade. Results: There was significant variation in structural models across race/ethnicity but not gender. Differences included the influence of neighborhood and school strength and, where similarities existed, differences in effect magnitude. Similarities included significant correlations among measurement components; the indirect influence of alcohol advertisement exposure, gender, area deprivation, and home alcohol access on alcohol use; direct influence of deviant peer affiliations and beliefs favorable to use on alcohol use; and indirect effects highlighting the importance of preventing home alcohol access, deviant peer affiliations, and beliefs favorable to use and promoting protective family management practices. Conclusions: Neighborhood and school strength may be particularly important in preventing alcohol use among African Americans, whereas preventing early onset of alcohol use among Hispanics remains important. Preventive efforts may wish to focus on neighborhood deprivation, exposure to alcohol advertisements, and home risks and protective factors because they have direct and indirect effects on intrapersonal factors and alcohol use. PMID:21906507
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NASA Astrophysics Data System (ADS)
Rist, Lucy; Shackleton, Charlie; Gadamus, Lily; Chapin, F. Stuart; Gowda, C. Made; Setty, Siddappa; Kannan, Ramesh; Shaanker, R. Uma
2016-04-01
Multiple actors are typically involved in forest management, namely communities, managers and researchers. In such cases, suboptimal management outcomes may, in addition to other factors, be symptomatic of a divergence in perspectives among these actors driven by fundamental differences in ecological knowledge. We examine the degree of congruence between the understandings of actors surrounding key issues of management concern in three case studies from tropical, subtropical and boreal forests. We identify commonly encountered points of divergence in ecological knowledge relating to key management processes and issues. We use these to formulate seven hypotheses about differences in the bodies of knowledge that frequently underlie communication and learning failures in forest management contexts where multiple actors are involved and outcomes are judged to be suboptimal. Finally, we present a set of propositions to acknowledge and narrow these differences. A more complete recognition of the full triangulation between all actors involved, and of the influence that fundamental differences in ecological knowledge can exert, may help lead to a more fruitful integration between local knowledge and practice, manager knowledge and practice, and contemporary science in forest management.
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Influence of patients' socioeconomic status on clinical management decisions: a qualitative study.
Bernheim, Susannah M; Ross, Joseph S; Krumholz, Harlan M; Bradley, Elizabeth H
2008-01-01
Little is known about how patients' socioeconomic status (SES) influences physicians' clinical management decisions, although this information may have important implications for understanding inequities in health care quality. We investigated physician perspectives on how patients' SES influences care. The study consisted of in-depth semistructured interviews with primary care physicians in Connecticut. Investigators coded interviews line by line and refined the coding structure and interview guide based on successive interviews. Recurrent themes emerged through iterative analysis of codes and tagged quotations. We interviewed 18 physicians from varied practice settings, 6 female, 9 from minority racial backgrounds, and 3 of Hispanic ethnicity. Four themes emerged from our interviews: (1) physicians held conflicting views about the effect of patient SES on clinical management, (2) physicians believed that changes in clinical management based on the patient's SES were made in the patient's interest, (3) physicians varied in the degree to which they thought changes in clinical management influenced patient outcomes, and (4) physicians faced personal and financial strains when caring for patients of low SES. Physicians indicated that patient SES did affect their clinical management decisions. As a result, physicians commonly undertook changes to their management plan in an effort to enhance patient outcomes, but they experienced numerous strains when trying to balance what they believed was feasible for the patient with what they perceived as established standards of care.
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Li, Hongxia; Di, Hongxi; Tian, Shuicheng; Li, Jian
2015-01-01
The aim of this study is research the impact of management level’s charismatic leadership style on miners' unsafe behavior by using the questionnaires on charismatic leadership style, safety attitude and the miners' unsafe behavior measurement to investigate 200 employees in Shen Dong Company. The research results suggest that management level’s charismatic leadership style have very important influence on miners' unsafe behavior and the influence is affected by the safety attitude which is the intermediary function. In the end, this study propose advice on how to improve the coal mine enterprise managers charismatic leadership style in the coal mine enterprise's safety management work, including attach great importance to a variety of incentive methods, set up safety moral models, practice of inductive leadership concept, create a good atmosphere of safety, etc for reference for coal mining enterprises. PMID:26628936
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Survey of Current Practice Patterns in the Management of Frontal Sinus Fractures
Choi, Kevin J.; Chang, Bora; Woodard, Charles R.; Powers, David B.; Marcus, Jeffrey R.; Puscas, Liana
2017-01-01
The management of frontal sinus fractures has evolved in the endoscopic era. The development of functional endoscopic sinus surgery (FESS) has been incorporated into management algorithms proposed by otolaryngologists, but the extent of its influence on plastic surgeons and oral and maxillofacial surgeons is heretofore unknown. A cross-sectional survey was performed to assess the practice pattern variations in frontal sinus fracture management across multiple surgical disciplines. A total of 298 surveys were reviewed. 33.5% were facial plastic surgeons with otolaryngology training, 25.8% general otolaryngologists, 25.5% plastic surgeons, and 15.1% oral and maxillofacial surgeons. 74.8% of respondents practiced in an academic setting. 61.7% felt endoscopic sinus surgery changed their management of frontal sinus fractures. 91.8% of respondents favored observation for uncomplicated, nondisplaced frontal sinus outflow tract fractures. 36.4% favored observation and 35.9% favored endoscopic sinus surgery for uncomplicated, displaced frontal sinus outflow tract fractures. For complicated, displaced frontal sinus outflow tract fractures, obliteration was more frequently favored by plastic surgeons and oral and maxillofacial surgeons than those with otolaryngology training. The utility of FESS in managing frontal sinus fractures appears to be recognized across multiple surgical disciplines. PMID:28523084
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Exploring Agricultural Drainage's Influence on Wetland and Watershed Connectivity
Artificial agricultural drainage (i.e. surface ditches or subsurface tile) is an important agricultural management tool. Artificial drainage allows for timely fieldwork and adequate root aeration, resulting in greater crop yields for farmers. This practice is widespread throughou...
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Invasive plant management on anticipated conservation benefits: a scientific Assessment
USDA-ARS?s Scientific Manuscript database
Invasive plants negatively impact rangelands throughout the western United States by displacing desirable species, altering ecological processes, reducing wildlife habitat, degrading systems, altering fire regimes, and decreasing productivity. Assessing the influence of conservation practices on var...
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48 CFR 9903.305 - Materiality.
Code of Federal Regulations, 2010 CFR
2010-10-01
... Section 9903.305 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS... Government funding. Changes in accounting treatment will have more impact if they influence the distribution...
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C.C. Grier; K.M. Lee; N.M. [and others] Nadkarni
1989-01-01
Data on net primary biological productivity of United States forests are summarized by geographic region. Site factors influencing productivity are reviewed. This paper is a review of existing literature in the productivity of various forest regions of the United States, the influence of site factors on forest productivity, and the impact of various...
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Nurse managed occupational health services: a primary care model in practice.
Childre, F
1997-10-01
1. Managed care focus on delivering health care which values prevention, early intervention, continuity of care, commitment to quality care, and outcomes, as well as client satisfaction. Occupational health nurses routinely integrate these values into their practice. 2. An on-site model of primary health care delivery, incorporating the fundamentals of occupational health nursing, can bring significant savings to the organization in health related costs. 3. Case management may provide the greatest potential for growth in occupational health nursing. It is a method that can be used together with managed care to maximize quality health care services. 4. Viewing health related costs as an investment as opposed to part of a benefit plan, influences employees to make positive choices. It also impacts the delivery of health care services on a systematic, global level, which affects total health care costs.
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NASA Astrophysics Data System (ADS)
Miniotti, Eleonora; Said-Pullicino, Daniel; Bertora, Chiara; Pelissetti, Simone; Sacco, Dario; Grignani, Carlo; Lerda, Cristina; Romani, Marco; Celi, Luisella
2013-04-01
The alternation of oxidizing and reducing conditions in paddy soils results in considerable complexity in the biogeochemical cycling of elements and their interactions, influencing important soil processes. Water management practices may play an important role in controlling the loss of nutrients from rice paddies to surface and subsurface waters, as well as soil organic matter (SOM) stabilization and the emission of green-house gases (GHG) such as methane and nitrous oxide. The aim of this study was therefore to evaluate the interaction between changes in soil redox conditions and element cycling in temperate paddy soils as a function of different water management practices. The research was carried out within an experimental platform (1.2 ha) located at the Rice Research Center of Ente Nazionale Risi (Castello d'Agogna, PV, NW Italy) where three water management practices are being compared with two plots for each treatment. These included (i) rice cultivation under traditional submerged conditions (FLD); (ii) seeding under dry soil conditions and flooding delayed by about 40 days (DRY); (iii) seeding under dry soil conditions and rotational irrigation (IRR). Surface and subsurface (25, 50 and 75 cm) water samples were collected at regular intervals over the cropping season from V-notch weirs and porous ceramic suction cups installed in each plot, and subsequently analyzed for DOC, SUVA, Fe(II), ammonium and nitrate-N. Moreover, methane and nitrous oxide fluxes were measured in situ by the closed-chamber technique. DOC concentrations in soil solutions were generally higher in FLD and DRY treatments with respect to IRR throughout the cropping season. Higher DOC contents after field flooding in FLD and DRY treatments also corresponded with greater concentrations of reduced Fe, higher SUVA values, lower Eh values and higher pH values, suggesting that desorption of more aromatic, mineral-associated SOM could be responsible for the observed increase in DOC. These trends were not observed in the IRR treatment. The differences in DOC contents and in Eh trend between treatments could possibly explain the increasing trend in cumulative methane emissions in the order IRR<
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Helping or hindering: the role of nurse managers in the transfer of practice development learning.
Currie, Kay; Tolson, Debbie; Booth, Jo
2007-09-01
This paper reports selected findings from a recent PhD study exploring how graduates from a BSc Specialist Nursing programme, with an NMC-approved Specialist Practitioner Qualification, engage in practice development during their subsequent careers. The UKCC (1998) defines specialist practice as requiring higher levels of judgement, discretion and decision-making, with leadership in clinical practice development forming a core dimension of this level of practice. However, there is little evidence in the published literature that describes or evaluates the practice development role of graduate specialist practitioners. This study applied a modified Glaserian approach to grounded theory methods. A preliminary descriptive survey questionnaire was posted to all graduates from the programme, response rate of 45% (n=102). From these respondents, theoretical sampling decisions directed the selection of 20 participants for interview, permitting data saturation. The grounded theory generated by this study discovered a basic social process labelled 'making a difference', whereby graduate specialist practitioners are increasingly able to impact in developing patient care at a strategic level by coming to own the identity of an expert practitioner (Currie, 2006). Contextual factors strongly influence the practitioner journey, with organizational position and other people presenting enabling or blocking conditions. The line manager plays a crucial role in helping or hindering graduate specialist practitioners to transfer their learning to the clinical setting and become active in practice development. Recommendations to enhance managerial support for the practice development role of graduate specialist practitioners are proposed. ADDING TO CURRENT KNOWLEDGE: This work adds to currently limited knowledge of the graduate specialist practitioners' role in the leadership of clinical practice development. In addition, the findings emphasize the potential influence of the workplace environment by analyzing organizational factors in the specific context of the graduate specialist practitioner attempting to develop practice.
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Socioeconomic trends in radiology.
Barneveld Binkhuysen, F H
1998-01-01
For radiology the socioeconomic environment is a topic of increasing importance. In addition to the well-known important scientific developments in radiology such as interventional MRI, several other major trends can be recognized: (1) changes in the delivery of health care, in which all kinds of managed care are developing and will influence the practice of radiology, and (2) the process of computerization and digitization. The socioeconomic environment of radiology will be transformed by the developments in managed care, teleradiology and the integration of information systems. If radiologists want to manage future radiology departments they must have an understanding of the changes in the fields of economics and politics that are taking place and that will increasingly influence radiology. Some important and recognizable aspects of these changes will be described here.
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Prpić, Igor; Ahel, Tea; Rotim, Krešimir; Gajski, Domagoj; Vukelić, Petar; Sasso, Antun
2014-12-01
In daily practice, neuroimaging studies are frequently performed for the management of childhood headache. The aim of this study was to determine whether there is significant discrepancy between clinical practice and clinical practice guidelines on the indications for neuroimaging studies. Medical records of children with chronic headache, aged 2 to 18 years and treated at Rijeka University Hospital Center, Kantrida Department of Pediatrics, were retrospectively reviewed. Indications for brain magnetic resonance imaging and computed tomography (MRI/CT) scanning were reviewed and compared with clinical practice guidelines. Brain imaging was performed in 164 (76.3%) of 215 children, MRI in 93 (56.7%) and CT in 71 (43.3%) children. Indications for brain MRI/CT were as follows: anxiety and/or insistence by the child's family (71.3%), presence of associated features suggesting neurologic dysfunction (13.4%), age under 5 years (12.8%) and abnormal neurologic examination (2.4%). The majority of children (71.4%) had normal neuroimaging findings. In the rest of imaging studies (28.1%), MRI/CT revealed different intracerebral/extracerebral findings not influencing changes in headache management. Only one (0.60%) patient required change in headache management after MRI/CT. Study results proved that, despite available evidence-based clinical guidelines, brain imaging in children with chronic headaches is overused, mostly in order to decrease anxiety of the family/patient.
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J.A. Foote; T.W. Boutton; D.A. Scott
2015-01-01
Land management practices have strong potential to modify the biogeochemistry of forest soils, with implications for the long-term sustainability and productivity of forestlands. The Long-Term Soil Productivity (LTSP) program, a network of 62 sites across the USA and Canada, was initiated to address concerns over possible losses of soil productivity due to soil...
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Effects of basal area on survival and growth of longleaf pine when practicing selection silviculture
Ferhat Kara; Edward F. Loewenstein; Dale G. Brockway
2017-01-01
Aim of study: Uneven-aged (UEA) management systems can achieve multiple-use objectives, however, use of UEA techniques to manage longleaf pine (Pinus palustris Mill.) forests are still open to question, because of the speciesâ intolerance of competition. It was our aim to examine the influence of different levels (9.2, 13.8 and...
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Production practices affecting worker task demands in concrete operations: A case study.
Memarian, Babak; Mitropoulos, Panagiotis
2015-01-01
Construction work involves significant physical, mental, and temporal task demands. Excessive task demands can have negative consequences for safety, errors and production. This exploratory study investigates the magnitude and sources of task demands on a concrete operation, and examines the effect of the production practices on the workers' task demands. The NASA Task Load Index was used to measure the perceived task demands of two work crews. The operation involved the construction of a cast-in-place concrete building under high schedule pressures. Interviews with each crew member were used to identify the main sources of the perceived demands. Extensive field observations and interviews with the supervisors and crews identified the production practices. The workers perceived different level of task demands depending on their role. The production practices influenced the task demands in two ways: (1) practices related to work organization, task design, resource management, and crew management mitigated the task demands; and (2) other practices related to work planning and crew management increased the crew's ability to cope with and adapt to high task demands. The findings identify production practices that regulate the workers' task demands. The effect of task demands on performance is mitigated by the ability to cope with high demands.
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Lepak, J.M.; Hooten, M.B.; Johnson, B.M.
2012-01-01
Mercury (Hg) contamination in sport fish is a global problem. In freshwater systems, food web structure, sport fish sex, size, diet and growth rates influence Hg bioaccumulation. Fish stocking is a common management practice worldwide that can introduce external energy and contaminants into freshwater systems. Thus, stocking can alter many of the factors that influence Hg concentrations in sport fish. Here we evaluated the influence of external subsidies, in the form of hatchery-raised rainbow trout Oncorhynchus mykiss on walleye Sander vitreus diet, growth and Hg concentrations in two freshwater systems. Stocking differentially influenced male and female walleye diets and growth, producing a counterintuitive size-contamination relationship. Modeling indicated that walleye growth rate and diet were important explanatory variables when predicting Hg concentrations. Thus, hatchery contributions to freshwater systems in the form of energy and contaminants can influence diet, growth and Hg concentrations in sport fish. Given the extensive scale of fish stocking, and the known health risks associated with Hg contamination, this represents a significant issue for managers monitoring and manipulating freshwater food web structures, and policy makers attempting to develop fish consumption advisories to protect human health in stocked systems.
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Tsujikawa, Norifumi; Tsuchida, Shoji; Shiotani, Takamasa
2016-01-01
Public support for nuclear power generation has decreased in Japan since the Fukushima Daiichi nuclear accident in March 2011. This study examines how the factors influencing public acceptance of nuclear power changed after this event. The influence factors examined are perceived benefit, perceived risk, trust in the managing bodies, and pro-environmental orientation (i.e., new ecological paradigm). This study is based on cross-sectional data collected from two online nationwide surveys: one conducted in November 2009, before the nuclear accident, and the other in October 2011, after the accident. This study's target respondents were residents of Aomori, Miyagi, and Fukushima prefectures in the Tohoku region of Japan, as these areas were the epicenters of the Great East Japan Earthquake and the locations of nuclear power stations. After the accident, trust in the managing bodies was found to have a stronger influence on perceived risk, and pro-environmental orientation was found to have a stronger influence on trust in the managing bodies; however, perceived benefit had a weaker positive influence on public acceptance. We also discuss the theoretical and practical implications of these findings. © 2015 Society for Risk Analysis.
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Lepak, Jesse M; Hooten, Mevin B; Johnson, Brett M
2012-10-01
Mercury (Hg) contamination in sport fish is a global problem. In freshwater systems, food web structure, sport fish sex, size, diet and growth rates influence Hg bioaccumulation. Fish stocking is a common management practice worldwide that can introduce external energy and contaminants into freshwater systems. Thus, stocking can alter many of the factors that influence Hg concentrations in sport fish. Here we evaluated the influence of external subsidies, in the form of hatchery-raised rainbow trout Oncorhynchus mykiss on walleye Sander vitreus diet, growth and Hg concentrations in two freshwater systems. Stocking differentially influenced male and female walleye diets and growth, producing a counterintuitive size-contamination relationship. Modeling indicated that walleye growth rate and diet were important explanatory variables when predicting Hg concentrations. Thus, hatchery contributions to freshwater systems in the form of energy and contaminants can influence diet, growth and Hg concentrations in sport fish. Given the extensive scale of fish stocking, and the known health risks associated with Hg contamination, this represents a significant issue for managers monitoring and manipulating freshwater food web structures, and policy makers attempting to develop fish consumption advisories to protect human health in stocked systems.
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Iliffe, Steve; Waugh, Amy; Poole, Marie; Bamford, Claire; Brittain, Katie; Chew-Graham, Carolyn; Fox, Chris; Katona, Cornelius; Livingston, Gill; Manthorpe, Jill; Steen, Nick; Stephens, Barbara; Hogan, Vanessa; Robinson, Louise
2014-08-01
People with dementia and their families need support in different forms, but currently services are often fragmented with variable quality of care. Case management offers a way of co-ordinating services along the care pathway and therefore could provide individualised support; however, evidence of the effectiveness of case management for dementia is inconclusive. To adapt the intervention used in a promising case management project in the USA and test its feasibility and acceptability in English general practice. In work package 1, a design group of varied professionals, with a carer and staff from the voluntary sector, met six times over a year to identify the skills and personal characteristics required for case management; protocols from the US study were adapted for use in the UK. The feasibility of recruiting general practices and patient-carer dyads and of delivering case management were tested in a pilot study (work package 2). An embedded qualitative study explored stakeholder views on study procedures and case management. Four general practices, two in the north-east of England (Newcastle) one in London and one in Norfolk, took part in a feasibility pilot study of case management. Community-dwelling people with dementia and their carers who were not already being case managed by other services. A social worker shared by the two practices in the north-east and practice nurses in the other two practices were trained to deliver case management. We aimed to recruit 11 people with dementia from each practice who were not already being case managed. Numbers of people with dementia and their carers recruited, numbers and content of contacts, needs identified and perceptions of case management among stakeholders. Recruitment of practices and patients was slow and none of the practices achieved its recruitment target. It took more than 6 months to recruit a total of 28 people with dementia. Practice Quality and Outcome Framework registers for dementia contained only 60% of the expected number of people, most living in care homes. All stakeholders were positive about the potential of case management; however, only one of the four practices achieved a level of case management activity that might have influenced patient and carer outcomes. Case managers' activity levels were not related solely to time available for case management. Delivery of case management was hindered by limited clarity about the role, poor integration with existing services and a lack of embeddedness within primary care. There were discrepancies between case manager and researcher judgements about need, and evidence of a high threshold for acting on unmet need. The practice nurses experienced difficulties in ring-fencing case management time. The model of case management developed and evaluated in this feasibility study is unlikely to be sustainable in general practice under current conditions and in our view it would not be appropriate to attempt a definitive trial of this model. This study could inform the development of a case management role with a greater likelihood of impact. Different approaches to recruiting and training case managers, and identifying people with dementia who might benefit from case management, are needed, as is exploration of the scale of need for this type of working. Current Controlled Trials ISRCTN74015152. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 52. See the NIHR Journals Library website for further project information.
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Rossi, Gabriele; Mangiagalli, Gerard; Paracchini, Giulia; Paltrinieri, Saverio
2014-03-01
Information about laboratory reference intervals (RIs) of European Hedgehog (Erinaceus europaeus) hospitalized at rehabilitation centers is scarce. The purpose of this study was to establish hematologic and biochemical RIs for rehabilitated hedgehogs before the release into the wild, and to assess whether sex and management of the center influence laboratory results. Blood was collected from 50 hedgehogs at 3 centers. Thirty-eight animals were included in the study based on normal body weight, absence of clinical signs of disease, Bunnell index > 0.80, and absence of hibernation during overwintering. CBCs were performed using an automated laser cell counter followed by morphologic analysis of blood smears. Clinical biochemistry was performed using an automated spectrophotometer. RIs were determined as recommended by the ASVCP guidelines. Hematology profiles revealed a prevalence of lymphocytes, a constant presence of nucleated RBCs, Howell-Jolly bodies and basophils, and bilobed nuclei in neutrophils and eosinophils. Biochemistry profiles were characterized by higher creatinine and urea concentrations, and higher ALP and GGT activities compared with other domestic species. The sex did not influence the results. Conversely, numbers of eosinophils, activated and large granular lymphocytes, and concentrations of total protein, glucose and cholesterol were different among the centers, likely due to different management practices (eg, antiparasitic treatments, environmental exposure to microorganisms, diet). The RIs established in this study can be used to monitor the health status of hedgehogs in rehabilitation centers. As management practices appeared to influence some variables, it is recommended to standardize the management protocols to minimize their influence on laboratory data. © 2014 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.
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Factors relating to professional self-concept among nurse managers.
Kantek, Filiz; Şimşek, Belkıs
2017-12-01
To investigate the self-concept in nurse managers in Turkey and the effects of certain variables on professional self-concept. Professional self-concept plays a significant role in improving certain professional behaviours. Nursing managers have the potential to influence other members of the profession with their attitudes and behaviours. The study was designed as a cross-sectional descriptive study. This study was conducted with 159 nurse managers in nine different hospitals. The study data were collected with a Personal Information Form and Professional Self-concept Nursing Inventory, and the data analysis was accomplished with descriptive statistics, Cronbach's alpha coefficients and Chi-squared Automatic Interaction Detector analyses. The professional self-concept score of nurse managers was 3·33 (SD = 0·308). Professional competence subdimension had the highest scores, while professional satisfaction subdimension had the lowest. The types of hospital were found to be influential on professional self-concept. The types of hospital were reported to influence the professional self-concept of nurses. Nursing managers are visionaries who can potentially influence nursing practices and decisions. Nursing leaders must monitor and administer strategies to improve their professional self-concept. © 2017 John Wiley & Sons Ltd.
