Science.gov

Sample records for management reduces injection-related

  1. Does opioid substitution treatment in prisons reduce injecting-related HIV risk behaviours? A systematic review.

    PubMed

    Larney, Sarah

    2010-02-01

    To review systematically the evidence on opioid substitution treatment (OST) in prisons in reducing injecting-related human immunodeficiency virus (HIV) risk behaviours. Systematic review in accordance with guidelines of the Cochrane Collaboration. Electronic databases were searched to identify studies of prison-based opioid substitution treatment programmes that included assessment of effects of prison OST on injecting drug use, sharing of needles and syringes and HIV incidence. Published data were used to calculate risk ratios for outcomes of interest. Risk ratios were not pooled due to the low number of studies and differences in study designs. Five studies were included in the review. Poor follow-up rates were reported in two studies, and representativeness of the sample was uncertain in the remaining three studies. Compared to inmates in control conditions, for treated inmates the risk of injecting drug use was reduced by 55-75% and risk of needle and syringe sharing was reduced by 47-73%. No study reported a direct effect of prison OST on HIV incidence. There may be a role for OST in preventing HIV transmission in prisons, but methodologically rigorous research addressing this question specifically is required. OST should be implemented in prisons as part of comprehensive HIV prevention programmes that also provide condoms and sterile injecting and tattooing equipment.

  2. Poultry litter moisture management to reduce ammonia

    USDA-ARS?s Scientific Manuscript database

    Ammonia generation in poultry houses results from the natural breakdown of litter (bedding material mixed with deposits of feces, feathers, spilled feed and water). Good management practices can reduce ammonia concentrations in poultry houses. This factsheet relates findings from a recent publicat...

  3. Fisheries management to reduce contaminant consumption

    SciTech Connect

    Stow, C.A.; Jackson, L.J.; Eby, L.A.

    1995-12-01

    Lake Michigan is a microcosm of global environmental issues. A history of problems has plagued the lake, arising from the wide range of human activities the basin supports. Much of Lake Michigan`s watershed is agriculturally developed, and the shoreline is dotted with major urban, industrial centers. The lake has supported important commercial shipping and fishing industries for more than a century. In the 1960s and 1970s eutrophication was a concern. More recently toxic contaminants, particularly PCBs, and invasions by exotic species, such as the zebra mussel (Dreissena polymorpha), have captured headlines. More than 200 years of development and exploitation have taken Lake Michigan far from a pristine state. The Lake Michigan fishery in intensively managed, and food web manipulation may more effectively reduce PCB exposure than cleanup activities do. Four management options are discussed in this article: trophic cascade; growth maximization; size of stocked fish; and selective species stocking. The most promising option, well supported by data is in many ways the simplist: selective stocking of species that accumulate contaminants at the lowest levels. 51 refs., 6 figs., 1 tab.

  4. Managing biogeochemical cycles to reduce greenhouse gases

    SciTech Connect

    Post, Wilfred M; Venterea, Rodney

    2012-01-01

    This special issue focuses on terrestrial biogeochemical cycles as they relate to North America-wide budgeting and future projection of biogenic greenhouse gases (GHGs). Understanding the current magnitude and providing guidance on the future trajectories of atmospheric concentrations of these gases requires investigation of their (i) biogeochemical origins, (ii) response to climate feedbacks and other environmental factors, and (iii) susceptibility to management practices. This special issue provides a group of articles that present the current state of continental scale sources and sinks of biogenic GHGs and the potential to better manage them in the future.

  5. The staying safe intervention: training people who inject drugs in strategies to avoid injection-related HCV and HIV infection.

    PubMed

    Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria; Sandoval, Milagros; Cleland, Charles M; Jordan, Ashly; Hagan, Holly; Lune, Howard; Friedman, Samuel R

    2014-04-01

    This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the intervention's two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, five-session intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks.

  6. THE STAYING SAFE INTERVENTION: TRAINING PEOPLE WHO INJECT DRUGS IN STRATEGIES TO AVOID INJECTION-RELATED HCV AND HIV INFECTION

    PubMed Central

    Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria; Sandoval, Milagros; Cleland, Charles M.; Jordan, Ashly; Hagan, Holly; Lune, Howard; Friedman, Samuel R.