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NASA Astrophysics Data System (ADS)
Tang, Shui-Yan; Li, Pansy Honying; Fryxell, Gerald E.; Lo, Carlos Wing-Hung
2015-09-01
This study examines the effects of internal motivations and external pressures on the integration of environmental management (EM) practices within manufacturing operations in China. The moderating role of perceptions toward the regulatory process is also considered along with comparisons between wholly Chinese-owned and foreign-owned enterprises. From a sample of 131 manufacturing companies in the Guangzhou area, it was found that the salience of fees and fines has a strong positive influence on perceptions toward the regulator (the local Environmental Protection Bureau, EPB). This also has a positive effect on perceptions toward regulations themselves for foreign-owned enterprises. Business-case motivations for EM positively shape enterprise perceptions toward regulations, whereas risk-reduction motivations have a negative effect on perceptions toward regulations in foreign-owned enterprises. Enterprise perceptions toward the regulatory process have direct effects on the integration of EM practices in wholly Chinese-owned enterprises, but in opposite directions. While positive perceptions toward regulations have positive influence, positive perceptions toward regulators (i.e., the EPB) negatively affect it. Overall, these results indicated that promoting the adoption of EM practices depends on convincing business leaders that EM practices contribute to profit making. The regulatory process can potentially promote these practices, but measures need to be taken to ensure that the regulator is not co-opted by the regulated, especially in wholly Chinese-owned enterprises.
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Tang, Shui-Yan; Li, Pansy Honying; Fryxell, Gerald E; Lo, Carlos Wing-Hung
2015-09-01
This study examines the effects of internal motivations and external pressures on the integration of environmental management (EM) practices within manufacturing operations in China. The moderating role of perceptions toward the regulatory process is also considered along with comparisons between wholly Chinese-owned and foreign-owned enterprises. From a sample of 131 manufacturing companies in the Guangzhou area, it was found that the salience of fees and fines has a strong positive influence on perceptions toward the regulator (the local Environmental Protection Bureau, EPB). This also has a positive effect on perceptions toward regulations themselves for foreign-owned enterprises. Business-case motivations for EM positively shape enterprise perceptions toward regulations, whereas risk-reduction motivations have a negative effect on perceptions toward regulations in foreign-owned enterprises. Enterprise perceptions toward the regulatory process have direct effects on the integration of EM practices in wholly Chinese-owned enterprises, but in opposite directions. While positive perceptions toward regulations have positive influence, positive perceptions toward regulators (i.e., the EPB) negatively affect it. Overall, these results indicated that promoting the adoption of EM practices depends on convincing business leaders that EM practices contribute to profit making. The regulatory process can potentially promote these practices, but measures need to be taken to ensure that the regulator is not co-opted by the regulated, especially in wholly Chinese-owned enterprises.
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NASA Astrophysics Data System (ADS)
Ahmad, Mohd Hafis; Ismail, Syuhaida; Rani, Wan Nurul Mardiah Wan Mohd; Wahab, Mohammad Hussaini
2017-10-01
Organisational change occurs when an organisation makes a transition from its current state to some desired future state in minimising employee resistance and cost to the organisation while simultaneously maximising the effectiveness of the change effort. This paper, aims at appraising the change management of organisation in Malaysia since limited research has been done to examine readiness for change by the employees in the organisation. This paper is materialising its objectives of (1) investigating the current practice of organisation and employees in the organisation towards change management and (2) assessing the factors influencing readiness of organisation and employees in the organisation towards change management. It is found via literature review that change management is a structured approach for ensuring that changes are thoroughly and smoothly implemented to transitioning individuals, teams, and organisations to a desired future state by focusing on the wider impacts of change, particularly on people, where change does not happen in isolation and it impacts the whole organisation. Furthermore, it is found that current practice of organisation and employees in the organisation towards change management involved in three main factors, namely trust in management, communication and organisational commitment; with the factor for trust in management is the positive vision for the future by management team, meanwhile for communication, it is found that there is good communication between supervisors and employees about the organisation's policy toward the changes. The factor found in organisational commitment is employees enjoying discussing about their organisation with outsiders. The findings of this paper provide a positive impact on change management planning, which ultimately help in ensuring more effective change programme implementation in the organisation in Malaysia.
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Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu
2016-01-01
Dual practice is defined as a physician's performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people's perception. A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals' human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals' human resource would promote physicians' willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics.
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Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu
2016-01-01
Objective Dual practice is defined as a physician’s performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people’s perception. Methods A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. Results The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals’ human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. Conclusion This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals’ human resource would promote physicians’ willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics. PMID:27621600
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Choowong, Jiraporn; Tillgren, Per; Söderbäck, Maja
2016-07-28
Thailand is 18th out of the 22 countries with the highest tuberculosis (TB) burden. It will be a challenge for Thailand to achieve the UN Millennium Development target for TB, as well as the new WHO targets for eliminating TB by 2035. More knowledge and a new approach are needed to tackle the complex challenges of managing the DOT program in Thailand. Contextual factors strongly influence the local implementation of evidence in practice. Using the PARIHS model, the aim has been to explore district leaders' perceptions of the management of the DOT program in Trang province, Thailand. A phenomenographic approach was used to explore the perceptions among district DOT program leaders in Trang province. We conducted semi-structured interviews with district leaders responsible for managing the DOT program in five districts. The analysis of the data transcriptions was done by grouping similarities and differences of perceptions, which were constructed in a hierarchical outcome space that shows a set of descriptive categories. The first descriptive category revealed a common perception of the leaders' duty and wish to comply with the NTP guidelines when managing and implementing the DOT program in their districts. More varied perceptions among the leaders concerned how to achieve successful treatment. Other perceptions concerned practical dilemmas, which included fear of infection, mutual distrust, and inadequate knowledge about TB. Further, the leaders perceived a need for improved management practices in implementing the TB guidelines. Using the PARIHS framework to gain a retrospective perspective on the district-level policy implementation of the DOT program and studying the leadership's perceptions about applying the guidelines to practice, has brought new knowledge about management practices. Additional support and resources from the regional level are needed to manage the challenges.
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Practice Patterns of Speech-Language Pathologists in Pediatric Vocal Health.
Hartley, Naomi A; Braden, Maia; Thibeault, Susan L
2017-05-17
The purpose of this study was to investigate current practices of speech-language pathologists (SLPs) in the management of pediatric vocal health, with specific analysis of the influence of clinical specialty and workplace setting on management approaches. American Speech-Language-Hearing Association-certified clinicians providing services within the United States (1%-100% voice caseload) completed an anonymous online survey detailing clinician demographics; employment location and service delivery models; approaches to continuing professional development; and specifics of case management, including assessment, treatment, and discharge procedures. Current practice patterns were analyzed for 100 SLPs (0-42 years of experience; 77 self-identifying as voice specialists) providing services in 34 U.S. states across a range of metropolitan and nonmetropolitan workplace settings. In general, SLPs favored a multidisciplinary approach to management; included perceptual, instrumental, and quality of life measures during evaluation; and tailored intervention to the individual using a combination of therapy approaches. In contrast with current practice guidelines, only half reported requiring an otolaryngology evaluation prior to initiating treatment. Both clinical specialty and workplace setting were found to affect practice patterns. SLPs in school settings were significantly less likely to consider themselves voice specialists compared with all other work environments. Those SLPs who considered themselves voice specialists were significantly more likely to utilize voice-specific assessment and treatment approaches. SLP practice largely mirrors current professional practice guidelines; however, potential exists to further enhance client care. To ensure that SLPs are best able to support children in successful communication, further research, education, and advocacy are required.
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Clinicians' expectations of Web 2.0 as a mechanism for knowledge transfer of stroke best practices.
David, Isabelle; Poissant, Lise; Rochette, Annie
2012-09-13
Health professionals are increasingly encouraged to adopt an evidence-based practice to ensure greater efficiency of their services. To promote this practice, several strategies exist: distribution of educational materials, local consensus processes, educational outreach visits, local opinion leaders, and reminders. Despite these strategies, gaps continue to be observed between practice and scientific evidence. Therefore, it is important to implement innovative knowledge transfer strategies that will change health professionals' practices. Through its interactive capacities, Web 2.0 applications are worth exploring. As an example, virtual communities of practice have already begun to influence professional practice. This study was initially developed to help design a Web 2.0 platform for health professionals working with stroke patients. The aim was to gain a better understanding of professionals' perceptions of Web 2.0 before the development of the platform. A qualitative study following a phenomenological approach was chosen. We conducted individual semi-structured interviews with clinicians and managers. Interview transcripts were subjected to a content analysis. Twenty-four female clinicians and managers in Quebec, Canada, aged 28-66 participated. Most participants identified knowledge transfer as the most useful outcome of a Web 2.0 platform. Respondents also expressed their need for a user-friendly platform. Accessibility to a computer and the Internet, features of the Web 2.0 platform, user support, technology skills, and previous technological experience were found to influence perceived ease of use and usefulness. Our results show that the perceived lack of time of health professionals has an influence on perceived behavioral intention to use it despite favorable perception of the usefulness of the Web 2.0 platform. In conclusion, female health professionals in Quebec believe that Web 2.0 may be a useful mechanism for knowledge transfer. However, lack of time and lack of technological skills may limit their use of a future Web 2.0 platform. Further studies are required with other populations and in other regions to confirm these findings.
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Selecting information technology for physicians' practices: a cross-sectional study.
Eden, Karen Beekman
2002-04-05
Many physicians are transitioning from paper to electronic formats for billing, scheduling, medical charts, communications, etc. The primary objective of this research was to identify the relationship (if any) between the software selection process and the office staff's perceptions of the software's impact on practice activities. A telephone survey was conducted with office representatives of 407 physician practices in Oregon who had purchased information technology. The respondents, usually office managers, answered scripted questions about their selection process and their perceptions of the software after implementation. Multiple logistic regression revealed that software type, selection steps, and certain factors influencing the purchase were related to whether the respondents felt the software improved the scheduling and financial analysis practice activities. Specifically, practices that selected electronic medical record or practice management software, that made software comparisons, or that considered prior user testimony as important were more likely to have perceived improvements in the scheduling process than were other practices. Practices that considered value important, that did not consider compatibility important, that selected managed care software, that spent less than 10,000 dollars, or that provided learning time (most dramatic increase in odds ratio, 8.2) during implementation were more likely to perceive that the software had improved the financial analysis process than were other practices. Perhaps one of the most important predictors of improvement was providing learning time during implementation, particularly when the software involves several practice activities. Despite this importance, less than half of the practices reported performing this step.
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From shared care to disease management: key-influencing factors.
Eijkelberg, I M; Spreeuwenberg, C; Mur-Veeman, I M; Wolffenbuttel, B H
2001-01-01
In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called 'shared care' projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? The theoretical framework is based on the concept of the learning organisation. Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skillful way. Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed.
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Career stress and female managers' health in Taiwan's hospitals: a multilevel model approach.
Chen, Duan-Rung; Lin, Yeh-Yun; Chung, Kuo-Piao
2008-01-01
This study investigates how perception-induced stress (barrier) and social capital (facilitator) affect the health of female managers. On the basis of the responses of 229 valid questionnaires of middle- and high-level female managers in large-scale hospitals, using a multilevel data analysis approach, this study investigates how perception-induced stress and social capital influence self-reported poor health of female managers. Analysis results indicate that all 3 perception-induced stresses (i.e., promotion-related procedural justice, promotion rate, and work-family conflict) and 2 social capital variables (i.e., mentor-assisted promotion and higher ranking mentor in other departments) are significantly associated with the health of female mangers. Factors involving the career success of women also affect their health. Health care organizations expecting to benefit from the long-term contribution of female elites must promote organizational equity and more heavily emphasize flexible work schedules, family-friendly policies, and perception management practices. In addition, adequately designed mentorship practices can greatly benefit female managers.
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Quantitative descriptions of rice plant architecture and their application
Li, Xumeng; Wang, Xiaohui; Peng, Yulin; Wei, Hailin; Zhu, Xinguang; Chang, Shuoqi; Li, Ming; Li, Tao; Huang, Huang
2017-01-01
Plant architecture is an important agronomic trait, and improving plant architecture has attracted the attention of scientists for decades, particularly studies to create desirable plant architecture for high grain yields through breeding and culture practices. However, many important structural phenotypic traits still lack quantitative description and modeling on structural-functional relativity. This study defined new architecture indices (AIs) derived from the digitalized plant architecture using the virtual blade method. The influences of varieties and crop management on these indices and the influences of these indices on biomass accumulation were analyzed using field experiment data at two crop growth stages: early and late panicle initiation. The results indicated that the vertical architecture indices (LAI, PH, 90%-DRI, MDI, 90%-LI) were significantly influenced by variety, water, nitrogen management and the interaction of water and nitrogen, and compact architecture indices (H-CI, Q-CI, 90%-LI, 50%-LI) were significantly influenced by nitrogen management and the interaction of variety and water. Furthermore, there were certain trends in the influence of variety, water, and nitrogen management on AIs. Biomass accumulation has a positive linear correlation with vertical architecture indices and has a quadratic correlation with compact architecture indices, respectively. Furthermore, the combination of vertical and compact architecture indices is the indicator for evaluating the effects of plant architecture on biomass accumulation. PMID:28545144
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Quantitative descriptions of rice plant architecture and their application.
Li, Xumeng; Wang, Xiaohui; Peng, Yulin; Wei, Hailin; Zhu, Xinguang; Chang, Shuoqi; Li, Ming; Li, Tao; Huang, Huang
2017-01-01
Plant architecture is an important agronomic trait, and improving plant architecture has attracted the attention of scientists for decades, particularly studies to create desirable plant architecture for high grain yields through breeding and culture practices. However, many important structural phenotypic traits still lack quantitative description and modeling on structural-functional relativity. This study defined new architecture indices (AIs) derived from the digitalized plant architecture using the virtual blade method. The influences of varieties and crop management on these indices and the influences of these indices on biomass accumulation were analyzed using field experiment data at two crop growth stages: early and late panicle initiation. The results indicated that the vertical architecture indices (LAI, PH, 90%-DRI, MDI, 90%-LI) were significantly influenced by variety, water, nitrogen management and the interaction of water and nitrogen, and compact architecture indices (H-CI, Q-CI, 90%-LI, 50%-LI) were significantly influenced by nitrogen management and the interaction of variety and water. Furthermore, there were certain trends in the influence of variety, water, and nitrogen management on AIs. Biomass accumulation has a positive linear correlation with vertical architecture indices and has a quadratic correlation with compact architecture indices, respectively. Furthermore, the combination of vertical and compact architecture indices is the indicator for evaluating the effects of plant architecture on biomass accumulation.
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Improving technical information use: what can be learnt from a manager's perspective?
Jacobson, C; Lisle, A; Carter, R W; Hockings, M T
2013-07-01
Conservation practice reportedly suffers from low use of technical information. Understanding of factors that affect the influence of technical information on management decision-making is limited. We sought to identify leverage points for improved technical information dissemination in the New South Wales Parks and Wildlife Service, Australia, given the significant recent investments in monitoring and evaluation that had been made. We did so by exploring the inter-relationships between factors affecting the influence of different information types on management decisions. Results indicate that managers have a high inclination toward adaptive behavior, given they operate in an information poor environment. The most influential types of information were those that enabled interaction between information provider and recipient (e.g., staff experience and expertise). An analysis of the concordance in individuals' responses for different information types showed that neither accessibility nor organizational expectation of use was aligned with influence on decision-making. Alignment of responses also varied by work area. Raising expectations of information use or increasing access to particular types of information is therefore unlikely to result in an increase in influence on management decision-making. Rather than focussing on matching accessibility and expected use of particular information types, our results indicate that technical information uptake is best supported through existing peer networks tailored to specific work areas.
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William G. Morris
1958-01-01
In the Douglas-fir region, is slash burning ultimately good or bad practice? During the early 1940's whenever a group of foresters, met to discuss management or silviculture of that region, they usually debated this question. Until then they had burned slash in most clear cuttings east of the narrow coastal fog belt as accepted practice. Fire...
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Integrated Theory of Health Behavior Change
RYAN, POLLY
2009-01-01
An essential characteristic of advanced practice nurses is the use of theory in practice. Clinical nurse specialists apply theory in providing or directing patient care, in their work as consultants to staff nurses, and as leaders influencing and facilitating system change. Knowledge of technology and pharmacology has far outpaced knowledge of how to facilitate health behavior change, and new theories are needed to better understand how practitioners can facilitate health behavior change. In this article, the Integrated Theory of Health Behavior Change is described, and an example of its use as foundation to intervention development is presented. The Integrated Theory of Health Behavior Change suggests that health behavior change can be enhanced by fostering knowledge and beliefs, increasing self-regulation skills and abilities, and enhancing social facilitation. Engagement in self-management behaviors is seen as the proximal outcome influencing the long-term distal outcome of improved health status. Person-centered interventions are directed to increasing knowledge and beliefs, self-regulation skills and abilities, and social facilitation. Using a theoretical framework improves clinical nurse specialist practice by focusing assessments, directing the use of best-practice interventions, and improving patient outcomes. Using theory fosters improved communication with other disciplines and enhances the management of complex clinical conditions by providing holistic, comprehensive care. PMID:19395894
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Isett, Kimberley Roussin; Burnam, M Audrey; Coleman-Beattie, Brenda; Hyde, Pamela S; Morrissey, Joseph P; Magnabosco, Jennifer L; Rapp, Charles; Ganju, Vijay; Goldman, Howard H
2008-06-01
The evidence-based practice demonstration for services to adults with serious mental illness has ended its pilot stage. This paper presents the approaches states employed to combine traditional policy levers with more strategic/institutional efforts (e.g., leadership) to facilitate implementation of these practices. Two rounds of site visits were completed and extensive interview data collected. The data were analyzed to find trends that were consistent across states and across practices. Two themes emerged for understanding implementation of evidence-based practices: the support and influence of the state mental health authority matters and so does the structure of the mental health systems.
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Perepelkin, Jason; Dobson, Roy Thomas
2010-12-01
Ownership of community pharmacies is increasingly being controlled by a relatively small number of corporate entities. The influence of this ownership type should not be ignored, because ownership has the ability to impact pharmacy practice. To examine the relationship between ownership type and community pharmacy managers with regard to role orientation, role affinity, and role conflict. This study consisted of a cross-sectional survey of community pharmacy managers in Canada by means of a self-administered postal questionnaire sent to a stratified sample of community pharmacies. Statistical analysis consisted of exploratory factor analysis with reliability testing on identified constructs. Frequencies, 1-way analyses of variance, and Scheffe post hoc tests were used to determine significant differences among groups, including ownership structure, on each of the constructs. A total of 646 completed questionnaires were received (32.9% response rate). Most of the respondents were males (60.8%), with slightly less than half of the respondents identifying their practice type as an independent pharmacy (44.6%). There were 5 multi-item scale constructs (professional orientation, business orientation, professional affinity, business affinity, and role conflict) arising from the data, which were analyzed against the pharmacy ownership structure (independent, franchise, corporate) independent variable. Analysis revealed significant differences for 3 of the 5 constructs; however, no differences were seen regarding the 2 professionally focused constructs. Community pharmacy managers/owners are generally oriented to their professional role; however, those working in a corporate pharmacy environment are less oriented to their business role when compared with those working in an independent or franchise pharmacy environment. Further research is needed to identify different practice cultures that may exist in various practice settings and the extent to which these cultures attract or define the managers working in them. Copyright © 2010 Elsevier Inc. All rights reserved.
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Jay, Melanie; Chintapalli, Sumana; Squires, Allison; Mateo, Katrina F; Sherman, Scott E; Kalet, Adina L
2015-11-14
Obesity is highly prevalent among Veterans. In the United States, the Veterans Health Administration (VHA) offers a comprehensive weight management program called MOVE!. Yet, fewer than 10 % of eligible patients ever attend one MOVE! visit. The VHA has a patient-centered medical home (PCMH) model of primary care (PC) called Patient-Aligned Care Teams (PACT) at all Veterans Affairs (VA) Medical Centers. PACT teamlets conduct obesity screening, weight management counseling, and refer to MOVE!. As part of a needs assessment to improve delivery of weight management services, the purpose of this study was to assess PACT teamlet and MOVE! staff: 1) current attitudes and perceptions regarding obesity care; 2) obesity-related counseling practices 3) experiences with the MOVE! program; and 4) targets for interventions to improve implementation of obesity care in the PC setting. We recruited 25 PACT teamlet members from a single VA study site-11 PC physicians, 5 registered nurses, 5 licensed practical nurses, 1 clerical assistant, and 3 MOVE! staff (2 dietitians, 1 psychologist)-for individual interviews using a combination of convenience and snowball sampling. Audio recorded interviews were professionally transcribed and iteratively coded by two independent reviewers. The analytic process was guided by discourse analysis in order to discover how the participants perceived and provided weight management care and what specific attitudes affected their practices, all as bounded within the organization. Emerging themes included: 1) role perceptions, 2) anticipated outcomes of weight management counseling and programs, and 3) communication and information dissemination. Perceived role among PCPs was influenced by training, whereas personal experience with their own weight management impacted role perception among LPNs/RNs. Attitudes about whether or not they could impact patients' weight outcomes via counseling or referral to MOVE! varied. System-level communication about VHA priorities through electronic health records and time allocation influenced teams to prioritize referral to MOVE! over weight management counseling. We found a diversity of attitudes, and practices within PACT, and identified factors that can enhance the MOVE! program and inform interventions to improve weight management within primary care. Although findings are site-specific, many are supported in the literature and applicable to other VA and non-VA sites with PCMH models of care.
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Achillas, Charisios; Moussiopoulos, Nicolas; Karagiannidis, Avraam; Banias, Georgias; Perkoulidis, George
2013-02-01
Problems in waste management have become more and more complex during recent decades. The increasing volumes of waste produced and social environmental consciousness present prominent drivers for environmental managers towards the achievement of a sustainable waste management scheme. However, in practice, there are many factors and influences - often mutually conflicting - criteria for finding solutions in real-life applications. This paper presents a review of the literature on multi-criteria decision aiding in waste management problems for all reported waste streams. Despite limitations, which are clearly stated, most of the work published in this field is reviewed. The present review aims to provide environmental managers and decision-makers with a thorough list of practical applications of the multi-criteria decision analysis techniques that are used to solve real-life waste management problems, as well as the criteria that are mostly employed in such applications according to the nature of the problem under study. Moreover, the paper explores the advantages and disadvantages of using multi-criteria decision analysis techniques in waste management problems in comparison to other available alternatives.
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Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal
2017-01-01
(1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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Northern bobwhite breeding season ecology on a reclaimed surface mine
Brooke, Jarred M.; Tanner, Evan P.; Peters, David C.; Tanner, Ashley M.; Harper, Craig A.; Keyser, Patrick D.; Clark, Joseph D.; Morgan, John J.
2017-01-01
Surface coal mining and subsequent reclamation of surface mines have converted large forest areas into early successional vegetative communities in the eastern United States. This reclamation can provide a novel opportunity to conserve northern bobwhite (Colinus virginianus). We evaluated the influence of habitat management activities on nest survival, nest-site selection, and brood resource selection on managed and unmanaged units of a reclaimed surface mine, Peabody Wildlife Management Area (Peabody), in west-central Kentucky, USA, from 2010 to 2013. We compared resource selection, using discrete-choice analysis, and nest survival, using the nest survival model in Program MARK, between managed and unmanaged units of Peabody at 2 spatial scales: the composition and configuration of vegetation types (i.e., macrohabitat) and vegetation characteristics at nest sites and brood locations (i.e., microhabitat). On managed sites, we also investigated resource selection relative to a number of different treatments (e.g., herbicide, disking, prescribed fire). We found no evidence that nest-site selection was influenced by macrohabitat variables, but bobwhite selected nest sites in areas with greater litter depth than was available at random sites. On managed units, bobwhite were more likely to nest where herbicide was applied to reduce sericea lespedeza (Lespedeza cuneata) compared with areas untreated with herbicide. Daily nest survival was not influenced by habitat characteristics or by habitat management but was influenced by nest age and the interaction of nest initiation date and nest age. Daily nest survival was greater for older nests occurring early in the breeding season (0.99, SE < 0.01) but was lower for older nests occurring later in the season (0.08, SE = 0.13). Brood resource selection was not influenced by macrohabitat or microhabitat variables we measured, but broods on managed units selected areas treated with herbicide to control sericea lespedeza and were located closer to firebreaks and disked native-warm season grass stands than would be expected at random. Our results suggest the vegetation at Peabody was sufficient without manipulation to support nesting and brood-rearing northern bobwhite at a low level, but habitat management practices improved vegetation for nesting and brood-rearing resource selection. Reproductive rates (e.g., nest survival and re-nesting rates) at Peabody were lower than reported in other studies, which may be related to nutritional deficiencies caused by the abundance of sericea lespedeza. On reclaimed mine lands dominated by sericea lespedeza, we suggest continuing practices such as disking and herbicide application that are targeted at reducing sericea lespedeza to improve the vegetation for nesting and brood-rearing bobwhite.
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Stilwell, Peter; Hayden, Jill A; Des Rosiers, Piaf; Harman, Katherine; French, Simon D; Curran, Janet A; Hefford, Warren
2018-01-01
This study aimed to assess chiropractors' awareness of clinical practice guidelines for low back pain and to identify barriers and facilitators to the screening and management of psychosocial factors in patients with low back pain. This qualitative study used semi-structured interviews informed by the Theoretical Domains Framework with 10 Nova Scotian chiropractors who were members of a practice-based research network. The participants correctly identified what the guidelines generally recommend and described the value of psychosocial factors; however, none of the participants could name specific clinical practice guidelines for low back pain. We identified 6 themes related to barriers and facilitators for chiropractors screening and managing psychosocial factors. The themes revolved around the participants' desire to fulfill patients' anatomy-focused treatment expectations and a perceived lack of training for managing psychosocial factors. Participants had concerns about going beyond the chiropractic scope of practice, and they perceived a lack of practical psychosocial screening and management resources. Social factors, such as the influence of other health care practitioners, were reported as both barriers and facilitators to screening and managing psychosocial factors. The participants in this study reported that they mostly treated with an anatomical and biomechanical focus and that they did not always address psychosocial factors identified in their patients with low back pain. Although these findings are limited to Nova Scotian chiropractors, the barriers identified appeared to be potentially modifiable and could be considered in other groups. Low-cost interventions, such as continuing education using evidence-informed behavior change techniques, could be considered to address these barriers. Copyright © 2017. Published by Elsevier Inc.
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Mintziori, G; Kita, M; Duntas, L; Goulis, D G
2016-08-01
Thyroid hormone acts on the oocytes, sperm and embryo during fertilization, implantation and placentation. Both hypothyroidism and hyperthyroidism may influence fertility. However, evidence of the association of hyperthyroidism with infertility is scarce and sometimes conflicting. Thyroid hormone influences human reproduction via a variety of mechanisms at both the central and the peripheral level. Infertility may occur in hyperthyroid men and women, but it is usually reversible upon restoration of euthyroidism. This review aims to summarize the available data on the association of hyperthyroidism and infertility in both men and women and to provide practical suggestions for the management of these patients.
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McCraw, Wendy M; Kelley, Patricia Watts; Righero, Anna M; Latimer, Renee
2010-01-01
A multidisciplinary, multifaceted approach to disease management that incorporates the health system, the provider, and the patient is supported in the literature. There was a need to improve patient outcomes to meet or to exceed the Health Plan Employer Data and Information Set (HEDIS) benchmarks for the management of patients with diabetes. The purpose of this study was to implement a process improvement effort using practice guidelines on the basis of an evidence-based practice model for the management of type II diabetes mellitus at two primary care clinics at two military medical facilities in Hawaii. A retrospective review of charts, electronic records, and system data revealed that the clinics used as project sites were not compliant with established guidelines for diabetes management. After a literature review and an analysis of the current processes, a multidisciplinary care delivery model was developed and implemented to identify spheres of influence involving all members of the diabetes management team and the tasks that influenced patient outcomes. Improvements were seen for more than 6 months of initial practice change, including compliance with annual glycosylated hemoglobin (HbA1c), lipid, blood pressure, and foot checks. At Site 1, HEDIS measures increased for adequately controlled HbA1c and low-density lipoprotein (LDL) from 80% to 85% and from 49% to 58%, respectively. Site 2 showed an increase in adequate control of HbA1c from 77% to 79% at 6 months. After a steady increase in compliance, the percentage for adequately controlled LDL dropped to 56% at 9 months. At Site 1, HEDIS measures decreased slightly to 82% for HbA1c control and to 54% for LDL control at the 9-month mark. Inconsistent delivery of care and lack of staff and patient involvement influenced process outcomes. There were challenges with database accuracy, adequate staffing, computer software upgrades, and overseas site locations. Annual foot examinations showed the largest improvement over time. Site 1 had a significant increase in filament testing because of an innovative strategy to develop a competency program to educate technicians to perform the assessment during the patient check-in process. Sustainability is needed to improve overall patient quality and patient safety and to decrease variation in care among medical treatment facilities over time.
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Modeling the influence of climate change on watershed systems: Adaptation through targeted practices
NASA Astrophysics Data System (ADS)
Dudula, John; Randhir, Timothy O.
2016-10-01
Climate change may influence hydrologic processes of watersheds (IPCC, 2013) and increased runoff may cause flooding, eroded stream banks, widening of stream channels, increased pollutant loading, and consequently impairment of aquatic life. The goal of this study was to quantify the potential impacts of climate change on watershed hydrologic processes and to evaluate scale and effectiveness of management practices for adaptation. We simulate baseline watershed conditions using the Hydrological Simulation Program Fortran (HSPF) simulation model to examine the possible effects of changing climate on watershed processes. We also simulate the effects of adaptation and mitigation through specific best management strategies for various climatic scenarios. With continuing low-flow conditions and vulnerability to climate change, the Ipswich watershed is the focus of this study. We quantify fluxes in runoff, evapotranspiration, infiltration, sediment load, and nutrient concentrations under baseline and climate change scenarios (near and far future). We model adaptation options for mitigating climate effects on watershed processes using bioretention/raingarden Best Management Practices (BMPs). It was observed that climate change has a significant impact on watershed runoff and carefully designed and maintained BMPs at subwatershed scale can be effective in mitigating some of the problems related to stormwater runoff. Policy options include implementation of BMPs through education and incentives for scale-dependent and site specific bioretention units/raingardens to increase the resilience of the watershed system to current and future climate change.
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Sadatsafavi, Hessam; Walewski, John
2013-01-01
Purpose of the Paper: The purpose of this study is to provide healthcare organizations with a new perspective for developing strategies to enrich their human resource capabilities and improve their performance outcomes. The focus of this study is on leveraging the synergy between organizational management strategies and environmental design interventions. This paper proposes a framework for linking the built environment with the human resource management system of healthcare organizations. The framework focuses on the impact of the built environment regarding job attitudes and behaviors of healthcare workers. Research from the disciplines of strategic human resource management, resource-based view of firms, evidence-based design, and green building are utilized to develop the framework. The positive influence of human resource practices on job attitudes and behaviors of employees is one mechanism to improve organizational performance outcomes. Organizational psychologists suggest that human resource practices are effective because they convey that the organization values employee contributions and cares about their well-being. Attention to employee socio-emotional needs can be reciprocated with higher levels of motivation and commitment toward the organization. In line with these findings, healthcare environmental studies imply that physical settings and features can have a positive influence on job attitudes and the behavior of caregivers by providing for their physical and socio-emotional needs. Adding the physical environment as a complementary resource to the array of human resource practices creates synergy in improving caregivers' job attitudes and behaviors and enhances the human capital of healthcare firms. Staff, evidence-based design, interdisciplinary, modeling, perceived organizational supportPreferred Citation: Sadatsafavi, H., & Walewski, J. (2013). Corporate sustainability: The environmental design and human resource management interface in healthcare settings. Health Environments Research & Design Journal 6(2), pp 98-118.
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Mumtaz, Ubaidullah; Ali, Yousaf; Petrillo, Antonella; De Felice, Fabio
2018-05-30
Pakistan is a developing country characterized by a growing industrialization, which is the major cause of environmental pollution in the country. To control the significant increase in pollution a green incentive has started, aiming to moderate the adverse effects of environmental pollution. Thus, Green Supply Chain Management (GSCM) plays an important role in influencing the total environment impact of any organizations. This study considers ten Pakistani industries that have implemented GSCM practices. The Decision-Making Trial and Evaluation Laboratory technique (DEMATEL) is used to find influential factors in selecting GSCM criteria. The results show that organizational involvement is the most important dimension useful to implement GSCM practices. In addition, commitment from senior managers, ISO 14000 certification of suppliers and recycle of waste heat are considered significant factors. The paper also signifies the casual relationship among the dimensions and the factors in the form of diagraphs. The main management implication of the paper is to help decision makers to focus on the critical dimensions/factors in order to implement the GSCM practices more effectively in Pakistan. Copyright © 2018 Elsevier B.V. All rights reserved.
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Plant Functional Traits: Soil and Ecosystem Services.
Faucon, Michel-Pierre; Houben, David; Lambers, Hans
2017-05-01
Decline of ecosystem services has triggered numerous studies aiming at developing more sustainable agricultural management practices. Some agricultural practices may improve soil properties by expanding plant biodiversity. However, sustainable management of agroecosystems should be performed from a functional plant trait perspective. Advances in functional ecology, especially plant functional trait effects on ecosystem processes and services, provide pivotal knowledge for ecological intensification of agriculture; this approach acknowledges that a crop field is an agroecosystem whose ecological processes influence soil properties. We highlight the links between plant functional traits and soil properties in relation to four major ecosystem processes involved in vital ecosystem services: food production, crop protection, climate change mitigation, and soil and water conservation, aiming towards ecological intensification of sustainable agricultural and soil management. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Doctor-patient relationships (DPR) in China.
Ma, Shaozhuang; Xu, Xuehu; Trigo, Virginia; Ramalho, Nelson J C
2017-03-20
Purpose The purpose of this paper is twofold: first, to develop and test theory on how commitment human resource (HR) practices affect hospital professionals' job satisfaction that motivates them to generate desirable patient care and subsequently improve doctor-patient relationships (DPR) and second, to examine how commitment HR practices influence hospital managers and clinicians in different ways. Design/methodology/approach Using a cross-sectional survey, the authors collected data from 508 clinicians and hospital managers from 33 tertiary public hospitals in China. Structural equation model was employed to test the relationships of the variables in the study. Findings Commitment HR practices positively affect the job satisfaction of the healthcare professionals surveyed and a positive relationship is perceived between job satisfaction and DPR. Overall, the model shows a reversal on the strongest path linking job satisfaction and DPR whereby managers' main association operates through extrinsic job satisfaction while for clinicians it occurs through intrinsic satisfaction only. Practical implications DPR might be improved by applying commitment HR practices to increase healthcare professional's intrinsic and extrinsic satisfaction. In addition, while recognizing the importance of compensation and benefits to address the underpayment issue of Chinese healthcare professionals, empowerment and autonomy in work, and the use of subjects' expertise and skills may serve as stronger motivators for clinicians rather than hard economic incentives in achieving DPR improvements. Originality/value This study contributes to the small but growing body of research on human resource management (HRM) in the healthcare sector with new evidence supporting the link between commitment HR practice and work attitudes, as well as work attitudes and patient care from the perspective of clinicians and hospital managers. This study represents an initial attempt to examine the associations among commitment HR practices, job satisfaction and DPR in the Chinese healthcare sector. The findings provide evidence to support the value of commitment HR practices in Chinese hospital context, and demonstrate the importance of effective HRM in improving both hospital managers and clinicians' work attitudes.
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Erik Schilling; Daniel McLaughlin; Matt Cohen; Larry Korhnak; Paul Decker; Camille Flinders
2016-01-01
Nutrient pollution can be a leading cause of impairment to some U.S. waters. As a result, state and federal agencies are actively engaged in designing management programs and numeric nutrient criteria (NNC) to address nutrient impairments. Following implementation of the Clean Water Act, Florida, like other timber producing states, developed, tested and implemented...
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George R., Jr. Trimble
1959-01-01
The U. S. Forest Service was authorized by Congress in late summer of 1954 to conduct watershed management research in New Hampshire. The purpose of this work is to determine the effect of forest cover on streamflow: the influence of forest cover type, forest condition, and forest treatment practices on water yield, rate of delivery, and on water quality. This is the...
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NASA Astrophysics Data System (ADS)
Wemheuer, Franziska; Kaiser, Kristin; Karlovsky, Petr; Daniel, Rolf; Vidal, Stefan; Wemheuer, Bernd
2017-01-01
Endophytic bacteria are critical for plant growth and health. However, compositional and functional responses of bacterial endophyte communities towards agricultural practices are still poorly understood. Hence, we analyzed the influence of fertilizer application and mowing frequency on bacterial endophytes in three agriculturally important grass species. For this purpose, we examined bacterial endophytic communities in aerial plant parts of Dactylis glomerata L., Festuca rubra L., and Lolium perenne L. by pyrotag sequencing of bacterial 16S rRNA genes over two consecutive years. Although management regimes influenced endophyte communities, observed responses were grass species-specific. This might be attributed to several bacteria specifically associated with a single grass species. We further predicted functional profiles from obtained 16S rRNA data. These profiles revealed that predicted abundances of genes involved in plant growth promotion or nitrogen metabolism differed between grass species and between management regimes. Moreover, structural and functional community patterns showed no correlation to each other indicating that plant species-specific selection of endophytes is driven by functional rather than phylogenetic traits. The unique combination of 16S rRNA data and functional profiles provided a holistic picture of compositional and functional responses of bacterial endophytes in agricultural relevant grass species towards management practices.
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What is Novel About Novel Ecosystems: Managing Change in an Ever-Changing World
NASA Astrophysics Data System (ADS)
Truitt, Amy M.; Granek, Elise F.; Duveneck, Matthew J.; Goldsmith, Kaitlin A.; Jordan, Meredith P.; Yazzie, Kimberly C.
2015-06-01
Influenced by natural climatic, geological, and evolutionary changes, landscapes and the ecosystems within are continuously changing. In addition to these natural pressures, anthropogenic drivers have increasingly influenced ecosystems. Whether affected by natural or anthropogenic processes, ecosystems, ecological communities, and ecosystem functioning are dynamic and can lead to "novel" or "emerging" ecosystems. Current literature identifies several definitions of these ecosystems but lacks an unambiguous definition and framework for categorizing what constitutes a novel ecosystem and for informing decisions around best management practices. Here we explore the various definitions used for novel ecosystems, present an unambiguous definition, and propose a framework for identifying the most appropriate management option. We identify and discuss three approaches for managing novel ecosystems: managing against, tolerating, and managing for these systems, and we provide real-world examples of each approach. We suggest that this framework will allow managers to make thoughtful decisions about which strategy is most appropriate for each unique situation, to determine whether the strategy is working, and to facilitate decision-making when it is time to modify the management approach.
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What is Novel About Novel Ecosystems: Managing Change in an Ever-Changing World.
Truitt, Amy M; Granek, Elise F; Duveneck, Matthew J; Goldsmith, Kaitlin A; Jordan, Meredith P; Yazzie, Kimberly C
2015-06-01
Influenced by natural climatic, geological, and evolutionary changes, landscapes and the ecosystems within are continuously changing. In addition to these natural pressures, anthropogenic drivers have increasingly influenced ecosystems. Whether affected by natural or anthropogenic processes, ecosystems, ecological communities, and ecosystem functioning are dynamic and can lead to "novel" or "emerging" ecosystems. Current literature identifies several definitions of these ecosystems but lacks an unambiguous definition and framework for categorizing what constitutes a novel ecosystem and for informing decisions around best management practices. Here we explore the various definitions used for novel ecosystems, present an unambiguous definition, and propose a framework for identifying the most appropriate management option. We identify and discuss three approaches for managing novel ecosystems: managing against, tolerating, and managing for these systems, and we provide real-world examples of each approach. We suggest that this framework will allow managers to make thoughtful decisions about which strategy is most appropriate for each unique situation, to determine whether the strategy is working, and to facilitate decision-making when it is time to modify the management approach.
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Partner expressed emotion and diabetes management among spouses living with Type 2 diabetes.
Lister, Zephon; Wilson, Colwick; Fox, Curtis; Herring, R Patricia; Simpson, Cheryl; Smith, Lucretia; Edwards, Lincoln
2016-12-01
Expressed emotion has been consistently shown to be a significant predictor of relapse and poor disease management across numerous physical and mental health conditions, however very little research has been conducted on its relationship to the management practices of individuals living with Type 2 diabetes. This study examines the relationship between expressed emotion (EE) and diabetes management among couples where 1 spouse has Type 2 diabetes. The authors surveyed 106 couples where 1 partner was diagnosed with Type 2 diabetes. Partners without diabetes completed questionnaires about their level of criticism, emotional involvement, and warmth toward their partners. Partners with diabetes completed questionnaires on diabetes control, diabetes management practices and attitude toward their diabetes. The authors found that, individuals living with diabetes who had partners with high EE reported significantly poorer diabetes management in all areas (diet, physical activity, and attitude toward diabetes). Diabetes management was found to mediate the relationship between EE and diabetes control. Results suggest that partners with high EE may have a significant influence on diabetes management practices in their partner. These findings highlight the important role couple interactions may play in diabetes management. Findings also emphasize the potential benefit of conceptualizing diabetes management from a systems/relational perspective. In addition, greater consideration should be given to using family-based approaches for diabetes management and treatment among coupled individuals living with Type 2 diabetes. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
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The impact of non-IPA HMOs on the number of hospitals and hospital capacity.
Chernew, M
1995-01-01
Concentration in the hospital market could limit the success of health care reform strategies that rely on managed care to constrain costs. Hospital market capacity also is important because capacity affects both costs and the degree of price competition. Because managed care plans, particularly non-individual practice association (non-IPA) model HMOs, practice a less hospital-intensive style of care, consolidation and downsizing in the hospital market potentially will accompany managed care growth, influencing the long-run effectiveness of managed care cost-containment strategies. Using Standard Metropolitan Statistical Area (SMSA) data from 1982 and 1987, a 10-percentage point increase in non-IPA HMO market share is estimated to reduce the number of hospitals by about 4%, causing an approximate 5% reduction in the number of hospital beds. No statistically significant relationship is found between non-IPA HMO penetration rates and hospital occupancy rates.
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Brourman, J D; Schertel, E R; Allen, D A; Birchard, S J; DeHoff, W D
1996-06-01
To evaluate factors associated with perioperative mortality in dogs with gastric dilatation-volvulus and to determine the influence of treatment differences between university and private specialty practices on outcome. Retrospective analysis of medical records. 137 dogs with gastric dilatation-volvulus. Signalment; frequency of preoperative and postoperative treatments and complications; intraoperative findings; surgical technique; and hematologic, serum biochemical, and electrocardiographic results were recorded, evaluated for association with mortality, and compared between institutions. Mortality did not differ between institutions, and overall mortality was 18% (24/137). Surgical techniques differed between institutions, but were not associated with mortality. Gastric necrosis was associated with significantly higher mortality (46%; 13/28). When partial gastrectomy or splenectomy was performed, mortality (35 and 32% or 8/23 and 10/31, respectively) was significantly increased. Splenectomy was performed in 11 of 23 dogs requiring partial gastrectomy, and when both procedures were performed, mortality (55%; 6/11) was significantly increased. Preoperative cardiac arrhythmias were associated with significantly higher mortality (38%; 6/16). Mortality in dogs > 10 years old was not significantly greater than that in younger dogs. Patient management differences between practices did not seem to influence survival in dogs with surgically managed gastric dilatation-volvulus. Signalment, including age, did not influence mortality. Gastric necrosis, gastric resection, splenectomy, and preoperative cardiac arrhythmias were associated with mortality > 30%.
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Non-speech oro-motor exercise use in acquired dysarthria management: regimes and rationales.
Mackenzie, Catherine; Muir, Margaret; Allen, Carolyn
2010-01-01
Non-speech oro-motor exercises (NSOMExs) are described in speech and language therapy manuals and are thought to be much used in acquired dysarthria intervention, though there is no robust evidence of an influence on speech outcome. Opinions differ as to whether, and for which dysarthria presentations, NSOMExs are appropriate. The investigation sought to collect development-phase data, in accordance with the Medical Research Council (MRC) evaluation of complex interventions. The aims were to establish the extent of use of NSOMExs in acquired disorders, the exercise regimes in use for dysarthria, with which dysarthric populations, and the anticipated clinical outcomes. A further aim was to determine the influencing rationales where NSOMExs were or were not used in dysarthria intervention. Speech and language therapists throughout Scotland, Wales, and Northern Ireland, working with adult-acquired dysarthria, were identified by their service heads. They received postal questionnaires comprising 21 closed and two open questions, covering respondent biographics, use of NSOMExs, anticipated clinical outcomes, and practice influencing rationales. One hundred and ninety-one (56% response) completed questionnaires were returned. Eighty-one per cent of respondents used NSOMExs in dysarthria. There was no association with years of speech and language therapy experience. Those who used and those who did not use NSOMExs provided similar influencing rationales, including evidence from their own practice, and Higher Education Institute teaching. More experienced speech and language therapists were more likely than those more recently qualified to be guided by results from their own practice. Input from the attended Higher Education Institute was more influential for those less experienced than for those more experienced. Clinical outcome aims were not confined to speech, but also included improvements in movement, sensory awareness, appearance, emotional status, dysphagia and drooling. NSOMExs were used with many neurological disorders, especially stroke, all dysarthria classes, especially flaccid, and all severity levels. Tongue and lip exercises were more frequent than face, jaw and soft palate. The most common regimes were four to six repetitions of each exercise, during three practice periods daily, each of 6–10 min. NSOMExs are a frequent component of dysarthria management in the UK-devolved government countries. This confirmation, along with the details of speech and language therapy practice, provides a foundation for clinical research which will compare outcomes for people with dysarthria, whose management includes and does not include NSOMExs. Speech and language therapy practice may be guided by evidence that speech outcome is or is not affected by NSOMExs.