    2014-01-01

    This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the intervention's two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, five-session intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks. PMID:24694328

  7. Fisheries management to reduce contaminant consumption

    USGS Publications Warehouse

    Stow, Craig A.; Carpenter, Stephen R.; Madenjian, Charles P.; Eby, Lisa A.; Jackson, Leland J.

    1995-01-01

    This paper concludes that contaminants in Lake Michigan fishes are likely to remain above detectable levels for some time. Some interest groups have called for measures ranging from additional effluent controls to a ban on the industrial use of chlorine. Such measures, however well intended, are likely to have little impact on many of the contaminants of primary concern. PCBs, in particular, are largely the legacy of past activities and are not likely to be substantially affected by additional regulation. The authors review several options for reducing human exposure to PCBs, using relatively simple fisheries manipulations, although they do not propose that these measures are the ultimate solution to the contaminant problem. Of the options presented, the most promising is the replacement of lake trout with less-contaminated species, such as rainbow trout.

  8. Reducing uncertainty about objective functions in adaptive management

    USGS Publications Warehouse

    Williams, B.K.

    2012-01-01

    This paper extends the uncertainty framework of adaptive management to include uncertainty about the objectives to be used in guiding decisions. Adaptive decision making typically assumes explicit and agreed-upon objectives for management, but allows for uncertainty as to the structure of the decision process that generates change through time. Yet it is not unusual for there to be uncertainty (or disagreement) about objectives, with different stakeholders expressing different views not only about resource responses to management but also about the appropriate management objectives. In this paper I extend the treatment of uncertainty in adaptive management, and describe a stochastic structure for the joint occurrence of uncertainty about objectives as well as models, and show how adaptive decision making and the assessment of post-decision monitoring data can be used to reduce uncertainties of both kinds. Different degrees of association between model and objective uncertainty lead to different patterns of learning about objectives. ?? 2011.

  9. Prospects for managing turfgrass pests with reduced chemical inputs.

    PubMed

    Held, David W; Potter, Daniel A

    2012-01-01

    Turfgrass culture, a multibillion dollar industry in the United States, poses unique challenges for integrated pest management. Why insect control on lawns, golf courses, and sport fields remains insecticide-driven, and how entomological research and extension can best support nascent initiatives in environmental golf and sustainable lawn care are explored. High standards for aesthetics and playability, prevailing business models, risk management-driven control decisions, and difficulty in predicting pest outbreaks fuel present reliance on preventive insecticides. New insights into pest biology, sampling methodology, microbial insecticides, plant resistance, and conservation biological control are reviewed. Those gains, and innovations in reduced-risk insecticides, should make it possible to begin constructing holistic management plans for key turfgrass pests. Nurturing the public's interest in wildlife habitat preservation, including beneficial insects, may be one means to change aesthetic perceptions and gain leeway for implementing integrated pest management practices that lend stability to turfgrass settings.

  10. Assessment of injection-related practices in a tribal community of Andaman and Nicobar Islands, India.

    PubMed

    Murhekar, M V; Rao, R C; Ghosal, S R; Sehgal, S C

    2005-07-01

    A survey to assess injection related practices carried out among the Nicobarese, a mongoloid tribe of Andaman and Nicobar Islands, India. The survey was carried out using the rapid assessment and response guide of Safe Injection Global Network of the World Health Organization and included review of randomly selected prescriptions of patients attending outpatient clinic of district hospital, interview and observation of injection providers in the district hospital and sub-centres and interview of the general population. The findings of the survey showed that 18.8% of prescriptions included at least one injection. The per capita injection rate was 3 per year. Majority of injections were administered with disposable syringe and needle and in hospital setting. All the injection providers were aware about possibility of HIV transmission through unsafe injections. However, the awareness among the general population was low. More than half of the individuals had preference to injections. It is suggested that remedial measures, such as education of prescribers to reduce the number of injections to a bare minimum, maintaining regular supply of disposable injection equipment, provision of adequate sharps containers with safe disposal facilities and community education be undertaken to avoid future spread of blood-borne pathogens.