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Williams, Eric S; Konrad, Thomas R; Linzer, Mark; McMurray, Julia; Pathman, Donald E; Gerrity, Martha; Schwartz, Mark D; Scheckler, William E; Douglas, Jeff
2002-01-01
Objective To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. Data Sources Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. Study Design A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. Principle Findings The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. Conclusions These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both “physician friendly” and “family friendly” seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.
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Pain Assessment and Management After a Knowledge Translation Booster Intervention.
Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Barwick, Melanie; Pinard, Marie
2016-10-01
Inadequate pain treatment leaves hospitalized children vulnerable to immediate and long-term sequelae. A multidimensional knowledge translation intervention (ie, the Evidence-based Practice for Improving Quality [EPIQ]) improved pain assessment, management, and intensity outcomes in 16 units at 8 Canadian pediatric hospitals. The sustained effectiveness of EPIQ over time is unknown, however. The goals of this study were to determine the following: (1) sustainability of the impact of EPIQ on pain assessment, management, and intensity outcomes 12, 24, and 36 months after EPIQ; (2) effectiveness of a pain practice change booster (Booster) intervention to sustain EPIQ outcomes over time; and (3) influence of context on sustainability. A prospective, repeated measures, cluster randomized controlled trial was undertaken in the 16 EPIQ units, 12 months after EPIQ completion, to determine the effectiveness of a practice change booster (Booster) to sustain EPIQ outcomes. Generalized estimating equation models examined outcomes controlling for child and unit contextual factors. Outcomes achieved during EPIQ were sustained in the use of any pain assessment measure (P = .01) and a validated pain assessment measure in the EPIQ units (P = .02) up to 36 months after EPIQ. Statistically significant improvements in pain management practices persisted in EPIQ units; results varied across time. There were no significant differences in outcomes after implementation of the Booster between the Booster and Nonbooster groups. Improved pain assessment and management practices were sustained after EPIQ; however, the Booster did not seem to provide additional impact. Copyright © 2016 by the American Academy of Pediatrics.
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Borrott, Narelle; Kinney, Sharon; Newall, Fiona; Williams, Allison; Cranswick, Noel; Wong, Ian; Manias, Elizabeth
2017-07-01
To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. Communication between health professionals influences medication incidents' occurrence and safe care. An ethnographic study was undertaken. Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. The actual communication act revealed health professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in interdisciplinary communication impacted on potential and actual medication incidents. Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure interprofessional respect for each other's roles and inherent demands. Interdisciplinary education delivered in healthcare organisations would facilitate greater clarity in communication related to medications. Encouraging the use of concise, clear words in communication would help to promote improved understanding between parties, and accuracy and efficacy of medication management. © 2016 John Wiley & Sons Ltd.
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Modelling multiple hospital outcomes: the impact of small area and primary care practice variation.
Congdon, Peter
2006-11-16
Appropriate management of care--for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care--is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs) responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need) and primary care factors (e.g. referral thresholds), that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. A fixed effects model shows variations in attendances and admissions are significantly related (positively) to area and practice need, and nursing home patients, and related (negatively) to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In managerial terms, the analysis points to the utility of formal statistical analysis of hospitalisation rates as a prelude to non-statistical investigation of primary care resourcing and organisation. For example, there may be implications for the location of staff involved in community management of chronic conditions; health managers may also investigate whether some practices have unusual populations (homeless, asylum seekers, students) that explain different hospital use patterns.
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Contextual influences on health worker motivation in district hospitals in Kenya
Mbindyo, Patrick; Gilson, Lucy; Blaauw, Duane; English, Mike
2009-01-01
Background Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals. Methods Franco LM, et al's (Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002, 54: 1255–66) model of motivational influences was used to frame the study Qualitative methods including individual in-depth interviews, small-group interviews and focus group discussions were used to gather data from 185 health workers during one-week visits to each of eight district hospitals. Data were collected prior to a planned intervention aiming to implement new practice guidelines and improve quality of care. Additionally, on-site observations of routine health worker behaviour in the study sites were used to inform analyses. Results Study settings are likely to have important influences on worker motivation. Effective management at hospital level may create an enabling working environment modifying the impact of resource shortfalls. Supportive leadership may foster good working relationships between cadres, improve motivation through provision of local incentives and appropriately handle workers' expectations in terms of promotions, performance appraisal processes, and good communication. Such organisational attributes may counteract de-motivating factors at a national level, such as poor schemes of service, and enhance personally motivating factors such as the desire to maintain professional standards. Conclusion Motivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may themselves be influenced by the processes chosen to implement change. PMID:19627590
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Hsiao, Ju-Ling; Chen, Rai-Fu
2016-01-16
With the widespread use of information communication technologies, computerized clinical practice guidelines are developed and considered as effective decision supporting tools in assisting the processes of clinical activities. However, the development of computerized clinical practice guidelines in Taiwan is still at the early stage and acceptance level among major users (physicians) of computerized clinical practice guidelines is not satisfactory. This study aims to investigate critical factors influencing physicians' intention to computerized clinical practice guideline use through an integrative model of activity theory and the technology acceptance model. The survey methodology was employed to collect data from physicians of the investigated hospitals that have implemented computerized clinical practice guidelines. A total of 505 questionnaires were sent out, with 238 completed copies returned, indicating a valid response rate of 47.1 %. The collected data was then analyzed by structural equation modeling technique. The results showed that attitudes toward using computerized clinical practice guidelines (γ = 0.451, p < 0.001), organizational support (γ = 0.285, p < 0.001), perceived usefulness of computerized clinical practice guidelines (γ = 0.219, p < 0.05), and social influence (γ = 0.213, p < 0.05) were critical factors influencing physicians' intention to use computerized clinical practice guidelines, and these factors can explain 68.6 % of the variance in intention to use computerized clinical practice guidelines. This study confirmed that some subject (human) factors, environment (organization) factors, tool (technology) factors mentioned in the activity theory should be carefully considered when introducing computerized clinical practice guidelines. Managers should pay much attention on those identified factors and provide adequate resources and incentives to help the promotion and use of computerized clinical practice guidelines. Through the appropriate use of computerized clinical practice guidelines, the clinical benefits, particularly in improving quality of care and facilitating the clinical processes, will be realized.
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2014-01-01
Background Over the last decade healthcare management and managers have increasingly been in focus in public debate. The purpose of the present study was to gain a deeper understanding of how prolonged, unfavorable media focus can influence both the individual as a person and his or her managerial practice in the healthcare organization. Methods In-depth interviews (n = 49) with 24 managers and their superiors, or subordinate human resources/information professionals, and partners were analyzed using a grounded theory approach. Results The conceptual model explains how perceived uncertainties related to the managerial role influence personification and its negative consequences. The role ambiguities comprised challenges regarding the separation of individual identity from the professional function, the interaction with intra-organizational support and political play, and the understanding and acceptance of roles in society. A higher degree of uncertainty in role ambiguity increased both personification and the personal reaction to intense media pressure. Three types of reactions were related to the feeling of being infringed: avoidance and narrow-mindedness; being hard on self, on subordinates, and/or family members; and resignation and dejection. The results are discussed so as to elucidate the importance of support from others within the organization when under media scrutiny. Conclusions The degree of personification seems to determine the personal consequences as well as the consequences for their managerial practice. Organizational support for managers appearing in the media would probably be beneficial for both the manager and the organization. PMID:24397306
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Dröes, R M; Chattat, R; Diaz, A; Gove, D; Graff, M; Murphy, K; Verbeek, H; Vernooij-Dassen, M; Clare, L; Johannessen, A; Roes, M; Verhey, F; Charras, K
2017-01-01
Because the pattern of illnesses changes in an aging population and many people manage to live well with chronic diseases, a group of health care professionals recently proposed reformulating the static WHO definition of health towards a dynamic one based on the ability to physically, mentally and socially adapt and self-manage. This paper is the result of a collaborative action of the INTERDEM Social Health Taskforce to operationalize this new health concept for people with dementia, more specifically the social domain, and to formulate directions for research and practice to promote social health in dementia. Based on the expertise of the Social Health Taskforce members (N = 54) three groups were formed that worked on operationalizing the three social health dimensions described by Huber et al.: (1) capacity to fulfil potential and obligations; (2) ability to manage life with some degree of independence; (3) participation in social activities. For each dimension also influencing factors, effective interventions and knowledge gaps were inventoried. After a consensus meeting, the operationalizations of the dimensions were reviewed by the European Working Group of People with Dementia (EWGPWD). The social health dimensions could be well operationalized for people with dementia and are assessed as very relevant according to the Social Health Taskforce and EWGPWD. Personal (e.g. sense of coherence, competencies), disease-related (e.g. severity of cognitive impairments, comorbidity), social (support from network, stigma) and environmental factors (e.g. enabling design, accessibility) that can influence the person with dementia's social health and many interventions promoting social health were identified. A consensus-based operationalization of social health in dementia is proposed, and factors that can influence, and interventions that improve, social health in dementia identified. Recommendations are made for research and practice.
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NASA Astrophysics Data System (ADS)
Pearlstein, S.; Compton, J.; Eldridge, A.; Henning, A.; Selker, J. S.; Brooks, J. R.; Schmitz, D.
2016-12-01
Groundwater nitrate contamination affects thousands of households in the southern Willamette Valley and many more across the Pacific Northwest. The southern Willamette Valley Groundwater Management Area (SWV GWMA) was established in 2004 due to nitrate levels in the groundwater exceeding the human health standard of 10 mg nitrate-N L-1. Much of the nitrogen inputs to the GWMA comes from agricultural nitrogen use, and thus efforts to reduce N inputs to groundwater are focused upon improving N management. Previous work in the 1990s in the Willamette Valley by researchers at Oregon State University determined the importance of cover crops and irrigation practices and made recommendations to the local farm community for reducing nitrogen (N) leaching. We are currently re-sampling many of the same fields studied by OSU to examine the influence of current crops and nutrient management practices on nitrate leaching below the rooting zone. This study represents important crops currently grown in the GWMA and includes four grass fields, three vegetable row-crop fields, two peppermint and wheat fields, and one each of hazelnuts and blueberries. New nutrient management practices include slow release fertilizers and precision agriculture approaches in some of the fields. Results from the first two years of sampling show nitrate leaching is lower in some crops like row crops grown for seed and higher in others like perennial rye grass seed when compared to the 1990s data. We will use field-level N input-output balances in order to determine the N use efficiency and compare this across crops and over time. The goal of this project is to provide information and tools that will help farmers, managers and conservation groups quantify the water quality benefits of management practices they are conducting or funding.
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Laws, Rachel A; Kemp, Lynn A; Harris, Mark F; Davies, Gawaine Powell; Williams, Anna M; Eames-Brown, Rosslyn
2009-01-01
Background Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed. Methods The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data. Results The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices. Conclusion The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices. PMID:19825189
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Practice and barriers toward breast self-examination among young Malaysian women.
Al-Naggar, Redhwan Ahmed; Al-Naggar, Dhekra Hamoud; Bobryshev, Yuri V; Chen, Robert; Assabri, Ali
2011-01-01
The etiology of breast cancer is still unknown and adequate primary prevention strategies or interventions are still not possible. Therefore, early detection remains the first priority and regular practice of breast self-examination (BSE) influences treatment, quality of life, survival, and prognosis of breast cancer patients. The objective of this study was to determine the practices and barriers towards breast self-examination among young Malaysian women. Cross-sectional study was conducted among 251 female students at the Management and Science University, Shah Alam, Selangor, Malaysia. Questionnaires were distributed at gathering places such as the university cafeteria, the university plaza, the Islamic center, and at the library. In addition, questionnaires were distributed in the lecture halls. The proposal of this study was approved by the Ethics and Research Committee of Management and Science University. Data was analysis using SPSS version 13, t-test was used to analyze the associated factors toward the practice of BSE. A total number of 251 students participated in this study. The majority of them were older than 20 years old,of Malay racial origin, single and from urban areas (66.5%; 63.7%; 96%; 70.9% respectively). Regarding their lifestyle practices, the majority of participants do exercise, are non-smokers and do not drink alcohol (71.3%; 98.4%; 94.4% respectively). More than half of the study participants mentioned that they have practiced BSE (55.4%). Regarding the sources of information about BSE, the majority mentioned that radio and TV were their main sources of information (38.2%). Age, exercise and family history of cancer significantly influenced the practice of BSE (p = 0.045; p=0.002; p=0.017 respectively). Regarding the barriers to BSE, the majority who never practiced BSE mentioned that lack of knowledge, not having any symptoms, and being afraid of being diagnosed with breast cancer were the main barriers to practicing BSE (20.3%; 14.3%; 4.4% respectively). More than half of the participants practiced BSE. Age, exercise and family history of cancer significantly influenced the practice of the BSE. Lack of knowledge, not having any symptoms and being afraid of being diagnosed with breast cancer were the main barriers to practicing BSE. There is an urgent need to develop a continuous awareness campaign among university students on the importance of performing BSE.
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Udod, Sonia; Racine, Louise
2014-12-01
This study considers empowerment in nurse-manager relations by examining how conflict is handled on both sides and how the critical social perspective has influenced these relations. The authors use inductive analysis of empirical data to explain how (1) nursing work is organized, structured, and circumscribed by centrally determined policies and practices that downplay nurses' professional judgement about patient care; (2) power is held over nurses in their relationship with their manager; and (3) nurses' response to power is to engage in strategies of resistance. The authors illustrate how power influences relations between staff nurses and managers and provide a critical analysis of the strategies of resistance that result in personal, relational, and critical empowerment among staff nurses. Through resistance, staff nurses engage in alternative discourses to counteract the prevailing neoliberal organizational and managerial discourses of efficiency and cost-effectiveness. Copyright© by Ingram School of Nursing, McGill University.
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Challenges of managing child behavior in the 21st century dental setting.
Sheller, Barbara
2004-01-01
This paper discussed factors influencing behavior management of the child dental patient. Pediatric dentists are affected by changes in: (1) society; (2) marketing and media; (3) communications and technology; and (4) parenting practices. Behavior of pediatric patients reflects fewer boundaries, less discipline and self-control, and lowered behavioral expectations by parents and contemporary culture. The insurance industry, regulatory bodies, legal system, dental staff, and pediatric dentist education are other influences on behavior management. Responses of the American Academy of Pediatric Dentistry (AAPD), which could support the pediatric dentist in the changing environment, include: (1) research; (2) continuing education for staff and dentists; (3) development of Internet accessible materials for the public; (4) legislative activity; (5) partnering with pediatric medicine to develop new behavior management strategies; (6) establishment of an AAPD Council on Child Behavior; and (7) ongoing critical reassessment of behavior issues by the AAPD.
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An exploratory study of the role of trust in medication management within mental health services.
Maidment, Ian D; Brown, Patrick; Calnan, Michael
2011-08-01
To develop understandings of the nature and influence of trust in the safe management of medication within mental health services. Mental health services in the UK. Qualitative methods were applied through focus groups across three different categories of service user--older adult, adults living in the community and forensic services. An inductive thematic analysis was carried out, using the method of constant comparison derived from grounded theory. Participants' views on the key factors influencing trust and the role of trust in safe medication management. The salient factors impacting trust were: the therapeutic relationship; uncertainty and vulnerability; and social control. Users of mental health services may be particularly vulnerable to adverse events and these can damage trust. Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust.
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The effects of medical group practice and physician payment methods on costs of care.
Kralewski, J E; Rich, E C; Feldman, R; Dowd, B E; Bernhardt, T; Johnson, C; Gold, W
2000-01-01
OBJECTIVE: To assess the effects of payment methods on the costs of care in medical group practices. DATA SOURCES: Eighty-six clinics providing services for a Blue Cross managed care program during 1995. The clinics were analyzed to determine the relationship between payment methods and cost of care. Cost and patient data were obtained from Blue Cross records, and medical group practice clinic data were obtained by a survey of those organizations. STUDY DESIGN: The effects of clinic and physician payment methods on per member per year (PMPY) adjusted patient costs are evaluated using a two-stage regression model. Patient costs are adjusted for differences in payment schedules; patient age, gender, and ACG; clinic organizational variables are included as explanatory variables. DATA COLLECTION: Patient cost data were extracted from Blue Cross claims files, and patient and physician data from their enrollee and provider data banks. Medical group practice data were obtained by a mailed survey with telephone follow-up. PRINCIPAL FINDINGS: Capitation payment is correlated with lower patient care costs. When combined with fee-for-service with withhold provisions, this effect is smaller indicating that these two clinic payment methods are not interchangeable. Clinics with more physician compensation based on measures of resource use or based on some share of the net revenue of the clinic have lower patient care costs than those with more compensation related to productivity or based on salary. Salary compensation is strongly associated with higher costs. The use of physician profiles and clinical guidelines is associated with lower costs, but referral management systems have no such effect. The lower cost clinics are the smaller, multispecialty clinics. CONCLUSIONS: This study indicates that payment methods at both the medical group practice and physician levels influence the cost of care. However, the methods by which that influence is manifest is not clear. Although the organizational structure of clinics and their use of managed care programs appear to play a role, this influence is less than expected. PMID:10966087
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Women's work. Maintaining a healthy body weight.
Welch, Nicky; Hunter, Wendy; Butera, Karina; Willis, Karen; Cleland, Verity; Crawford, David; Ball, Kylie
2009-08-01
This study describes women's perceptions of the supports and barriers to maintaining a healthy weight among currently healthy weight women from urban and rural socio-economically disadvantaged areas. Using focus groups and interviews, we asked women about their experiences of maintaining a healthy weight. Overwhelmingly, women described their healthy weight practices in terms of concepts related to work and management. The theme of 'managing health' comprised issues of managing multiple responsibilities, time, and emotions associated with healthy practices. Rural women faced particular difficulties in accessing supports at a practical level (for example, lack of childcare) and due to the gendered roles they enacted in caring for others. Family background (in particular, mothers' attitudes to food and weight) also appeared to influence perceptions about healthy weight maintenance. In the context of global increases in the prevalence of obesity, the value of initiatives aimed at supporting healthy weight women to maintain their weight should not be under-estimated. Such initiatives need to work within the social and personal constraints that women face in maintaining good health.
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Haraway, Dana L; Haraway, William M
2005-01-01
Conflict is inevitable and can be both positive and negative. Although it is impossible, and probably not wise, to eliminate conflict, it is prudent for healthcare organizations to provide direct instruction in conflict-management training. In this study, 23 supervisors and managers in a local healthcare organization participated in two 3-hour sessions designed to teach practical conflict-management strategies immediately applicable to their workplace duties and responsibilities. A comparison of pretest and posttest measures indicates statistically significant differences in four areas and suggests a positive influence of the brief intervention.
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Mogollón, Beatriz; Frimpong, Emmanuel A.; Hoegh, Andrew B.; Angermeier, Paul L.
2016-01-01
The southeastern United States has undergone anthropogenic changes in landscape structure, with the potential to increase (e.g., urbanization) and decrease (e.g., reservoir construction) stream flashiness and flooding. Assessment of the outcome of such change can provide insight into the efficacy of current strategies and policies to manage water resources. We (1) examined trends in precipitation, floods, and stream flashiness and (2) assessed the relative influence of land cover and flow-regulating features (e.g., best management practices and artificial water bodies) on stream flashiness from 1991 to 2013. We found mean annual precipitation decreased, which coincided with decreasing trends in floods. In contrast, stream flashiness, overall, showed an increasing trend during the period of study. However, upon closer examination, 20 watersheds showed stable stream flashiness, whereas 5 increased and 6 decreased in flashiness. Urban watersheds were among those that increased or decreased in flashiness. Watersheds that increased in stream flashiness gained more urban cover, lost more forested cover and had fewer best management practices installed than urban watersheds that decreased in stream flashiness. We found best management practices are more effective than artificial water bodies in regulating flashy floods. Flashiness index is a valuable and straightforward metric to characterize changes in streamflow and help to assess the efficacy of management interventions.
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Quantifying human impact on hydrological drought using an Earth System Model
NASA Astrophysics Data System (ADS)
van Huijgevoort, Marjolein; Chaney, Nathaniel; Malyshev, Sergey; Shevliakova, Elena; Milly, Chris
2017-04-01
Predicting the human impact on the present and future hydrological cycle remains a significant scientific challenge. Anthropogenic impact includes water management practices like diverting water for irrigation, abstraction of groundwater, and reservoirs. Hydrological extremes, in particular, are heavily affected by water management practices, due to the existing stress on the system during droughts and floods. Therefore, to prepare adaptation plans for hydrological extremes in the future, it is essential to account for water management and other human influences in Earth System Models. In this study we have implemented water management practices in the state-of-the-art GFDL land model, which includes terrestrial water, energy, and carbon balances. Both irrigation practices and reservoirs have been added in the land surface model component of the model. Irrigation amounts are determined from the soil water balance, the evaporative demand of the vegetation and fractional coverage of croplands. The resulting water demand is fulfilled by abstractions from surface water and groundwater. Reservoir outflow is dynamically coupled to the downstream water demand and available reservoir storage. Retrospective model simulations over the contiguous United States indicate a strong human influence on hydrological drought. A water management attribution analysis shows a significant impact on the water availability, mostly in the Midwest of the United States and California. Implementation of reservoirs alters the flow regime, thereby decreasing the short-term drought impact, however, in the case of multi-year drought, impacts are delayed due to the dependency on the reservoir outflow. Irrigation, on the other hand, decreases the water availability in rivers due to increased evapotranspiration leading to a higher drought impact. The average increase in evapotranspiration amounted up to 2 mm/day for cropland areas in California and Texas. Overall, the results show the importance of including water management in global scale models. This new modelling framework can be used to understand how humans will impact future water availability, water scarcity, and drought. Next steps will include coupled model simulations to investigate the human impact on feedbacks in land-atmosphere interactions.
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Examining Acceptance of an Integrated Personal Health Record (PHR)
ERIC Educational Resources Information Center
Morton, Alicia A.
2011-01-01
Objective: The purpose of this project was to examine the practice question, "What are the factors influencing acceptance of integrated PHRs for self-care management among the Howard University Hospital (HUH) Diabetes Treatment Clinic (DTC) patients?" These factors include a) demographic characteristics, b) computer…
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2015-06-12
Publicity Campaign without Going Broke (New York: Harper Business, 2008), 282. 46 Gini Dietrich, Spin Sucks: Communication and Reputation Management ...65 Religious themes stress the strict emulation of the practices of the Prophet and his companions as well as the personal, vice collective...but also dynamic medias that target children, teenagers , and adults. A variety of online games, cartoons, and stories have been designed
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From shared care to disease management: key-influencing factors
Eijkelberg, Irmgard M.J.G.; Spreeuwenberg, Cor; Mur-Veeman, Ingrid M.; Wolffenbuttel, Bruce H.R.
2001-01-01
Abstract Background In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called ‘shared care’ projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Objective Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? Theory The theoretical framework is based on the concept of the learning organisation. Design Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. Results In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skilful way. Conclusion Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed. PMID:16896415
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Primary Care Interventions to Reduce Childhood Obesity in Latino Families.
Gonzalez, Giulliana
2016-01-01
Increasing rates of obesity in Latino children call for culturally sensitive primary care interventions. Despite recent efforts to address this growing disparity, little is known about cultural variables that influence obesity management programs in Latino children. A literature search was conducted using CINHAL, Scopus, PubMed, and PsycINFO to review the state of the science regarding primary care interventions to decrease obesity in Latino children. The author analyzed the effects of several cultural practices on obesity and made recommendations based on their clinical implications for weight reduction management programs. Obesity in Latino children is a multifactorial problem influenced by family behaviors, cultural perceptions of weight and health, traditional dietary norms, and socioeconomic status. Current practice lags behind national obesity management recommendations and is further hindered by a lack of consideration of the roles of key cultural differences in Latino families. It is imperative to recognize the importance of family preferences and culture when developing weight reduction programs so as to foster long-term behavior changes. More research assessing the efficacy of culturally competent interventions is necessary to guide national efforts to address this increasing disparity. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
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A systematic review of factors influencing knowledge management and the nurse leaders' role.
Lunden, Anne; Teräs, Marianne; Kvist, Tarja; Häggman-Laitila, Arja
2017-09-01
To describe factors facilitating or inhibiting the development of registered nurses' competency and nurse leader's role in knowledge management. Nurses' competency directly influences patient safety and the quality and effectiveness of patient care. Challenges of nurse leaders in knowledge management include acquiring, assessing and utilising current knowledge and assessing and enhancing competency. A systematic search was conducted in PubMed, CINAHL, SCOPUS and ERIC databases in April 2015. The search identified 18 relevant research articles published between 2009 and 2015. The quality of the studies was appraised in accordance with study designs. Knowledge management is facilitated by an organisation culture that supports learning, sharing of information and learning together. Leader commitment and competency were factors related to leadership facilitating knowledge management. Nurse leaders need evidence-based interventions to support shared learning and to create infrastructures that facilitate competence development. Future research is especially needed to evaluate connections between knowledge management and patient outcomes. The results of this review can be utilised in enhancing factors to facilitate knowledge management in clinical practice and identifying nurse leaders' role in strengthening nurses' competency. © 2017 John Wiley & Sons Ltd.
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Safety intelligence: an exploration of senior managers' characteristics.
Fruhen, L S; Mearns, K J; Flin, R; Kirwan, B
2014-07-01
Senior managers can have a strong influence on organisational safety. But little is known about which of their personal attributes support their impact on safety. In this paper, we introduce the concept of 'safety intelligence' as related to senior managers' ability to develop and enact safety policies and explore possible characteristics related to it in two studies. Study 1 (N = 76) involved direct reports to chief executive officers (CEOs) of European air traffic management (ATM) organisations, who completed a short questionnaire asking about characteristics and behaviours that are ideal for a CEO's influence on safety. Study 2 involved senior ATM managers (N = 9) in various positions in interviews concerning their day-to-day work on safety. Both studies indicated six attributes of senior managers as relevant for their safety intelligence, particularly, social competence and safety knowledge, followed by motivation, problem-solving, personality and interpersonal leadership skills. These results have recently been applied in guidance for safety management practices in a White Paper published by EUROCONTROL. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.
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Hildebran, Christi; Leichtling, Gillian; Irvine, Jessica M; Cohen, Deborah J; Hallvik, Sara E; Deyo, Richard A
2016-11-01
Clinician communication with patients regarding worrisome findings in Prescription Drug Monitoring Programs (PDMPs) may influence patient responses and subsequent care. The authors studied the range of approaches clinicians report when communicating with patients in this situation and how practice policies and procedures may influence this communication. Qualitative interviews of clinician PDMP users. Oregon registrants in the state's PDMP. Thirty-three clinicians practicing in pain management, emergency medicine, primary care, psychiatry, dentistry, and surgery. The authors conducted semi-structured interviews via telephone with clinicians who routinely used the PDMP. A multidisciplinary team used a grounded theory approach to identify ways clinicians reported using information from the PDMP when communicating with patients, and policies that influenced that communication. Clinicians reported using a range of approaches for communicating about PDMP results, from openly sharing, to questioning patients without disclosing access to the PDMP, to avoiding the conversation. Clinicians also reported practice policies and procedures that influenced communication with their patients about prescribing and ongoing care, including policies that normalized use of the PDMP with all patients and those that facilitated difficult conversations by providing a rationale not to prescribe in certain circumstances. Clinicians' self-reported approaches to sharing PDMP findings and communicating prescribing decisions with patients vary and may be facilitated by appropriate practice policies. Such communication may have implications for patient engagement and alliance building. More research is needed to identify best practices and potential guidelines for effectively communicating about PDMP findings, as this may enhance health outcomes. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Torres, Ignacio; Blancas, José; León, Alejandro; Casas, Alejandro
2015-08-05
Mescal production is the main economic activity associated to agaves in Mexico, which involves 53 species mostly harvested from forests. The increasing mescal demand has influenced risk in both agave populations and mescal production, but other social and ecological factors also intervene. We hypothesized that the greater the risk the greater the complexity of management responses; otherwise, the greater the probability of populations' depletion. We analysed this hypothesis by examining the diversity of risk conditions and management practices of Agave inaequidens in the state of Michoacán, in central-western Mexico. We studied five communities of Michoacán, documenting through 41 semi-structured interviews the use forms, risk perception, number of agaves annually extracted, and the management practices. Using a matrix with social-ecological and technological data analyzed by PCA, we evaluated similarities of management contexts. A data matrix with information on risk of agave populations, and other about management practices were analysed also through CCA and PCA. The scores of the first principal components were considered as indexes of risk and management complexity, respectively. A regression analysis of these indexes evaluated their relation. We recorded 34 different uses of A. inaequidens, the most important being mescal production (mentioned by 76.1 % of people interviewed). Nearly 12.5 % of people practice only gathering, but others mentioned the following practices: Selective let standing of agaves for seed production (20 %); in situ transplanting of saplings; seed propagation in nurseries and saplings transplanting to forest (10 %); suckers transplanting (7.5 %); seed dispersal in forests; banning (5 %); enhancing of agave growth by removing tree canopies (2.5 %); transplanting from the wild to live fences (45 %); intensive plantations (35 %). The highest vulnerability of agave populations was identified in communities where risk is not counteracted by management. In two communities we identified the highest risk (annual extraction from 4,353 to 6,557 agaves), but different actions counteracting such risk. Interchange of knowledge and management experiences developed by handlers is crucial for the regional conservation, recovering, and sustainable management of A. inaequidens populations.
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Lipworth, Wendy; Kerridge, Ian; Sweet, Melissa; Jordens, Christopher; Bonfiglioli, Catriona; Forsyth, Rowena
2012-08-01
The phone-hacking scandal that led to the closure of the News of the World newspaper in Britain has prompted international debate about media practices and regulation. It is timely to broaden the discussion about journalistic ethics and conduct to include consideration of the impact of media practices upon the population's health. Many commercial organisations cultivate relationships with journalists and news organisations with the aim of influencing the content of health-related news and information communicated through the media. Given the significant influence of the media on the health of individuals and populations, we should be alert to the potential impact of industry-journalist relationships on health care, health policy and public health. The approach taken by the medical profession to its interactions with the pharmaceutical industry provides a useful model for management of industry influence.
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Emotional intelligence and spiritual well-being: implications for spiritual care.
Beauvais, Audrey; Stewart, Julie G; DeNisco, Susan
2014-01-01
Understanding factors that influence spiritual well-being may improve nurses' spiritual caregiving. This study examined relationships between emotional intelligence (EI) and spiritual well-being (SWB) in undergraduate and graduate nursing students. Using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and the spiritual well-being scale (SWBS) relationships were found between managing emotion and spiritual well-being, and managing emotion and existential well-being. Implications for education and practice are discussed.
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Jadalla, Ahlam A; Hattar, Marianne; Schubert, Christiane C
2015-01-01
A cross-sectional descriptive study was done using the Acculturation Rating scale of Arab Americans-II, and the Health Promotion and Lifestyle Profile II to assess the relationship between acculturation and health promotion practices among Arab Americans. Findings showed that attraction to American culture was the most important predictor of physical activity; whereas attraction to Arabic culture was the most important predictor of stress management and nutritional practices. Results suggest that, when demographics are controlled, acculturation predicts various health promotion practices in different patterns among members of this group. These findings contribute to a better understanding of acculturation's influence on immigrants' health promotion practices.
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Managing insulin therapy during exercise in type 1 diabetes mellitus.
Toni, Sonia; Reali, Maria Francesca; Barni, Federica; Lenzi, Lorenzo; Festini, Filippo
2006-01-01
Exercise is integral to the life of T1DM subjects. Several factors influence the metabolic response to exercise in these patients. Despite physical and psychological benefits of exercise, its hypo- and hyperglycemic effects may cause discouragement from participation in sports and games. To use existing evidence from literature to provide practical indications for the management of insulin therapy in subjects with T1DM who practice sports or physical activities. Bibliographic research was performed on PubMed and the main Systematic Review and Guidelines database were also searched. Existing guidelines are useful but the exact adjustments of insulin dose must be made on an individual basis and these adjustments can be made only by "trial and error" approach. These clinical indications may be a starting point from which health care providers can find practical advices for each patient.
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The impact of nursing leadership and management on the control of HIV/AIDS: an ethnographic study.
Nawafleh, Hani; Francis, Karen; Chapman, Ysanne
2012-10-01
This paper reports on an aspect of a larger ethnographic study that sought to investigate the impact of HIV/AIDS on the practice of primary care nurses in Jordan. Nursing leadership and the style of management adopted by senior nursing and medical administrators at the Ministry of Heath were identified as factors impacting on the practice of the nurses and their capacity to raise community awareness and contribute to the prevention and control of HIV/AIDS. The study was undertaken in three rural and three urban primary health care centres (PHCC). Data collection included participant observation, key informant interviews, and document analysis. These data informed the development of descriptive ethnographic accounts that allowed for the subsequent identification of common and divergent themes reflective of factors recognized as influencing the practice of the nurse participants.
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Ergonomic design for dental offices.
Ahearn, David J; Sanders, Martha J; Turcotte, Claudia
2010-01-01
The increasing complexity of the dental office environment influences productivity and workflow for dental clinicians. Advances in technology, and with it the range of products needed to provide services, have led to sprawl in operatory setups and the potential for awkward postures for dental clinicians during the delivery of oral health services. Although ergonomics often addresses the prevention of musculoskeletal disorders for specific populations of workers, concepts of workflow and productivity are integral to improved practice in work environments. This article provides suggestions for improving workflow and productivity for dental clinicians. The article applies ergonomic principles to dental practice issues such as equipment and supply management, office design, and workflow management. Implications for improved ergonomic processes and future research are explored.
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Omar, Yahya Y; Parker, Alison; Smith, Jennifer A; Pollard, Simon J T
2017-01-15
We investigated cultural influences on the implementation of water safety plans (WSPs) using case studies from WSP pilots in India, Uganda and Jamaica. A comprehensive thematic analysis of semi-structured interviews (n=150 utility customers, n=32 WSP 'implementers' and n=9 WSP 'promoters'), field observations and related documents revealed 12 cultural themes, offered as 'enabling', 'limiting', or 'neutral', that influence WSP implementation in urban water utilities to varying extents. Aspects such as a 'deliver first, safety later' mind set; supply system knowledge management and storage practices; and non-compliance are deemed influential. Emergent themes of cultural influence (ET1 to ET12) are discussed by reference to the risk management, development studies and institutional culture literatures; by reference to their positive, negative or neutral influence on WSP implementation. The results have implications for the utility endorsement of WSPs, for the impact of organisational cultures on WSP implementation; for the scale-up of pilot studies; and they support repeated calls from practitioner communities for cultural attentiveness during WSP design. Findings on organisational cultures mirror those from utilities in higher income nations implementing WSPs - leadership, advocacy among promoters and customers (not just implementers) and purposeful knowledge management are critical to WSP success. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.
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Organizational climate and hospital nurses' caring practices: a mixed-methods study.
Roch, Geneviève; Dubois, Carl-Ardy; Clarke, Sean P
2014-06-01
Organizational climate in healthcare settings influences patient outcomes, but its effect on nursing care delivery remains poorly understood. In this mixed-methods study, nurse surveys (N = 292) were combined with a qualitative case study of 15 direct-care registered nurses (RNs), nursing personnel, and managers. Organizational climate explained 11% of the variation in RNs' reported frequency of caring practices. Qualitative data suggested that caring practices were affected by the interplay of organizational climate dimensions with patients and nurses characteristics. Workload intensity and role ambiguity led RNs to leave many caring practices to practical nurses and assistive personnel. Systemic interventions are needed to improve organizational climate and to support RNs' involvement in a full range of caring practices. © 2014 Wiley Periodicals, Inc.
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Critical management practices influencing on-site waste minimization in construction projects.
Ajayi, Saheed O; Oyedele, Lukumon O; Bilal, Muhammad; Akinade, Olugbenga O; Alaka, Hafiz A; Owolabi, Hakeem A
2017-01-01
As a result of increasing recognition of effective site management as the strategic approach for achieving the required performance in construction projects, this study seeks to identify the key site management practices that are requisite for construction waste minimization. A mixed methods approach, involving field study and survey research were used as means of data collection. After confirmation of construct validity and reliability of scale, data analysis was carried out through a combination of Kruskal-Wallis test, descriptive statistics and exploratory factor analysis. The study suggests that site management functions could significantly reduce waste generation through strict adherence to project drawings, and by ensuring fewer or no design changes during construction process. Provision of waste skips for specific materials and maximisation of on-site reuse of materials are also found to be among the key factors for engendering waste minimization. The result of factor analysis suggests four factors underlying on-site waste management practices with 96.093% of total variance. These measures include contractual provisions for waste minimization, waste segregation, maximisation of materials reuse and effective logistic management. Strategies through which each of the underlying measures could be achieved are further discussed in the paper. Findings of this study would assist construction site managers and other site operatives in reducing waste generated by construction activities. Copyright © 2016 Elsevier Ltd. All rights reserved.
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The effect of physician practice organization on efficient utilization of hospital resources.
Burns, L R; Chilingerian, J A; Wholey, D R
1994-12-01
This study examines variations in the efficient use of hospital resources across individual physicians. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior.
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The effect of physician practice organization on efficient utilization of hospital resources.
Burns, L R; Chilingerian, J A; Wholey, D R
1994-01-01
OBJECTIVE. This study examines variations in the efficient use of hospital resources across individual physicians. DATA SOURCES AND SETTING. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. STUDY DESIGN. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. PRINCIPAL FINDINGS. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. CONCLUSIONS. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior. PMID:8002351
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USDA-ARS?s Scientific Manuscript database
Watershed simulation models are used extensively to investigate hydrologic processes, landuse and climate change impacts, pollutant load assessments and best management practices (BMPs). Developing, calibrating and validating these models require a number of critical decisions that will influence t...
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ABSTRACT Background and Aims. Waterborne diseases originating from bovine fecal material are a significant public health issue. Ensuring water quality requires the use of methods that can consistently identify pollution across a broad range of management practices. One practi...
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Sydenham, Markus A K; Moe, Stein R; Stanescu-Yadav, Diana N; Totland, Ørjan; Eldegard, Katrine
2016-02-01
Anthropogenic landscape elements, such as roadsides, hedgerows, field edges, and power line clearings, can be managed to provide important habitats for wild bees. However, the effects of habitat improvement schemes in power line clearings on components of diversity are poorly studied. We conducted a large-scale experiment to test the effects of different management practices on the species, phylogenetic, and functional diversity of wild bees in power line clearings (n = 19 sites across southeastern Norway) and explored whether any treatment effects were modified by the environmental context. At each site, we conducted the following treatments: (1) Cut: all trees cut and left to decay in the clearing; (2) Cut + Remove: all trees cut and removed from the plot; and (3) Uncut: uncleared. The site-specific environmental context (i.e., elevation and floral diversity) influenced the species, phylogenetic, and functional diversity within bee species assemblages. The largest number of species was found in the Cut + Remove treatment in plots with a high forb species richness, indicating that the outcome of management practices depends on the environmental context. Clearing of treatment plots with many forb species also appeared to alter the phylogenetic composition of bee species assemblages, that is, more closely related species were found in the Cut and the Cut + Remove plots than in the Uncut plots. Synthesis and applications: Our experimental simulation of management practices in power line clearings influenced the species, phylogenetic, and functional diversity of bee species assemblages. Frequent clearing and removal of the woody debris at low elevations with a high forb species richness can increase the value of power line clearings for solitary bees. It is therefore important for managers to consider the environmental context when designing habitat improvement schemes for solitary bees.
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Rangel-Landa, Selene; Casas, Alejandro; García-Frapolli, Eduardo; Lira, Rafael
2017-10-30
Identifying factors influencing plant management allows understanding how processes of domestication operate. Uncertain availability of resources is a main motivation for managing edible plants, but little is known about management motives of non-edible resources like medicinal and ceremonial plants. We hypothesized that uncertain availability of resources would be a general factor motivating their management, but other motives could operate simultaneously. Uncertainty and risk might be less important motives in medicinal than in edible plants, while for ceremonial plants, symbolic and spiritual values would be more relevant. We inventoried edible, medicinal, and ceremonial plants in Ixcatlán, Oaxaca, Mexico, and conducted in-depth studies with 20 native and naturalized species per use type; we documented their cultural importance and abundance by interviewing 25 households and sampling vegetation in 33 sites. Consumption amounts and preferences were studied through surveys and free listings with 38 interviewees. Management intensity and risk indexes were calculated through PCA and their relation analyzed through regression analyses. Canonical methods allowed identifying the main sociocultural and ecological factors influencing management of plants per use type. Nearly 64, 63, and 55% of all ceremonial, edible, and medicinal wild plants recorded, respectively, are managed in order to maintain or increase their availability, embellishing environments, and because of ethical reasons and curiosity. Management intensity was higher in edible plants under human selection and associated with risk. Management of ceremonial and medicinal plants was not associated with indexes of risk or uncertainty in their availability. Other sociocultural and ecological factors influence management intensity, the most important being reciprocal relations and abundance perception. Plant management through practices and collectively regulated strategies is strongly related to control of risk and uncertainty in edible plants, compared with medicinal and ceremonial plants, in which reciprocal interchanges, curiosity, and spiritual values are more important factors. Understanding how needs, worries, social relations, and ethical values influence management decisions is important to understand processes of constructing management strategies and how domestication could be started in the past and are operated at the present.
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Influencers of generic drug utilization: A systematic review.
Howard, Jennifer N; Harris, Ilene; Frank, Gavriella; Kiptanui, Zippora; Qian, Jingjing; Hansen, Richard
2017-08-04
With an increase in prescription drug spending and rising drug costs there is a need to encourage the use of generic prescription drugs. However, maximizing generic drug use is not possible without the public's positive perception and meeting their informational needs about generic drugs. Thus, improving the public's confidence in, and knowledge of generic drugs on the market is critical. The objective of this systematic review is to examine and evaluate the studies focusing on the nature and extent of key factors influencing generic drug use in the United States in order to help guide policy, education and practice interventions. Using multiple search engines and key word screening criteria, empirical studies published in English between January 1, 2005 and December 31, 2015 were identified. A qualitative synthesis of the evidence identified domains of key factors that influenced generic drug use across studies. Over 3000 citations met the key word screening criteria; 67 of these met inclusion criteria for the systematic review. Seven domains of factors that influence generic drug utilization were identified: 1) patient-related factors, 2) formulary management or cost containment, 3) healthcare policies, 4) promotional activities, 5) educational initiatives, 6) technology, and 7) physician-related factors. Patients, physicians, pharmacists, formulary managers, and policymakers play an important role in generic drug use. Understanding the factors influencing generic drug use can help guide future policy, education, and practice interventions to increase generic drug use. Copyright © 2017 Elsevier Inc. All rights reserved.
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The Influence of a Wound Care Teleassistance Service on Nursing Practice: A Case Study in Quebec
Breton, Erik; Courcy, François; Quirion, Sonia; Côté, José; Paré, Guy
2014-01-01
Abstract Background: Although telehealth is a promising solution for healthcare professionals who work in remote and rural regions, the influence of specific telehealth applications on the nursing workforce remains unknown. This case study aimed to explore the potential influence of a teleassistance service in wound care (the acronym in French is TASP) on nursing practices and on nurse retention in peripheral areas. Materials and Methods: We carried out an exploratory single case study based on 16 semistructured interviews with two promoters of TASP, five nursing managers, and nine nurses from three levels of expertise associated with this service. Results: According to participants, the main positive influences of TASP were observed in quality of care, professional autonomy, professional development, and decrease of professional isolation. Participants mentioned increased workload associated with global patient data collection at first consultation as a negative effect of TASP. Finally, three possible effects of TASP on nurse retention were identified: none or minimal, imprecise, or mostly positive. Conclusions: This case study highlights the positive influence of TASP on several dimensions of nursing practice, in addition to its essential role in improving the quality of care. However, it is important to consider that the service cannot be considered as a solution to or replacement for the shortage of nurses. PMID:24694008
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Zald, Harold S J; Dunn, Christopher J
2018-04-26
Many studies have examined how fuels, topography, climate, and fire weather influence fire severity. Less is known about how different forest management practices influence fire severity in multi-owner landscapes, despite costly and controversial suppression of wildfires that do not acknowledge ownership boundaries. In 2013, the Douglas Complex burned over 19,000 ha of Oregon & California Railroad (O&C) lands in Southwestern Oregon, USA. O&C lands are composed of a checkerboard of private industrial and federal forestland (Bureau of Land Management, BLM) with contrasting management objectives, providing a unique experimental landscape to understand how different management practices influence wildfire severity. Leveraging Landsat based estimates of fire severity (Relative differenced Normalized Burn Ratio, RdNBR) and geospatial data on fire progression, weather, topography, pre-fire forest conditions, and land ownership, we asked (1) what is the relative importance of different variables driving fire severity, and (2) is intensive plantation forestry associated with higher fire severity? Using Random Forest ensemble machine learning, we found daily fire weather was the most important predictor of fire severity, followed by stand age and ownership, followed by topographic features. Estimates of pre-fire forest biomass were not an important predictor of fire severity. Adjusting for all other predictor variables in a general least squares model incorporating spatial autocorrelation, mean predicted RdNBR was higher on private industrial forests (RdNBR 521.85 ± 18.67 [mean ± SE]) vs. BLM forests (398.87 ± 18.23) with a much greater proportion of older forests. Our findings suggest intensive plantation forestry characterized by young forests and spatially homogenized fuels, rather than pre-fire biomass, were significant drivers of wildfire severity. This has implications for perceptions of wildfire risk, shared fire management responsibilities, and developing fire resilience for multiple objectives in multi-owner landscapes. © 2018 by the Ecological Society of America.
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Santa Maria, Diane; Swartz, Maria C; Markham, Christine; Chandra, Joya; McCurdy, Sheryl; Basen-Engquist, Karen
2014-01-01
Childhood central nervous system tumor survivors (CCNSTS) are at risk for adverse health issues. Little research has been conducted to explore the role of parental factors in weight management to mitigate adverse health outcomes. We conducted 9 group interviews (n=20) with CCNSTS, their parents, and health care providers to ascertain parental factors that may influence weight management practices in CCNSTS. Three main themes were identified: parenting style, parent-child connectedness, and food and physical activity (PA) environment. Although most parents adopted an authoritative parenting style related to diet and PA practices, some adopted a permissive parenting style. Participants expressed high levels of connection that may hinder the development of peer relationships and described the food and PA environments that promote or hinder weight management through parental modeling of healthy eating and PA and access to healthy food and activities. Weight management interventions for CCNSTS may experience greater benefit from using a family-focused approach, promoting positive food and PA environments, parental modeling of healthy eating and exercise, and partnering with youth to adopt weight management behaviors.