  11. Transitional care management reimbursement to reduce COPD readmission.

    PubMed

    Kangovi, Shreya; Grande, David

    2014-01-01

    Reducing preventable readmissions for COPD is an important national health policy goal. Thus far, Centers for Medicare & Medicaid Services (CMS) policies focused on incentivizing improvements in inpatient quality have had variable success. In its 2013 physician-payment rule, CMS announced new payments that reimburse ambulatory care providers for timely posthospital visits and transitional care management services. CMS hopes that posthospital transitional care and services will substitute for readmission, but the evidence supporting this hypothesis is mixed. In this article, we discuss ways for ambulatory pulmonologists to leverage transitional care management payments to enhance access for their patients with COPD while minimizing the risk of a paradoxic increase in readmission rates.

  12. Can agent based models effectively reduce fisheries management implementation uncertainty?

    NASA Astrophysics Data System (ADS)

    Drexler, M.

    2016-02-01

    Uncertainty is an inherent feature of fisheries management. Implementation uncertainty remains a challenge to quantify often due to unintended responses of users to management interventions. This problem will continue to plague both single species and ecosystem based fisheries management advice unless the mechanisms driving these behaviors are properly understood. Equilibrium models, where each actor in the system is treated as uniform and predictable, are not well suited to forecast the unintended behaviors of individual fishers. Alternatively, agent based models (AMBs) can simulate the behaviors of each individual actor driven by differing incentives and constraints. This study evaluated the feasibility of using AMBs to capture macro scale behaviors of the US West Coast Groundfish fleet. Agent behavior was specified at the vessel level. Agents made daily fishing decisions using knowledge of their own cost structure, catch history, and the histories of catch and quota markets. By adding only a relatively small number of incentives, the model was able to reproduce highly realistic macro patterns of expected outcomes in response to management policies (catch restrictions, MPAs, ITQs) while preserving vessel heterogeneity. These simulations indicate that agent based modeling approaches hold much promise for simulating fisher behaviors and reducing implementation uncertainty. Additional processes affecting behavior, informed by surveys, are continually being added to the fisher behavior model. Further coupling of the fisher behavior model to a spatial ecosystem model will provide a fully integrated social, ecological, and economic model capable of performing management strategy evaluations to properly consider implementation uncertainty in fisheries management.

  13. Can managed care reduce employers' retiree medical liability?

    PubMed

    Taylor, R S; Newton, B

    1991-01-01

    The Financial Accounting Standards Board (FASB) has forced U.S. companies to look squarely at their current retiree health obligations and their future commitments. Accounting Statement No. 106 (FAS 106) requires employers to accrue liabilities for retiree health benefits during employees' active service, rather than record the costs as benefits are paid. Employers are scrambling to find ways to reduce the statement's effect on corporate balance sheets. While managed health care has been increasingly employed to control benefit costs in active employee health plans, it has not been as popular in retiree plans. This article reviews important demographic and health trends in the retiree population and summarizes employers' early responses to FAS 106. It explores why managed health care has thus far played a limited role in reducing employers' postretirement medical liability, and offers insight into how that role could be increased in the future.

  14. Enhancing outpatient clinics management software by reducing patients' waiting time.

    PubMed

    Almomani, Iman; AlSarheed, Ahlam

    The Kingdom of Saudi Arabia (KSA) gives great attention to improving the quality of services provided by health care sectors including outpatient clinics. One of the main drawbacks in outpatient clinics is long waiting time for patients-which affects the level of patient satisfaction and the quality of services. This article addresses this problem by studying the Outpatient Management Software (OMS) and proposing solutions to reduce waiting times. Many hospitals around the world apply solutions to overcome the problem of long waiting times in outpatient clinics such as hospitals in the USA, China, Sri Lanka, and Taiwan. These clinics have succeeded in reducing wait times by 15%, 78%, 60% and 50%, respectively. Such solutions depend mainly on adding more human resources or changing some business or management policies. The solutions presented in this article reduce waiting times by enhancing the software used to manage outpatient clinics services. Both quantitative and qualitative methods have been used to understand current OMS and examine level of patient's satisfaction. Five main problems that may cause high or unmeasured waiting time have been identified: appointment type, ticket numbering, doctor late arrival, early arriving patient and patients' distribution list. These problems have been mapped to the corresponding OMS components. Solutions to the above problems have been introduced and evaluated analytically or by simulation experiments. Evaluation of the results shows a reduction in patient waiting time. When late doctor arrival issues are solved, this can reduce the clinic service time by up to 20%. However, solutions for early arriving patients reduces 53.3% of vital time, 20% of the clinic time and overall 30.3% of the total waiting time. Finally, well patient-distribution lists make improvements by 54.2%. Improvements introduced to the patients' waiting time will consequently affect patients' satisfaction and improve the quality of health care services.