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The management of household hazardous waste in the United Kingdom.
Slack, R J; Gronow, J R; Voulvoulis, N
2009-01-01
Waste legislation in the United Kingdom (UK) implements European Union (EU) Directives and Regulations. However, the term used to refer to hazardous waste generated in household or municipal situations, household hazardous waste (HHW), does not occur in UK, or EU, legislation. The EU's Hazardous Waste Directive and European Waste Catalogue are the principal legislation influencing HHW, although the waste categories described are difficult to interpret. Other legislation also have impacts on HHW definition and disposal, some of which will alter current HHW disposal practices, leading to a variety of potential consequences. This paper discusses the issues affecting the management of HHW in the UK, including the apparent absence of a HHW-specific regulatory structure. Policy and regulatory measures that influence HHW management before disposal and after disposal are considered, with particular emphasis placed on disposal to landfill.
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Sustaining the rural workforce: nursing perspectives on worklife challenges.
Hunsberger, Mabel; Baumann, Andrea; Blythe, Jennifer; Crea, Mary
2009-01-01
Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. Semi-structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well-being of the nurses and patients. The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.
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Animal house: University risk environments and the regulation of students' alcohol use.
Wilkinson, Blair; Ivsins, Andrew
2017-09-01
This article extends the risk environment framework to understand the factors that universities identify as influencing university students' risky drinking behaviours and universities attempts at managing risky alcohol use on their campuses. This article examines data collected as part of qualitative fieldwork on university corporate security services, and others involved in university alcohol policy implementation (e.g., residence services), conducted at five Canadian universities. Interviews (n=56), fieldnotes from 246h of observations of university corporate security personnel, and university policy documents (i.e., codes of student behaviour, residence policies) were analysed to understand the influence of risk environments on high-risk alcohol use. We identify three risk environments on university campuses in relation to the use and regulation of alcohol: the physical, social, and policy environments. Residence buildings and abutting spaces (physical risk environment) and the university "party" culture (social risk environment) are principal contributors to risk within their risk environments. University policies and practices (policy risk environment) attempt to modify these environments in order to manage risky alcohol use. We suggest current approaches to regulating student alcohol use may not be the best approach to preventing harms (e.g., health problems, legal troubles) to students. Given university policies and practices have the potential to shape and influence risky alcohol use and associated harms we argue it is necessary for university administrators to adopt the best practices of "harm reduction" and seek new ways to address on-campus alcohol use. Copyright © 2017 Elsevier B.V. All rights reserved.
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Multidisciplinary management of chronic heart failure: principles and future trends.
Davidson, Patricia M; Newton, Phillip J; Tankumpuan, Thitipong; Paull, G; Dennison-Himmelfarb, Cheryl
2015-10-01
Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect individuals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF. Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management. Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to individual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention. Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that individual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design, implementation, and evaluation of the interventions. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.
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Socioeconomic thresholds that affect use of customary fisheries management tools.
Cinner, Joshua E; Sutton, Stephen G; Bond, Trevor G
2007-12-01
Customary forms of resource management, such as taboos, have received considerable attention as a potential basis for conservation initiatives in the Indo-Pacific. Yet little is known about how socioeconomic factors influence the ability of communities to use customary management practices and whether socioeconomic transformations within communities will weaken conservation initiatives with a customary foundation. We used a comparative approach to examine how socioeconomic factors may influence whether communities use customary fisheries management in Papua New Guinea. We examined levels of material wealth (modernization), dependence on marine resources, population, and distance to market in 15 coastal communities. We compared these socioeconomic conditions in 5 communities that used a customary method of closing their fishing ground with 10 communities that did not use this type of management. There were apparent threshold levels of dependence on marine resources, modernization, distance to markets (<16.5 km), and population (>600 people) beyond which communities did not use customary fisheries closures. Nevertheless, economic inequality, rather than mean modernization levels seemed to influence the use of closures. Our results suggest that customary management institutions are not resilient to factors such as population growth and economic modernization. If customary management is to be used as a basis for modern conservation initiatives, cross-scale institutional arrangements such as networks and bridging organizations may be required to help filter the impacts of socioeconomic transformations.
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A medical home: value and implications of knowledge management.
Orzano, A John; McInerney, Claire R; McDaniel, Reuben R; Meese, Abigail; Alajmi, Bibi; Mohr, Stewart M; Tallia, Alfred F
2009-01-01
Central to the "medical home" concept is the premise that the delivery of effective primary care requires a fundamental shift in relationships among practice members and between practice members and patients. Primary care practices can potentially increase their capacity to deliver effective care through knowledge management (KM), a process of sharing and making existing knowledge available or by developing new knowledge among practice members and patients. KM affects performance by influencing work relationships to enhance learning, decision making, and task execution. We extend our previous work to further characterize, describe, and contrast how primary care practices exhibit KM and explain why KM deserves attention in medical home redesign initiatives. Case studies were conducted, drawn from two higher and lower performing practices, which were purposely selected based on disease management, prevention, and productivity measures from an improvement trial. Observations of operations, clinical encounters, meetings, and interviews with office members and patients were transcribed and coded independently using a KM template developed from a previous secondary analysis. Face-to-face discussions resolved coding differences among research team members. Confirmation of findings was sought from practice participants. Practices manifested varying degrees of KM effectiveness through six interdependent processes and multiple overlapping tools. Social tools, such as face-to-face-communication for sharing and developing knowledge, were often more effective than were expensive technical tools such as an electronic medical record. Tool use was tailored for specific outcomes, interacted with each other, and leveraged by other organizational capacities. Practices with effective KM were more open to adopting and sustaining new ways of functioning, ways reflecting attributes of a medical home. Knowledge management differences occur within and between practices and can explain differences in performance. By relying more on social tools rather than costly, high-tech investment, KM leverages primary care's relationship-centered strength, facilitating practice redesign as a medical home.
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The future of capitation: the physician role in managing change in practice.
Goodson, J D; Bierman, A S; Fein, O; Rask, K; Rich, E C; Selker, H P
2001-04-01
Capitation-based reimbursement significantly influences the practice of medicine. As physicians, we need to assure that payment models do not jeopardize the care we provide when we accept higher levels of personal financial risk. In this paper, we review the literature relevant to capitation, consider the interaction of financial incentives with physician and medical risk, and conclude that primary care physicians need to work to assure that capitated systems incorporate checks and balances which protect both patients and providers. We offer the following proposals for individuals and groups considering capitated contracts: (1) reimbursement for primary care physicians should recognize both individual patient encounters and the administrative work of patient care management; (2) reimbursement for subspecialists should recognize both access to subspecialty knowledge and expertise as well as patient care encounters, but in some situations, subspecialists may provide the majority of care to individual patients and will be reimbursed as primary care providers; (3) groups of physicians should accept financial risk for patient care only if they have the tools and resources to manage the care; (4) physicians sharing risk for patient care should meet regularly to discuss care and resource management; and (5) physicians must disclose the financial relationships they have with health plans and medical care organizations, and engage patients and communities in discussions about resource allocation. As a payment model, capitation offers opportunities for primary care physicians to influence the future of health care by improving the management of resources at a local level.
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Spence Laschinger, Heather K; Zhu, Junhong; Read, Emily
2016-07-01
To test a model examining the effects of structural empowerment and support for professional practice on new graduate nurses' perceived professional practice behaviours, perceptions of care quality and subsequent job satisfaction and career turnover intentions. The nursing worklife model describes relationships between supportive nursing work environments and nurse and patient outcomes. The influence of support for professional practice on new nurses' perceptions of professional nursing behaviours within this model has not been tested. Structural equation modelling in Mplus was used to analyse data from a national survey of new nurses across Canada (n = 393). The hypothesised model was supported: χ²(122) = 346.726, P = 0.000; CFI = 0.917; TLI = 0.896; RMSEA = 0.069. Professional practice behaviour was an important mechanism through which empowerment and supportive professional practice environments influenced nurse-assessed quality of care, which was related to job satisfaction and lower intentions to leave nursing. Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviours and high-quality patient care. Nurse managers can support new graduate nurses' professional practice behaviour by providing empowering supportive professional practice environments. © 2016 John Wiley & Sons Ltd.
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Lammoglia, Sabine-Karen; Makowski, David; Moeys, Julien; Justes, Eric; Barriuso, Enrique; Mamy, Laure
2017-02-15
STICS-MACRO is a process-based model simulating the fate of pesticides in the soil-plant system as a function of agricultural practices and pedoclimatic conditions. The objective of this work was to evaluate the influence of crop management practices on water and pesticide flows in contrasted environmental conditions. We used the Morris screening sensitivity analysis method to identify the most influential cropping practices. Crop residues management and tillage practices were shown to have strong effects on water percolation and pesticide leaching. In particular, the amount of organic residues added to soil was found to be the most influential input. The presence of a mulch could increase soil water content so water percolation and pesticide leaching. Conventional tillage was also found to decrease pesticide leaching, compared to no-till, which is consistent with many field observations. The effects of the soil, crop and climate conditions tested in this work were less important than those of cropping practices. STICS-MACRO allows an ex ante evaluation of cropping systems and agricultural practices, and of the related pesticides environmental impacts. Copyright © 2016 Elsevier B.V. All rights reserved.
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Lindahl, Jared R; Fisher, Nathan E; Cooper, David J; Rosen, Rochelle K; Britton, Willoughby B
2017-01-01
Buddhist-derived meditation practices are currently being employed as a popular form of health promotion. While meditation programs draw inspiration from Buddhist textual sources for the benefits of meditation, these sources also acknowledge a wide range of other effects beyond health-related outcomes. The Varieties of Contemplative Experience study investigates meditation-related experiences that are typically underreported, particularly experiences that are described as challenging, difficult, distressing, functionally impairing, and/or requiring additional support. A mixed-methods approach featured qualitative interviews with Western Buddhist meditation practitioners and experts in Theravāda, Zen, and Tibetan traditions. Interview questions probed meditation experiences and influencing factors, including interpretations and management strategies. A follow-up survey provided quantitative assessments of causality, impairment and other demographic and practice-related variables. The content-driven thematic analysis of interviews yielded a taxonomy of 59 meditation-related experiences across 7 domains: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Even in cases where the phenomenology was similar across participants, interpretations of and responses to the experiences differed considerably. The associated valence ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring. In order to determine what factors may influence the valence, impact, and response to any given experience, the study also identified 26 categories of influencing factors across 4 domains: practitioner-level factors, practice-level factors, relationships, and health behaviors. By identifying a broader range of experiences associated with meditation, along with the factors that contribute to the presence and management of experiences reported as challenging, difficult, distressing or functionally impairing, this study aims to increase our understanding of the effects of contemplative practices and to provide resources for mediators, clinicians, meditation researchers, and meditation teachers.
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The influence of facility design and human resource management on health care professionals.
Sadatsafavi, Hessam; Walewski, John; Shepley, Mardelle M
2015-01-01
Cost control of health care services is a strategic concern for organizations. To lower costs, some organizations reduce staffing levels. However, this may not be worth the trade-off, as the quality of services will likely be reduced, morale among health care providers tends to suffer, and patient satisfaction is likely to decline. The potential synergy between human resource management and facility design and operation was investigated to achieve the goal of providing cost containment strategies without sacrificing the quality of services and the commitment of employees. About 700 health care professionals from 10 acute-care hospitals participated in this cross-sectional study. The authors used structural equation modeling to test whether employees' evaluations of their physical work environment and human resource practices were significantly associated with lower job-related anxiety, higher job satisfaction, and higher organizational commitment. The analysis found that employees' evaluations of their physical work environment and human resource practices influenced their job-related feelings and attitudes. Perceived organizational support mediated this relationship. The study also found a small but positive interaction effect between the physical work environment and human resource practices. The influence of physical work environment was small, mainly because of the high predictive value of human resource practices and strong confounding variables included in the analysis. This study specifically showed the role of facility design in reducing job-related anxiety among caregivers. Preliminary evidence is provided that facility design can be used as a managerial tool for improving job-related attitudes and feelings of employees and earning their commitment. Providing a healthy and safe work environment can be perceived by employees as an indication that the organization respects them and cares about their well-being, which might be reciprocated with higher levels of motivation and commitment toward the organization.
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NASA Astrophysics Data System (ADS)
Perrault, Anne Marie
The purpose of this study was to examine biology teachers' perceptions of how their online information seeking practices influence their instructional planning. When teachers engage in activities to locate, evaluate, and use online information and resources, a myriad of inter-related and often inseparable consequences follows. These influences may be any combination of direct/indirect, desirable/undesirable, or anticipated/unanticipated (Rogers, 2003). This exploratory study collected baseline data regarding teachers' online practices and its influence on their practice. There were two phases of data collection in this study. Phase I was an online survey of more than seventy New York State biology teachers. The survey was intended to capture (1) a snapshot of the biology teachers' online information seeking practices during the summer and fall 2004, and (2) their perceptions regarding how their online practices influenced their instructional planning. In Phase II, ten study participants were interviewed in order to explore in greater detail the consequences of their online information seeking practices on their instructional planning. Four themes reflecting the consequences of teachers' information seeking practices emerged from the data analysis: Currency of Information; Sparking of Ideas and Gaining Personal Knowledge; Resource Management and the Role of Time; and Webs of Sharing. Each theme encompassed both the purposeful and the indirect actions by teachers to access knowledge and resources to refine and improve their instructional planning. This study's findings show that teachers are using a greater number and wider range of current and multi-modal resources than pre-Internet and they perceive this as an advantage in creating authentic, inquiry-based learning experiences. A notable discovery was of the under-use by teachers of educational online resources specifically designed to support teaching and learning activities (e.g., digital libraries, online databases, and listservs). This study's findings point to a recursive process in which teachers are engaged in ongoing online information seeking practices; continually learning and fostering new knowledge; integrating the learning into their instructional planning practices; changing their teaching strategies; and going back online to search for information and resources and begin the cycle again.
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SAFE Medication Management for Patients with Physical Impairments of Stroke, Part One.
Yetzer, Elizabeth; Blake, Karen; Goetsch, Nancy; Shook, Mary; St Paul, Marilyn
2015-01-01
This article focuses on the extensive impairments of stroke and their influence on medication management. The impairments of motor skills due to paralysis-loss of mobility and balance, lack of hand-to-mouth coordination, and difficulty swallowing-are discussed. A future article will discuss sensory impairments of vision, hearing, cognition, comprehension, communication, and emotional disorders and how these impairments influence medication management. Each of the impairments are presented and discussed, and possible interventions are proposed. Every patient is an individual and requires variable care plans. Intervention strategies that include tools for patient assessment, practice tips, and devices available to assist the patient and family in safe medication management are presented. Patient outcomes and successes vary, but the strategies outlined will return the patient to as close to previous capabilities as possible. Teaching SAFE (Systematic, Accurate, Functional, Effective) medication management to the patient, family, and caregivers will increase medication safety and decrease the number of adverse effects. The rehabilitation nurse is charged with evaluating the patients' needs and developing strategies to assist them to manage their medications. © 2014 Association of Rehabilitation Nurses.
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Systems Theory, Excellence, and Values: Will They Mix?
ERIC Educational Resources Information Center
Bowen, Howard R.
1977-01-01
Academic planning in higher education is strongly influenced by business management theories and practices. The author questions the usefulness of this approach because the nature of higher education differs from the nature of a profit-making business. However, rational planning to achieve efficiency is relevant if efficiency is not confined to…
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ERIC Educational Resources Information Center
Andergassen, Monika; Mödritscher, Felix; Neumann, Gustaf
2014-01-01
Learner-centric research on factors influencing learning results has focused, among other things, on student characteristics, demographic data, and usage patterns in learning management systems (LMSs). This paper complements the existing research by investigating potential correlations between learning results and LMS usage during exam…
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Campus-Based Practices for Promoting Student Success: Financial Aid. Research Brief
ERIC Educational Resources Information Center
Horn, Aaron S.; Reinert, Leah
2014-01-01
Financial aid may be particularly critical for promoting full-time enrollment, continuous enrollment, and a manageable balance of school and work responsibilities, which influence the likelihood of timely degree completion (Adelman, 2006; Attewell, Heil, & Reisel, 2012; Hossler et al., 2009). For example, Attewell, Heil, and Reisel (2012)…
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Social and Emotional Learning and Teachers
ERIC Educational Resources Information Center
Schonert-Reichl, Kimberly A.
2017-01-01
Teachers are the engine that drives social and emotional learning (SEL) programs and practices in schools and classrooms, and their own social-emotional competence and wellbeing strongly influence their students. But when teachers poorly manage the social and emotional demands of teaching, students' academic achievement and behavior both suffer.…
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Thinning increases climatic resilience of red pine
Matthew Magruder; Sophan Chhin; Brian Palik; John B. Bradford
2013-01-01
Forest management techniques such as intermediate stand-tending practices (e.g., thinning) can promote climatic resiliency in forest stands by moderating tree competition. Residual trees gain increased access to environmental resources (i.e., soil moisture, light), which in turn has the potential to buffer trees from stressful climatic conditions. The influences of...
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Management and Leadership Issues for School Building Leaders
ERIC Educational Resources Information Center
Tobin, James
2014-01-01
School principals are confronted with a variety of issues as they provide leadership and organization to their schools. Evidence is growing that successful school leaders influence achievement through the support and development of effective teachers and the implementation of effective organizational practice (Davis, Darling-Hammond, LaPointe,…
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Grazing effect on woody plant recruitment in a Sonoran Desert grassland across space and time
USDA-ARS?s Scientific Manuscript database
Livestock grazing is a commonly cited factor contributing to shrub encroachment in savannas and grasslands. Patterns of woody plant proliferation are known to influence rates of erosion and spread of disturbance and are of practical importance to livestock management with regard to forage distribut...
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Influence of forest management and previous herbivory on cattle diets
Kenric J. Walburger; Timothy DelCurto; Martin Vavra
2007-01-01
Grazing cattle and timber harvest are common practices associated with forested rangelands. Therefore, the objective was to document the effects of timber harvest and herbivory on nutritional quality and botanical composition of steer diets in grand fir (Abies grandis [Dougl. ex D. Don] Lindl.) and ponderosa pine (Pinus ponderosa...
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Enhancing wildlife habitat when regenerating stands
Frank R., III Thompson
1989-01-01
Forest regeneration cuttings affect wildlife habitat more drastically than most forest management practices because a mature forest stand is replaced by a young sapling stand. Regeneration cuttings quickly provide habitat for many wildlife species but they also influence wildlife use of the new stand and adjacent areas throughout the rotation. Retaining snags, cavity...
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Manure storage capacity and application timing influence watershed-level nutrient losses
USDA-ARS?s Scientific Manuscript database
Current concerns over water quality requires best management practices for land-applied manure. One important strategy is to apply manure at right timing, which though is often greatly affected by manure generation and storage capacities in a given watershed. This study was to test the hypotheses: (...
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Landscape-scale geographic variations in microbial indices and labile phosphorus in Hapludults
USDA-ARS?s Scientific Manuscript database
Long-term soil and nutrient management practices can have lasting effects on the geographic distribution of soil microorganisms, function, and non-mobile nutrients such as phosphorus (P). The non-random redistribution can influence nutrient turnover rate and use efficiency of crops, in comparison to...
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Negotiating Contexts to Construct an Identity as a Mathematics Teacher
ERIC Educational Resources Information Center
Hodges, Thomas E.; Cady, Jo Ann
2012-01-01
The authors focused on 1 middle-grades mathematics teacher's identity and her efforts to implement standards-based instructional practices. As professionals, teachers participate in multiple professional communities and must negotiate and manage conflicting agendas. The authors analyze how the contexts of these communities influence the teacher's…
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USDA-ARS?s Scientific Manuscript database
Agricultural production responds to economic, social, environmental, and technological drivers operating both internal and external to the production system. These drivers influence producers’ decision making processes, and act to shape the individual production systems through modification of produ...
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Use of a Laboratory Field Project in an Introductory Crop Science Course.
ERIC Educational Resources Information Center
Lane, Robert A.
1986-01-01
Assesses the benefits resulting from a laboratory field project and report for agricultural students in an introductory crop science course. Student responses to evaluation statements indicated that the project helped them identify crops, understand cultural and management practices, and recognize environmental influences that affect crop…
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The Mechanism for Organising and Propelling Educational Technology in China
ERIC Educational Resources Information Center
Yongqian, Liu; Dongyuan, Cheng; Xinli, Liu
2010-01-01
Having started early in the 1920s as a spontaneously launched educational activity by civil organisations under the influence of American audio-visual theory and practice, Chinese educational technology was later put under governmental management. This paper is composed of five parts covering mainly the historical development of educational…
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Assessing quality of citizen scientists’ soil texture estimates to evaluate land potential
USDA-ARS?s Scientific Manuscript database
Texture influences nearly all soil processes and is often the most measured parameter in soil science. Estimating soil texture is a universal and fundamental practice applied by resource scientists to classify and understand the behavior and management of soil systems. While trained soil scientist c...
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Kozaruk, M K; Churchill, R; Windsor, P A
2015-04-01
To describe an ovine parasitological monitoring service delivered by a rural veterinary practice and determine associations between flock, anthelmintic and monitoring factors and worm control. Retrospective study of records from a rural veterinary practice in south-eastern Australia over an 8.75-year period. Records of sheep producers using veterinary services for gastrointestinal parasite management from 1 August 2003 to 30 April 2012 were analysed. Results from pre- (FECt1 ) and post-treatment faecal egg counts (FECt2 ) were used to identify factors influencing anthelmintic effectiveness, calculated as faecal egg count reduction percentage (FECR%) by linear mixed model analyses. The trends in anthelmintic merchandising and uptake of veterinary services for parasite management were determined by logistic regression analyses. FECR% varied according to the treatment group used (P < 0.001), with an apparent decreasing effectiveness of the macrocylic lactone group over the duration of the study (P = 0.008). Wether and ram flocks displayed lower FECR% than ewe flocks (P < 0.05). Time between FECt1 and treatment (P = 0.031), as well as time between treatment and FECt2 (P < 0.001), had a significant negative association with FECR%. The proportion of properties purchasing 4-way combination anthelmintics increased significantly over the study period (P < 0.001), with declines observed in other anthelmintics (P < 0.05). The proportion of properties performing FECR% monitoring to those that purchased anthelmintics increased significantly over the study period (P = 0.001). Anthelmintic treatment type, sex of the flock and time between drenching and testing had the greatest influence on drench effectiveness (FECR%). An increasing reliance on 4-way combination drenches to manage gastrointestinal parasitism was demonstrated. Benefits of parasitological monitoring include: appropriate advice on parasitological management; observations on trends in regional anthelmintic usage; estimation of drench effectiveness; early indication of anthelmintic resistance; and improved service provision by the rural veterinary practice. © 2015 Australian Veterinary Association.
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Egan, Gary; Crawley, Michael J; Fornara, Dario A
2018-02-01
Common grassland management practices include animal grazing and the repeated addition of lime and nutrient fertilizers to soils. These practices can greatly influence the size and distribution of different soil aggregate fractions, thus altering the cycling and storage of carbon (C) and nitrogen (N) in grassland soils. So far, very few studies have simultaneously addressed the potential long-term effect that multiple management practices might have on soil physical aggregation. Here we specifically ask whether and how grazing, liming and nutrient fertilization might influence C and N content (%) as well as C and N pools of different soil aggregate fractions in a long-term grassland experiment established in 1991 at Silwood Park, Berkshire, UK. We found that repeated liming applications over 23years significantly decreased the C pool (i.e. gCKg -1 soil) of Large Macro Aggregate (LMA>2mm) fractions and increased C pools within three smaller soil aggregate fractions: Small Macro Aggregate (SMA, 250μm-2mm), Micro Aggregate (MiA, 53-250μm), and Silt Clay Aggregate (SCA<53μm). Soil C (and N) accrual in smaller fractions was mainly caused by positive liming effects on aggregate fraction mass rather than on changes in soil C (and N) content (%). Liming effects could be explained by increases in soil pH, as this factor was significantly positively related to greater soil C and N pools of smaller aggregate fractions. Long-term grazing and inorganic nutrient fertilization had much weaker effects on both soil aggregate-fraction mass and on soil C and N concentrations, however, our evidence is that these practices could also contribute to greater C and N pools of smaller soil fractions. Overall our study demonstrates how agricultural liming can contribute to increase C pools of small (more stable) soil fractions with potential significant benefits for the long-term C balance of human-managed grassland soils. Copyright © 2017 Elsevier B.V. All rights reserved.
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Orthopedic Surgeons' Management of Elective Surgery for Patients Who Use Nicotine.
Lilley, Matthew; Krosin, Michael; Lynch, Tennyson L; Leasure, Jeremi
2017-01-01
Despite significant research documenting the detrimental effects of tobacco, the orthopedic literature lacks evidence regarding how surgeons alter their management of elective surgery when patients use nicotine. To better understand how patients' use of nicotine influences orthopedic surgeons' pre- and postoperative management of elective surgery, a 9-question paper survey was distributed at the 2012 annual meeting of the American Academy of Orthopaedic Surgeons among attending US orthopedic surgeons, including general orthopedists and specialty-trained orthopedic surgeons. Survey questions focused on attitudes and practice management regarding patients who use nicotine. Using a chi-square test, no statistically significant variation was observed between subspecialists and general orthopedists or among different subspecialties. Ninety-eight percent of the orthopedic surgeons surveyed counseled tobacco users about the adverse effects of nicotine. However, approximately half of all of the respondents spent less than 5 minutes on perioperative nicotine counseling. Forty-one percent of all of the respondents never delayed elective surgery because of a patient's nicotine use, followed closely by 39% delaying surgery for less than 3 months. Subspecialty had little influence on how orthopedic surgeons managed nicotine users. The high rate of counseling on the adverse effects of nicotine suggested agreement regarding the detrimental effects of smoking. However, the study population infrequently delayed surgery or used smoking cessation measures. Studies are needed to determine why few surgeons frequently alter the management of nicotine users and what modifications in orthopedic practice could improve outcomes for these patients. [Orthopedics. 2017; 40(1):e90-e94.]. Copyright 2016, SLACK Incorporated.
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Water demand management in Yemen and Jordan: addressing power and interests.
Zeitoun, Mark; Allan, Tony; Al Aulaqi, Nasser; Jabarin, Amer; Laamrani, Hammou
2012-01-01
This paper investigates the extent to which entrenched interests of stakeholder groups both maintain water use practice, and may be confronted. The focus is on the agricultural sectors of Yemen and Jordan, where water resource policymakers face resistance in their attempts to reduce water use to environmentally sustainable levels through implementation of water demand management (WDM) activities. Some farmers in both countries that have invested in irrigated production of high-value crops (such as qat and bananas) benefit from a political economy that encourages increased rather than reduced water consumption. The resultant over-exploitation of water resources affects groups in unequal measures. Stakeholder analysis demonstrates that the more ‘powerful’ groups (chiefly the large landowners and the political elites, as well as the ministries of irrigation over which they exert influence) are generally opposed to reform in water use, while the proponents of WDM (e.g. water resource managers, environmental ministries and NGOs, and the international donor community) are found to have minimal influence over water use policy and decisionmaking. Efforts and ideas attempted by this latter group to challenge the status quo are classified here as either (a) influencing or (b) challenging the power asymmetry, and the merits and limits of both approaches are discussed. The interpretation of evidence suggests current practice is likely to endure, but may be more effectively challenged if a long-term approach is taken with an awareness of opportunities generated by windows of opportunity and the participation of ‘overlap groups’.
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Betschart, J
1996-01-01
Healthcare providers who work with adolescents with diabetes are in an ideal position to provide education and support regarding contraceptive issues. Diabetes educators and other health professionals who counsel teens focus on other aspects of diabetes care and management but frequently do not address sexual issues or assess contraceptive practices. The purpose of this paper is to review oral contraceptive issues for teens with diabetes and to provide practice implications for health professionals who are in a favorable position to influence the quality of diabetes and general health care for these adolescents.
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2012-12-01
problems in this area. Similarly, only 4 Nations were not able in general to provide the required numbers of medical NCOs ( nurses , paramedics, etc.) and...of service and employment status (i.e. license for private practice , teaching, etc.) n 1Other measures 6Human Resources Management 12Financial... practical skills in speciality.” Private practice and private teaching have to conform to some requirements : flexible working hours on duty, “good
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Managing heart failure in the long-term care setting: nurses' experiences in Ontario, Canada.
Strachan, Patricia H; Kaasalainen, Sharon; Horton, Amy; Jarman, Hellen; D'Elia, Teresa; Van Der Horst, Mary-Lou; Newhouse, Ian; Kelley, Mary Lou; McAiney, Carrie; McKelvie, Robert; Heckman, George A
2014-01-01
Implementation of heart failure guidelines in long-term care (LTC) settings is challenging. Understanding the conditions of nursing practice can improve management, reduce suffering, and prevent hospital admission of LTC residents living with heart failure. The aim of the study was to understand the experiences of LTC nurses managing care for residents with heart failure. This was a descriptive qualitative study nested in Phase 2 of a three-phase mixed methods project designed to investigate barriers and solutions to implementing the Canadian Cardiovascular Society heart failure guidelines into LTC homes. Five focus groups totaling 33 nurses working in LTC settings in Ontario, Canada, were audiorecorded, then transcribed verbatim, and entered into NVivo9. A complex adaptive systems framework informed this analysis. Thematic content analysis was conducted by the research team. Triangulation, rigorous discussion, and a search for negative cases were conducted. Data were collected between May and July 2010. Nurses characterized their experiences managing heart failure in relation to many influences on their capacity for decision-making in LTC settings: (a) a reactive versus proactive approach to chronic illness; (b) ability to interpret heart failure signs, symptoms, and acuity; (c) compromised information flow; (d) access to resources; and (e) moral distress. Heart failure guideline implementation reflects multiple dynamic influences. Leadership that addresses these factors is required to optimize the conditions of heart failure care and related nursing practice.
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Romani, Simona; Grappi, Silvia; Bagozzi, Richard P; Barone, Ada Maria
2018-02-01
Recent research has started to show the key role of daily food provision practices in affecting household food waste. Building on and extending these previous contributions, the objective of this paper is to investigate how individuals' everyday practices regarding food (e.g., shopping, cooking, eating, etc.) lead to food waste, and how policy makers and the food industry can implement effective strategies to influence such practices and ultimately help consumers reduce food waste. The research performs three Studies; a critical incident qualitative study (Study 1; N = 514) and a quantitative, survey-based study (Study 2; N = 456) to identify and examine relevant food management behaviors associated with domestic waste. Lastly, findings from a field experiment (Study 3; N = 210) suggest that a specific educational intervention, directed at increasing consumers' perceived skills related to food preparation planning behaviors, reduces domestic food waste. Implications of the research for policy makers and the food industry are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.
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2013-01-01
Background Organizational culture is manifest in patterns of behaviour underpinned by beliefs, values, attitudes and assumptions, which can influence working practices. Cultural factors and working practices have been suggested to influence the transition of young people moving from child to adult mental health services. Failure to manage and integrate transitional care effectively can lead to young people losing contact with health and social care systems, resulting in adverse effects on health, well-being and potential. Methods The study aim was to identify the organisational factors which facilitate or impede transition of young people from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) from the perspective of health professionals and representatives of voluntary organisations. Specific objectives were (i) to explore organizational cultures, structures, processes and resources which influence transition from child to adult mental health services; (ii) identify factors which constitute barriers and facilitators to transition and continuity of care and (iii) make recommendations for service improvements. Within an exploratory, qualitative design thirty four semi-structured interviews were conducted with health and social care professionals working in CAMHS and AMHS in four NHS Mental Health Trusts and four voluntary organizations, in England. Results A cultural divide appears to exist between CAMHS and AMHS, characterized by different beliefs, attitudes, mutual misperceptions and a lack of understanding of different service structures. This is exacerbated by working practices relating to communication and information transfer which could impact negatively on transition, relational, informational and cross boundary continuity of care. There is also evidence of a cultural shift, with some positive approaches to collaborative working across services and agencies, involving joint posts, parallel working, shared clinics and joint meetings. Conclusions Cultural factors embodied in mutual misperceptions, attitudes, beliefs exist between CAMHS and AMHS. Working practices can exert either positive or negative effects on transition and continuity of care. Implementation of shared education and training, standardised approaches to record keeping and information transfer, supported by compatible IT resources are recommended, alongside management strategies which evaluate the achievement of outcomes related to transition and continuity of care. PMID:23822089
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McLaren, Susan; Belling, Ruth; Paul, Moli; Ford, Tamsin; Kramer, Tami; Weaver, Tim; Hovish, Kimberly; Islam, Zoebia; White, Sarah; Singh, Swaran P
2013-07-03
Organizational culture is manifest in patterns of behaviour underpinned by beliefs, values, attitudes and assumptions, which can influence working practices. Cultural factors and working practices have been suggested to influence the transition of young people moving from child to adult mental health services. Failure to manage and integrate transitional care effectively can lead to young people losing contact with health and social care systems, resulting in adverse effects on health, well-being and potential. The study aim was to identify the organisational factors which facilitate or impede transition of young people from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) from the perspective of health professionals and representatives of voluntary organisations. Specific objectives were (i) to explore organizational cultures, structures, processes and resources which influence transition from child to adult mental health services; (ii) identify factors which constitute barriers and facilitators to transition and continuity of care and (iii) make recommendations for service improvements. Within an exploratory, qualitative design thirty four semi-structured interviews were conducted with health and social care professionals working in CAMHS and AMHS in four NHS Mental Health Trusts and four voluntary organizations, in England. A cultural divide appears to exist between CAMHS and AMHS, characterized by different beliefs, attitudes, mutual misperceptions and a lack of understanding of different service structures. This is exacerbated by working practices relating to communication and information transfer which could impact negatively on transition, relational, informational and cross boundary continuity of care. There is also evidence of a cultural shift, with some positive approaches to collaborative working across services and agencies, involving joint posts, parallel working, shared clinics and joint meetings. Cultural factors embodied in mutual misperceptions, attitudes, beliefs exist between CAMHS and AMHS. Working practices can exert either positive or negative effects on transition and continuity of care. Implementation of shared education and training, standardised approaches to record keeping and information transfer, supported by compatible IT resources are recommended, alongside management strategies which evaluate the achievement of outcomes related to transition and continuity of care.
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Points of Influence for Lethal Means Counseling and Safe Gun Storage Practices.
Runyan, Carol W; Brooks-Russell, Ashley; Betz, Marian E
2018-06-07
Counseling about reducing access to lethal means of suicide, especially firearms, is a recommended practice in emergency departments (EDs) but does not occur routinely. Understanding influencers of decisions makers in health care (ED nurse leaders, mental health providers) and temporary firearm storage (law enforcement and gun retailers) could enhance practice. We surveyed these 4 groups in the 8-state region of the Mountain West. For ED nurse leaders (n = 190), hospital legal, risk management, and quality improvement representatives, and the ED nursing director were most often cited as influential, whereas mental health providers (n = 67) cited their own team. Law enforcement officials (n = 448) identified the overall community and leaders of mental health or general health organizations as influential. Firearm retailers (n = 95) cited local law enforcement and national firearm organizations. Advocacy from influential groups may encourage efforts to provide lethal means counseling and temporary off-site storage of firearms for suicide prevention.
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Clinicians’ Expectations of Web 2.0 as a Mechanism for Knowledge Transfer of Stroke Best Practices
David, Isabelle; Rochette, Annie
2012-01-01
Background Health professionals are increasingly encouraged to adopt an evidence-based practice to ensure greater efficiency of their services. To promote this practice, several strategies exist: distribution of educational materials, local consensus processes, educational outreach visits, local opinion leaders, and reminders. Despite these strategies, gaps continue to be observed between practice and scientific evidence. Therefore, it is important to implement innovative knowledge transfer strategies that will change health professionals’ practices. Through its interactive capacities, Web 2.0 applications are worth exploring. As an example, virtual communities of practice have already begun to influence professional practice. Objective This study was initially developed to help design a Web 2.0 platform for health professionals working with stroke patients. The aim was to gain a better understanding of professionals’ perceptions of Web 2.0 before the development of the platform. Methods A qualitative study following a phenomenological approach was chosen. We conducted individual semi-structured interviews with clinicians and managers. Interview transcripts were subjected to a content analysis. Results Twenty-four female clinicians and managers in Quebec, Canada, aged 28-66 participated. Most participants identified knowledge transfer as the most useful outcome of a Web 2.0 platform. Respondents also expressed their need for a user-friendly platform. Accessibility to a computer and the Internet, features of the Web 2.0 platform, user support, technology skills, and previous technological experience were found to influence perceived ease of use and usefulness. Our results show that the perceived lack of time of health professionals has an influence on perceived behavioral intention to use it despite favorable perception of the usefulness of the Web 2.0 platform. Conclusions In conclusion, female health professionals in Quebec believe that Web 2.0 may be a useful mechanism for knowledge transfer. However, lack of time and lack of technological skills may limit their use of a future Web 2.0 platform. Further studies are required with other populations and in other regions to confirm these findings. PMID:23195753
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Scientism, conflicts of interest, and the marginalization of ethics in medical education.
Mayes, Christopher; Williams, Jane; Kerridge, Ian; Lipworth, Wendy
2017-11-03
This paper reports on the findings from 6 focus groups conducted with Australian medical students. The focus groups sought students' perspectives on how the influence of commercial interests on medical practice and education could be managed. We conducted 6 focus groups with medical students in New South Wales, Australia. Participants were recruited via student-run medical society and faculty e-mail lists. Forty-nine students from 6 medical schools in New South Wales participated. The research team reflected on the extent to which students uncritically appealed to science in the abstract as a management solution for conflicts of interest. Data analysis was largely inductive, looking for uses of scientific terminology, EBM, and appeals to "science" in the management of COI and applied theoretical analyses of scientism. The students in our study suggested that science and evidence-based medicine, rather than ethics or professionalism, were the best tools to deal with undue influence and bias. This paper uses philosophy of science literature to critically examine these scientistic appeals to science and EBM as a means of managing the influence of pharmaceutical reps and commercial interests. We argue that a scientistic style of reasoning is reinforced through medical curricula and that students need to be made aware of the epistemological assumptions that underpin science, medicine, and EBM to address the ethical challenges associated with commercialised health care. More work is needed to structure medical curricula to reflect the complexities of practice and realities of science. However, curricula change alone will not sufficiently address issues associated with commercial interests in medicine. For real change to occur, there needs to be a broader social and professional debate about the ways in which medicine and industry interact, and structural changes that restrict or mitigate commercial influences in educational, research, and policy settings. © 2017 John Wiley & Sons, Ltd.
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Agricultural practices and residual corn during spring crane and waterfowl migration in Nebraska
Sherfy, M.H.; Anteau, M.J.; Bishop, A.A.
2011-01-01
Nebraska's Central Platte River Valley (CPRV) is a major spring-staging area for migratory birds. Over 6 million ducks, geese, and sandhill cranes (Grus canadensis) stage there en route to tundra, boreal forest, and prairie breeding habitats, storing nutrients for migration and reproduction by consuming primarily corn remaining in fields after harvest (hereafter residual corn). In springs 2005-2007, we measured residual corn density in randomly selected harvested cornfields during early (n=188) and late migration (n=143) periods. We estimated the mean density of residual corn for the CPRV and examined the influence of agricultural practices (post-harvest field management) and migration period on residual corn density. During the early migration period, residual corn density was greater in idle harvested fields than any other treatments of fields (42%, 48%, 53%, and 92% more than grazed, grazed and mulched, mulched, and tilled fields, respectively). Depletion of residual corn from early to late migration did not differ among post-harvest treatments but was greatest during the year when overall corn density was lowest (2006). Geometric mean early-migration residual corn density for the CPRV in 2005-2007 (42.4 kg/ha; 95% CI=35.2-51.5 kg/ha) was markedly lower than previously published estimates, indicating that there has been a decrease in abundance of residual corn available to waterfowl during spring staging. Increases in harvest efficiency have been implicated as a cause for decreasing corn densities since the 1970s. However, our data show that post-harvest management of cornfields also can substantially influence the density of residual corn remaining in fields during spring migration. Thus, managers may be able to influence abundance of high-energy foods for spring-staging migratory birds in the CPRV through programs that influence post-harvest management of cornfields. ?? 2011 The Wildlife Society.
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Hoskins, Gaylor; Williams, Brian; Jackson, Cathy; Norman, Paul; Donnan, Peter
2012-05-01
Achieving asthma control is central to optimising patient quality of life and clinical outcome. Contemporary models of chronic disease management across a variety of countries point to the importance of micro, meso and macro level influences on patient care and outcome. However, asthma outcomes research has almost invariably concentrated on identifying and addressing patient predictors. Little is known about higher level organisational influences. This paper explores the contribution of organisational factors on poor asthma control, allowing for patient factors, at three organisational levels: the individual patient, local service deliverers, and strategic regional providers. Prospective cross-sectional observational cohort study of 64,929 people with asthma from 1205 primary care practices spread throughout the United Kingdom (UK). Patient clinical data were recorded during a routine asthma review. Data were analysed using simple descriptive, multiple regression and complex multi-level modelling techniques, accounting for practice clustering of patients. Poor asthma control was associated with areas of higher deprivation [regression coefficient 0.026 (95% confidence intervals 0.006; 0.046)] and urban practice [-0.155 (-0.275; -0.035)] but not all local and regional variation was explained by the data. In contrast, patient level predictors of poor control were: short acting bronchodilator overuse [2.129 (2.091; 2.164)], days-off due to asthma [1.203 (1.148; 1.258)], PEFR<80 [0.76 (0.666; 0.854)], non-use of a self-management plan (SMP) [0.554 (0.515; 0.593)], poor inhaler technique [0.53 (0.475; 0.585)], poor medication compliance [0.385 (-0.007; 0.777)], and gender [0.314 (0.281; 0.347)]. Pattern of medication use, smoking history, age, body mass index (BMI), and health service resource use were also significant factors for predicting control. Targeting of health service resource requires knowledge of the factors associated with poor control of asthma symptoms. In the UK the contribution of local and regional structures appears minimal in explaining variation in asthma outcomes. However, unexplained variation in the data suggests other unrecorded factors may play a part. While patient personal characteristics (including self-management plan use, inhaler technique, medication compliance) appear to be the predominant influence the complex nature of the disease means that some, perhaps more subtle, influences are affecting the variability at all levels and this variance needs to be explored. Further research in other international contexts is required to identify the likely applicability of these findings to other health care systems. Copyright © 2011 Elsevier Ltd. All rights reserved.
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European cardiac nurses' current practice and knowledge on anticoagulation therapy.
Oterhals, Kjersti; Deaton, Christi; De Geest, Sabina; Jaarsma, Tiny; Lenzen, Mattie; Moons, Philip; Mårtensson, Jan; Smith, Karen; Stewart, Simon; Strömberg, Anna; Thompson, David R; Norekvål, Tone M
2014-06-01
Successful management of warfarin, new anti-thrombotic agents and self-monitoring devices requires that health care professionals effectively counsel and educate patients. Previous studies indicate that health care professionals do not always have the knowledge to provide patients with the correct information. The purpose of this study was to investigate European cardiovascular nurses' knowledge on the overall management of anticoagulation therapy and examine if this knowledge was influenced by level of education and years in clinical practice. A questionnaire including 47 items on practice patterns and knowledge on warfarin, new anticoagulants, warfarin-drug and warfarin-food interactions, and self-management of International Normalized Ratio (INR) was distributed to the attendants at a European conference in 2012. The response rate was 32% (n=206), of whom 84% reported having direct patient contact. Warfarin was the most common used oral anticoagulation in daily practice. One third offered their patients both patient self-testing and patient self-management of INR. The mean total score on the knowledge questions was 28±6 (maximum possible score 53). Nurses in direct patient care had a higher mean score (p=0.011). Knowledge on warfarin and medication-interactions were low, but knowledge on warfarin-diet interactions and how to advise patients on warfarin as somewhat better. European cardiac nurses need to improve their knowledge and practice patterns on oral anticoagulation therapy. This area of knowledge is important in order to deliver optimal care to cardiac patients and to minimise adverse effects of the treatment.
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Rural practice preferences among medical students in Ghana: a discrete choice experiment
Johnson, Jennifer C; Gyakobo, Mawuli; Agyei-Baffour, Peter; Asabir, Kwesi; Kotha, S Rani; Kwansah, Janet; Nakua, Emmanuel; Snow, Rachel C; Dzodzomenyo, Mawuli
2010-01-01
Abstract Objective To determine how specific job attributes influenced fourth year medical students’ stated preference for hypothetical rural job postings in Ghana. Methods Based on discussions with medical student focus groups and physicians in practice and in the Ministry of Health, we created a discrete choice experiment (DCE) that assessed how students’ stated preference for certain rural postings was influenced by various job attributes: a higher salary, free superior housing, an educational allowance for children, improved equipment, supportive management, shorter contracts before study leave and a car. We conducted the DCE among all fourth year medical students in Ghana using a brief structured questionnaire and used mixed logit models to estimate the utility of each job attribute. Findings Complete data for DCE analysis were available for 302 of 310 (97%) students. All attribute parameter estimates differed significantly from zero and had the expected signs. In the main effects mixed logit model, improved equipment and supportive management were most strongly associated with job preference (β = 1.42; 95% confidence interval, CI: 1.17 to 1.66, and β = 1.17; 95% CI: 0.96 to 1.39, respectively), although shorter contracts and salary bonuses were also associated. Discontinuing the provision of basic housing had a large negative influence (β = −1.59; 95% CI: −1.88 to −1.31). In models including gender interaction terms, women’s preferences were more influenced by supportive management and men’s preferences by superior housing. Conclusion Better working conditions were strongly associated with the stated choice of hypothetical rural postings among fourth year Ghanaian medical students. Studies are needed to find out whether job attributes determine the actual uptake of rural jobs by graduating physicians. PMID:20458371
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Joshi, M S; Bernard, D B
1999-08-01
In recent years, health and disease management has emerged as an effective means of delivering, integrating, and improving care through a population-based approach. Since 1997 the University of Pennsylvania Health System (UPHS) has utilized the key principles and components of continuous quality improvement (CQI) and disease management to form a model for health care improvement that focuses on designing best practices, using best practices to influence clinical decision making, changing processes and systems to deploy and deliver best practices, and measuring outcomes to improve the process. Experience with 28 programs and more than 14,000 patients indicates significant improvement in outcomes, including high physician satisfaction, increased patient satisfaction, reduced costs, and improved clinical process and outcome measures across multiple diseases. DIABETES DISEASE MANAGEMENT: In three months a UPHS multidisciplinary diabetes disease management team developed a best practice approach for the treatment of all patients with diabetes in the UPHS. After the program was pilot tested in three primary care physician sites, it was then introduced progressively to additional practice sites throughout the health system. The establishment of the role of the diabetes nurse care managers (certified diabetes educators) was central to successful program deployment. Office-based coordinators ensure incorporation of the best practice protocols into routine flow processes. A disease management intranet disseminates programs electronically. Outcomes of the UPHS health and disease management programs so far demonstrate success across multiple dimensions of performance-service, clinical quality, access, and value. The task of health care leadership today is to remove barriers and enable effective implementation of key strategies, such as health and disease management. Substantial effort and resources must be dedicated to gain physician buy-in and achieve compliance. The challenge is to provide leadership support, to reward and recognize best practice performers, and to emphasize the use of data for feedback and improvement. As these processes are implemented successfully, and evidence of improved outcomes is documented, it is likely that this approach will be more widely embraced and that organizationwide performance improvement will increase significantly. Health care has traditionally invested extraordinary resources in developing best practice approaches, including guidelines, education programs, or other tangible products and services. Comparatively little time, effort, and resources have been targeted to implementation and use, the stage at which most efforts fail. CQI's emphasis on data, rapid diffusion of innovative programs, and rapid cycle improvements enhance the implementation and effectiveness of disease management.