  15. Do continence management strategies reduce falls? a systematic review.

    PubMed

    Batchelor, Frances A; Dow, Briony; Low, May-Ann

    2013-12-01

    Urinary incontinence is associated with increased fall risk, and fall prevention programs include recommendations to manage continence as one component of fall reduction. However, the evidence to support this recommendation is unclear. The aim of this study was to identify continence management interventions that are effective in decreasing falls. A systematic review of the literature was conducted. Studies were included if they evaluated the effect of any type of continence management strategy on falls in older adults. The included studies were assessed for quality, and data relating to participants, interventions and outcomes were extracted by two independent reviewers. Four articles met the inclusion criteria. Two studies were randomised controlled trials, one a retrospective cohort study and one an uncontrolled intervention study. Interventions included pharmacological agents, a toileting regime combined with physical activity and an individualised continence program. Only the study evaluating the combination of physical activity and prompted voiding found an effect on falls. It is surprising that there has been so little research into continence management interventions that include fall outcomes. A toileting regime combined with physical activity may reduce falls in residential care. There is a need for further studies investigating the impact of continence management on falls.

  16. Forest management strategies for reducing carbon emissions, the French case

    NASA Astrophysics Data System (ADS)

    Valade, Aude; Luyssaert, Sebastiaan; Bellassen, Valentin; Vallet, Patrick; Martin, Manuel

    2015-04-01

    International agreements now recognize the role of forest in the mitigation of climate change through the levers of in-situ sequestration, storage in products and energy and product substitution. These three strategies of carbon management are often antagonistic and it is still not clear which strategy would have the most significant impact on atmospheric carbon concentrations. With a focus on France, this study compares several scenarios of forest management in terms of their effect on the overall carbon budget from trees to wood-products. We elaborated four scenarios of forest management that target different wood production objectives. One scenario is 'Business as usual' and reproduces the current forest management and wood production levels. Two scenarios target an increase in bioenergy wood production, with either long-term or short-term goals. One scenario aims at increasing the production of timber for construction. For this, an empirical regression model was developed building on the rich French inventory database. The model can project the current forest resource at a time horizon of 20 years for characteristic variables diameter, standing volume, above-ground biomass, stand age. A simplified life-cycle analysis provides a full carbon budget for each scenario from forest management to wood use and allows the identification of the scenario that most reduces carbon emissions.

  17. Reputation management: evidence for ability but reduced propensity in autism.

    PubMed

    Cage, Eilidh; Pellicano, Elizabeth; Shah, Punit; Bird, Geoffrey

    2013-10-01

    Previous research has reported that autistic adults do not manage their reputation, purportedly due to problems with theory of mind [Izuma, Matsumoto, Camerer, & Adolphs]. The current study aimed to test alternative explanations for this apparent lack of reputation management. Twenty typical and 19 autistic adults donated to charity and to a person, both when alone and when observed. In an additional manipulation, for half of the participants, the observer was also the recipient of their donations, and participants were told that this observer would subsequently have the opportunity to donate to them (motivation condition). This manipulation was designed to encourage an expectation of a reciprocal "tit-for-tat" strategy in the participant, which may motivate participants to change their behavior to receive more donations. The remaining participants were told that the person watching was just observing the procedure (no motivation condition). Our results replicated Izuma et al.'s finding that autistic adults did not donate more to charity when observed. Yet, in the motivation condition, both typical and autistic adults donated significantly more to the observer when watched, although this effect was significantly attenuated in autistic individuals. Results indicate that, while individuals with autism may have the ability to think about reputation, a reduced expectation of reciprocal behavior from others may reduce the degree to which they engage in reputation management. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.