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NASA Astrophysics Data System (ADS)
Kempler, Toni M.
The influence of inquiry science instruction on the motivation of 1360 minority inner-city seventh graders was examined. The project-based curriculum incorporates motivating features like real world questions, collaboration, technology, and lesson variety. Students design investigations, collect and analyze data, and create artifacts; challenging tasks require extensive use of learning and metacognitive strategies. Study 1 used Structural Equation Modeling to investigate student perceptions of the prevalence of project-based features, including real world connections, collaboration, academic press, and work norms, and their relation to interest, efficacy, cognitive engagement, and achievement. Perceptions of features related to different motivational outcomes, indicating the importance of using differentiated rather than single measures to study motivation in context. Cognitive engagement was enhanced by interest and efficacy but did not influence achievement, perhaps because students were not proficient strategy users and were new to inquiry. Study 2 examined the relationship between instructional practices and motivation. The 23 teachers in study 1 were observed six times during one unit. Observations focused on curriculum congruence, content accuracy, contextualization, sense making, and management and climate. A majority of teacher enactment was congruent with the curriculum, indicating that students experienced motivating features of project-based science. Hierarchical Linear Modeling showed that contextualization accounted for between-teacher variance in student interest, efficacy, and cognitive engagement; Teachers encouraged motivation through extended real world examples that related material to students' experiences. Cluster analysis was used to determine how patterns of practice affected motivation. Unexpectedly these patterns did not differentially relate to cognitive engagement. Findings showed that interest and efficacy were enhanced when teachers used particular sense making practices. These teachers provided explicit scaffolding for accomplishing complex tasks with questioning and feedback that highlighted key points. Teachers also used effective management practices and maintained a positive classroom climate. In contrast, a pattern of practice where teachers used questioning and feedback to press students to make connections and synthesize concepts without scaffolding support diminished motivation, because students may have needed more help to deal with challenge. Implications from both studies suggest inquiry teachers need to use explicit scaffolding and academic press together, with effective management practices, to support motivation.
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Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Stinson, Jennifer; Harrison, Denise; Victor, J Charles
2014-11-25
Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation. Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period. Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p < 0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies. Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.
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Blok, Amanda C
2017-04-01
To report an analysis of the concept of self-management behaviors. Self-management behaviors are typically associated with disease management, with frequent use by nurse researchers related to chronic illness management and by international health organizations for development of disease management interventions. A concept analysis was conducted within the context of Orem's self-care framework. Walker and Avant's eight-step concept analysis approach guided the analysis. Academic databases were searched for relevant literature including CIHAHL, Cochrane Databases of Systematic Reviews and Register of Controlled Trials, MEDLINE, PsycARTICLES and PsycINFO, and SocINDEX. Literature using the term "self-management behavior" and published between April 2001 and March 2015 was analyzed for attributes, antecedents, and consequences. A total of 189 journal articles were reviewed. Self-management behaviors are defined as proactive actions related to lifestyle, a problem, planning, collaborating, and mental support, as well as reactive actions related to a circumstantial change, to achieve a goal influenced by the antecedents of physical, psychological, socioeconomic, and cultural characteristics, as well as collaborative and received support. The theoretical definition and middle-range explanatory theory of self-management behaviors will guide future collaborative research and clinical practice for disease management. © 2016 Wiley Periodicals, Inc.
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Rejeh, N; Ahmadi, F; Mohammadi, E; Anoosheh, M; Kazemnejad, A
2008-12-01
Unrelieved post-operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice. To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post-operative pain. This study was qualitative with 26 participant nurses. Data were obtained through semi-structured serial interviews and analysed using the content analysis method. Several themes emerged to describe the factors that hindered or facilitated post-operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post-operative pain management that included the nurse-patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills. Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management.
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Elbogen, Eric B; Tomkins, Alan J; Pothuloori, Antara P; Scalora, Mario J
2003-01-01
Studies have identified risk factors that show a strong association with violent behavior in psychiatric populations. Yet, little research has been conducted on the documentation of violence risk information in actual clinical practice, despite the relevance of such documentation to risk assessment liability and to conducting effective risk management. In this study, the documentation of cues of risk for violence were examined in psychiatric settings. Patient charts (n = 283) in four psychiatric settings were reviewed for documentation of violence risk information summarized in the MacArthur Violence Risk Assessment Study. The results revealed that particular patient and institutional variables influenced documentation practices. The presence of personality disorder, for example, predicted greater documentation of cues of violence risk, regardless of clinical setting. These findings have medicolegal implications for risk assessment liability and clinical implications for optimizing risk management in psychiatric practice.
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Medical practice in organized settings. Redefining medical autonomy.
Astrachan, J H; Astrachan, B M
1989-07-01
Physicians are perplexed by the ongoing erosion of their individual professional autonomy. While the economic forces underlying such change have received much attention, the evolution of new organizational forms that modify and often diminish medical autonomy is less well understood. The practice of medicine is becoming more organized and more hierarchical. We emphasize the importance of organized medical groups, including the medical staff organization, as structures for appropriate peer monitoring, and for counterbalancing the burgeoning influence of governance and administrative constraints on practice. There is an ongoing tension within organizations between management, governance, and physicians. Over time one or another of these groups achieves some measure of dominance, but good management requires a balance of power. The role of the medical staff, which is poorly represented in some health care institutions and under threat in others, is considered. In general, we find that medical work is becoming more hierarchical, and that physician "leaders" do not substitute for collegial processes.
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Baumgart-Getz, Adam; Stalker Prokopy, Linda; Floress, Kristin
2012-01-01
This meta-analysis of both published and unpublished studies assesses factors believed to influence adoption of agricultural Best Management Practices in the United States. Using an established statistical technique to summarize the adoption literature in the United States, we identified the following variables as having the largest impact on adoption: access to and quality of information, financial capacity, and being connected to agency or local networks of farmers or watershed groups. This study shows that various approaches to data collection affect the results and comparability of adoption studies. In particular, environmental awareness and farmer attitudes have been inconsistently used and measured across the literature. This meta-analysis concludes with suggestions regarding the future direction of adoption studies, along with guidelines for how data should be presented to enhance the adoption of conservation practices and guide research.
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Guerrero, Erick; Andrews, Christina M.
2011-01-01
BACKGROUND Culturally competent practice is broadly acknowledged to be an important strategy to increase the quality of services for racial/ethnic minorities in substance abuse treatment. However, few empirically derived measures of organizational cultural competence exist, and relatively little is known about how these measures affect treatment outcomes. METHOD Using a nationally representative sample of outpatient substance abuse treatment (OSAT) programs, this study used item response theory to create two measures of cultural competence-organizational practices and managers' culturally sensitive beliefs—and examined their relationship to client wait time and retention using Poisson regression modeling RESULTS The most common and precisely measured organizational practices reported by OSAT managers included matching providers and clients based on language/dialect; offering cross-cultural training; and fostering connections with community and faith-based organizations connected to racial and ethnic minority groups. The most culturally sensitive belief among OSAT managers was support for language/dialect matching for racial and ethnic minority clients. Results of regression modeling indicate that organizational practices were not related to either outcome. However, managers' culturally sensitive beliefs were negatively associated with average wait time (p < 0.05), and positively associated with average retention (p < 0.01). CONCLUSIONS Managers' culturally sensitive beliefs—considered to be influential for effective implementation of culturally competent practices—may be particularly relevant in influencing wait time and retention in OSAT organizations that treat Latinos and African American clients. PMID:21680111
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Clinical factors affecting physicians' management decisions in cases of female partner abuse.
Ferris, L E; Norton, P; Dunn, E V; Gort, E H
1999-06-01
This study determined which clinical factors influence Canadian primary care physicians' management decisions in cases of female partner abuse. We used a cross-sectional survey design and randomly sampled (n = 2,014) English-speaking Canadian physicians with a primary interest in family or general practice who were practicing in any of the 12 provinces and territories in Canada and who were active in private practice and registered to prescribe. Respondents completed a questionnaire that required them to score management decision plans in response to case scenarios illustrating typical office-based situations that might involve domestic violence. The response rate was 50.7% (n = 1,022). Using forward stepwise regression analysis, the strongest predictor of whether a physician endorsed a management plan in response to violence was whether the woman acknowledged or revealed the abuse. Male physicians were more likely than females to endorse talking with the suspected abuser if he was known to them, regardless of the quality of this patient-physician relationship with the abuser. Decisions about whether to deal with the abuse or the selection of a management plan are not dependent on the severity of the physical abuse and the emotional consequences. Whether a woman acknowledges or reveals the abuse, as well as whether both the male and female patients are in the physician's practice, are predictive of whether a physician's response to a case scenario involves dealing with spousal abuse and how he/she will address it.
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Transferring Aviation Practices into Clinical Medicine for the Promotion of High Reliability.
Powell-Dunford, Nicole; McPherson, Mark K; Pina, Joseph S; Gaydos, Steven J
2017-05-01
Aviation is a classic example of a high reliability organization (HRO)-an organization in which catastrophic events are expected to occur without control measures. As health care systems transition toward high reliability, aviation practices are increasingly transferred for clinical implementation. A PubMed search using the terms aviation, crew resource management, and patient safety was undertaken. Manuscripts authored by physician pilots and accident investigation regulations were analyzed. Subject matter experts involved in adoption of aviation practices into the medical field were interviewed. A PubMed search yielded 621 results with 22 relevant for inclusion. Improved clinical outcomes were noted in five research trials in which aviation practices were adopted, particularly with regard to checklist usage and crew resource-management training. Effectiveness of interventions was influenced by intensity of application, leadership involvement, and provision of staff training. The usefulness of incorporating mishap investigation techniques has not been established. Whereas aviation accident investigation is highly standardized, the investigation of medical error is characterized by variation. The adoption of aviation practices into clinical medicine facilitates an evolution toward high reliability. Evidence for the efficacy of the checklist and crew resource-management training is robust. Transference of aviation accident investigation practices is preliminary. A standardized, independent investigation process could facilitate the development of a safety culture commensurate with that achieved in the aviation industry.Powell-Dunford N, McPherson MK, Pina JS, Gaydos SJ. Transferring aviation practices into clinical medicine for the promotion of high reliability. Aerosp Med Hum Perform. 2017; 88(5):487-491.
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Pressure damage prevention: basing practice on evidence.
Parker, K; Morgan, L; Clayton, J; Gerrish, K; Nolan, M
As part of an initiative to develop evidence-based practice at the Northern General Hospital, Sheffield, a three-part project was undertaken. The aims were to identify barriers to using research in nursing, establish a baseline of nurses' knowledge and its influence on their practice in one essential area of nursing care--pressure damage prevention--and develop a strategy for change which took account of the findings from the first two parts of the project. In this article, the authors describe the second part of the project which examined nursing knowledge and practice with reference to the management of pressure damage prevention. The findings are discussed and the authors recommend that nurses integrate into their practice evidence from sources such as systematic reviews.
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Irimu, Grace W; Greene, Alexandra; Gathara, David; Kihara, Harrison; Maina, Christopher; Mbori-Ngacha, Dorothy; Zurovac, Dejan; Migiro, Santau; English, Mike
2014-02-07
Implementation of World Health Organization case management guidelines for serious childhood illnesses remains a challenge in hospitals in low-income countries. Facilitators of and barriers to implementation of locally adapted clinical practice guidelines (CPGs) have not been explored. This ethnographic study based on the theory of participatory action research (PAR) was conducted in Kenyatta National Hospital, Kenya's largest teaching hospital. The primary intervention consisted of dissemination of locally adapted CPGs. The PRECEDE-PROCEED health education model was used as the conceptual framework to guide and examine further reinforcement activities to improve the uptake of the CPGs. Activities focussed on introduction of routine clinical audits and tailored educational sessions. Data were collected by a participant observer who also facilitated the PAR over an eighteen-month period. Naturalistic inquiry was utilized to obtain information from all hospital staff encountered while theoretical sampling allowed in-depth exploration of emerging issues. Data were analysed using interpretive description. Relevance of the CPGs to routine work and emergence of a champion of change facilitated uptake of best-practices. Mobilization of basic resources was relatively easily undertaken while activities that required real intellectual and professional engagement of the senior staff were a challenge. Accomplishments of the PAR were largely with the passive rather than active involvement of the hospital management. Barriers to implementation of best-practices included i) mismatch between the hospital's vision and reality, ii) poor communication, iii) lack of objective mechanisms for monitoring and evaluating quality of clinical care, iv) limited capacity for planning strategic change, v) limited management skills to introduce and manage change, vi) hierarchical relationships, and vii) inadequate adaptation of the interventions to the local context. Educational interventions, often regarded as 'quick-fixes' to improve care in low-income countries, may be necessary but are unlikely to be sufficient to deliver improved services. We propose that an understanding of organizational issues that influence the behaviour of individual health professionals should guide and inform the implementation of best-practices.
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VandenBygaart, A. J. [Agriculture and Agri-Food Canada, Ottowa, Canada; Gregorich, E. G. [Agriculture and Agri-Food Canada, Ottowa, Canada; Angers, D. A. [Agriculture and Agri-Food Canada, Ottowa, Canada
2004-01-01
To fulfill commitments under the Kyoto Protocol, Canada is required to provide verifiable estimates and uncertainties for soil oganic carbon (SOC) stocks, and for changes in those stocks over time. Estimates and uncertainties for agricultural soils can be derived from long-term studies that have measured differences in SOC between different management practices. We compiled published data from long-term studies in Canada to assess the effect of agricultural management on SOC. A total of 62 studies were compiled, in which the difference in SOC was determined for conversion from native land to cropland, and for different tillage, crop rotation and fertilizer management practices. There was a loss of 24 ± 6% of the SOC after native land was converted to agricultural land. No-till (NT) increased the storage of SOC in western Canada by 2.9 ± 1.3 Mg ha–1; however, in eastern Canada conversion to NT did not increase SOC.
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Stelzenmüller, V; Lee, J; Garnacho, E; Rogers, S I
2010-10-01
For the UK continental shelf we developed a Bayesian Belief Network-GIS framework to visualise relationships between cumulative human pressures, sensitive marine landscapes and landscape vulnerability, to assess the consequences of potential marine planning objectives, and to map uncertainty-related changes in management measures. Results revealed that the spatial assessment of footprints and intensities of human activities had more influence on landscape vulnerabilities than the type of landscape sensitivity measure used. We addressed questions regarding consequences of potential planning targets, and necessary management measures with spatially-explicit assessment of their consequences. We conclude that the BN-GIS framework is a practical tool allowing for the visualisation of relationships, the spatial assessment of uncertainty related to spatial management scenarios, the engagement of different stakeholder views, and enables a quick update of new spatial data and relationships. Ultimately, such BN-GIS based tools can support the decision-making process used in adaptive marine management. Copyright © 2010 Elsevier Ltd. All rights reserved.
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Zhang, Ling; Gallagher, Robyn; Ding, Ding; Neubeck, Lis
2018-06-01
Health outcomes and impact of cardiovascular disease vary between populations, where ethnic minorities and immigrant groups are more likely to be disadvantaged. Compared with the majority residents, health outcomes, especially short-term mortality from coronary heart disease event are worse in people of Chinese ethnicity, potentially due to poor self-management and experiences with the healthcare system in host countries. A scoping review was conducted. Four overarching themes were found: (1) understanding of heart disease, risk factors and symptom recognition, (2) adherence to medication and lifestyle modification, (3) health service/information choice, and (4) family role in disease self-management and decision making. All themes were greatly influenced by English language proficiency and cultural practices. English language proficiency and cultural practices should be taken into consideration when providing healthcare services for people of Chinese ethnicity, as it plays an important role in self-management and experiences with the healthcare system.
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Ulrich, Connie; Soeken, Karen; Miller, Nancy
2003-07-01
To identify the predictors of autonomy of nurse practitioners (NPs) affiliated directly and/or indirectly with managed-care systems (e.g., HMOs). A mailed survey sent to a stratified random sample of 254 NPs certified and licensed to practice in the state of Maryland. The measures consisted of selected organizational characteristics; market factors of HMO penetration and percentage of client population enrolled in managed care; and factors of ethical concern, such as ethical ideology, ethics education, and autonomy. The County Surveyor Database was used to assess market penetration in the state. Although NPs were ethically concerned about their autonomy in a managed-care environment (70.2%), actual autonomy scores were high. The higher the percentage of HMO penetration, percentage of client population enrolled in managed care, and perceived ethical concern, the lower the perceived autonomy of NPs. Findings may be used for future research to address the complexity of variables that influence the autonomous practice of NPs.
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Social support, stress, and practice of prenatal care in married immigrant women in Korea.
Kim, Yeon A; Choi, So Young; Ryu, Eunjung
2010-10-01
This study aimed to identify the correlations among social support, stress, and practice of prenatal care and elucidate the predictors affecting the practice of prenatal care in married immigrant women in Korea. This study employed a descriptive correlational Social support and prenatal-care practice were positively correlated, and stress was negatively correlated with both prenatal-care practice and social support. The practice of prenatal care in married immigrant women was most influenced by social support. As such, there is a need for nursing intervention that fosters social support for pregnant immigrant women. Concerted efforts are also required to reduce their stressors. This study could form the basis for developing childbirth management programs for pregnant women who have immigrated to Korea in order to marry.
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Monitoring trail conditions: New methodological considerations
Marion, Jeffrey L.; Leung, Yu-Fai; Nepal, Sanjay K.
2006-01-01
The U.S. National Park Service (NPS) accommodates nearly 300 million visitors per year, visitation that has the potential to produce negative effects on fragile natural and cultural resources. The policy guidance from the NPS Management Policies recognizes the legitimacy of providing opportunities for public enjoyment of parks while acknowledging the need for managers to “seek ways to avoid, or to minimize to the greatest degree practicable, adverse impacts on park resources and values” (NPS 2001). Thus, relative to visitor use, park managers must evaluate the types and extents of resource impacts associated with recreational activities, and determine to what extent they are unacceptable and constitute impairment. Visitor impact monitoring programs can assist managers in making objective evaluations of impact acceptability and impairment and in selecting effective impact management practices by providing quantitative documentation of the types and extent of recreationrelated impacts on natural resources. Monitoring programs are explicitly authorized in Section 4.1 of the Management Policies: Natural systems in the national park system, and the human influences upon them, will be monitored to detect change. The Service will use the results of monitoring and research to understand the detected change and to develop appropriate management actions.
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Dunn, Sandra; Sprague, Ann E; Grimshaw, Jeremy M; Graham, Ian D; Taljaard, Monica; Fell, Deshayne; Peterson, Wendy E; Darling, Elizabeth; Harrold, JoAnn; Smith, Graeme N; Reszel, Jessica; Lanes, Andrea; Truskoski, Carolyn; Wilding, Jodi; Weiss, Deborah; Walker, Mark
2016-05-04
There are wide variations in maternal-newborn care practices and outcomes across Ontario. To help institutions and care providers learn about their own performance, the Better Outcomes Registry & Network (BORN) Ontario has implemented an audit and feedback system, the Maternal-Newborn Dashboard (MND), for all hospitals providing maternal-newborn care. The dashboard provides (1) near real-time feedback, with site-specific and peer comparison data about six key performance indicators; (2) a visual display of evidence-practice gaps related to the indicators; and (3) benchmarks to provide direction for practice change. This study aims to evaluate the effects of the dashboard, dashboard attributes, contextual factors, and facilitation/support needs that influence the use of this audit and feedback system to improve performance. The objectives of this study are to (1) evaluate the effect of implementing the dashboard across Ontario; (2) explore factors that potentially explain differences in the use of the MND among hospitals; (3) measure factors potentially associated with differential effectiveness of the MND; and (4) identify factors that predict differences in hospital performance. A mixed methods design includes (1) an interrupted time series analysis to evaluate the effect of the intervention on six indicators, (2) key informant interviews with a purposeful sample of directors/managers from up to 20 maternal-newborn care hospitals to explore factors that influence the use of the dashboard, (3) a provincial survey of obstetrical directors/managers from all maternal-newborn hospitals in the province to measure factors that influence the use of the dashboard, and (4) a multivariable generalized linear mixed effects regression analysis of the indicators at each hospital to quantitatively evaluate the change in practice following implementation of the dashboard and to identify factors most predictive of use. Study results will provide essential data to develop knowledge translation strategies for facilitating practice change, which can be further evaluated through a future cluster randomized trial.
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UK GPs' and practice nurses' views of continuity of care for patients with type 2 diabetes.
Alazri, Mohammed H; Heywood, Philip; Neal, Richard D; Leese, Brenda
2007-04-01
Continuity of care is widely regarded as a core value of primary care. Type 2 diabetes is a common chronic disease with major health, social and economic impacts. Primary health care professionals in many countries are involved in the management of patients with type 2 diabetes, but their perspectives on continuity remain neglected in research. To explore UK GPs' and nurses' experiences of continuity of care for patients with type 2 diabetes in primary care settings. Semi-structured individual interviews were conducted with 16 GPs and 18 practice nurses who manage patients with type 2 diabetes recruited from 20 practices with various organizational structures in Leeds, UK. Three types of continuities were identified: relational continuity from the same health care professional, team continuity from a group of health care professionals and cross-boundary continuity across primary-secondary care settings. Relational continuity was influenced by the quality of the patient-health care professional relationship, policy of the National Health Service (NHS) in the UK (new General Medical Services contract), walk-in centres, the behaviour of receptionists and the structure and systems of the practice. Team and cross-boundary continuities were influenced by the relationship between team members and by effective communication. Relational continuity contributed to more 'personal care', but the usual health care professional might know less about diabetes. Team continuity was important in providing 'physical care', but patients could be confused by conflicting advice from different professionals. Cross-boundary continuity helps to provide 'expert advice', but is dependent upon effective communication. GPs and practice nurses dealing with patients with type 2 diabetes identified three types of continuities, each influenced by several factors. Relational continuity deals better with psychosocial care while team continuity promotes better physical care; therefore, imposing one type of continuity may inhibit good diabetic care. Cross-boundary continuity between primary and secondary care is fundamental to contemporary diabetic services and ways should be found to achieve more effective communication.