  18. Strategies to reduce hospitalization in the management of heart failure.

    PubMed

    Berkowitz, Robert; Blank, Lenore J; Powell, Suzanne K

    2005-01-01

    Progressive and debilitating heart failure (HF) affects almost 5 million, mostly elderly, individuals in the United States. As the elderly population grows in coming decades, the prevalence of HF is expected to increase substantially. In addition to its human toll, HF yields a substantial economic burden, with direct and indirect cost estimates ranging from $27 to $56 billion annually. It is associated with an unacceptably high rehospitalization rate--50% within 6 months--which not only drives burgeoning costs but also provides a signal that current management approaches to HF are less than optimal. Evidence-based treatment approaches, which include the use of beta-blockers, angiotensin-converting enzyme inhibitors, spironolactone, and nesiritide, may offer opportunities for reducing mortality and rehospitalization rates in HF. Yet, because of inadequate discharge guidance and follow-up, many patients with HF are caught in a "revolving door" process that ultimately culminates in exacerbation and rehospitalization. Hospital-based disease management programs have consistently been shown to optimize care and reduce rehospitalization rates in patients with HF. The Hackensack University Medical Center HF program is discussed as an example of a successful HF program. This program represents a multidisciplinary, multifaceted approach to care that emphasizes case management. The core goal of this program is to provide a continuum of care that extends through hospitalization and into the patients' home environment.

  19. Reducing Wildlife Damage with Cost-Effective Management Programmes

    PubMed Central

    Krull, Cheryl R.; Stanley, Margaret C.; Burns, Bruce R.; Choquenot, David; Etherington, Thomas R.

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  20. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    PubMed

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return.

  1. Can disease management reduce health care costs by improving quality?

    PubMed

    Fireman, Bruce; Bartlett, Joan; Selby, Joe

    2004-01-01

    Disease management (DM) promises to achieve cost savings by improving the quality of care for chronic diseases. During the past decade the Permanente Medical Group in Northern California has implemented extensive DM programs. Examining quality indicators, utilization, and costs for 1996-2002 for adults with four conditions, we find evidence of substantial quality improvement but not cost savings. The causal pathway--from improved care to reduced morbidity to cost savings--has not produced sufficient savings to offset the rising costs of improved care. We conclude that the rationale for DM programs, like the rationale for any medical treatments, should rest on their effectiveness and value.

  2. A case management protocol: reducing unnecessary Medicare admissions in Florida.

    PubMed

    Michelman, Mark; Collier, Patricia; Dion, Charles; Richards, Ferdinand; Ohleyer, Henry; Vasey, Paulette; Henshaw, Zachary; Davison, Karen

    2005-01-01

    The Florida Medicare quality improvement organization implemented a case management project with 20 acute care hospitals to reduce unnecessary Medicare admissions. The project called for hospitals to implement a protocol to assign patients to observation or inpatient admission status. Results of the project showed a 67% reduction in the denial rate for the participating facilities. This relative reduction in denial rates was nearly 3 times greater for the participating facilities as compared to the control facilities. The protocol can easily be adopted by hospitals.

  3. Can climate-effective land management reduce regional warming?

    NASA Astrophysics Data System (ADS)

    Hirsch, A. L.; Wilhelm, M.; Davin, E. L.; Thiery, W.; Seneviratne, S. I.

    2017-02-01

    Limiting global warming to well below 2°C is an imminent challenge for humanity. However, even if this global target can be met, some regions are still likely to experience substantial warming relative to others. Using idealized global climate simulations, we examine the potential of land management options in affecting regional climate, with a focus on crop albedo enhancement and irrigation (climate-effective land management). The implementation is performed over all crop regions globally to provide an upper bound. We find that the implementation of both crop albedo enhancement and irrigation can reduce hot temperature extremes by more than 2°C in North America, Eurasia, and India over the 21st century relative to a scenario without management application. The efficacy of crop albedo enhancement scales with the magnitude, where a cooling response exceeding 0.5°C for hot temperature extremes was achieved with a large (i.e., ≥0.08) change in crop albedo. Regional differences were attributed to the surface energy balance response with temperature changes mostly explained by latent heat flux changes for irrigation and net shortwave radiation changes for crop albedo enhancement. However, limitations do exist, where we identify warming over the winter months when climate-effective land management is temporarily suspended. This was associated with persistent cloud cover that enhances longwave warming. It cannot be confirmed if the magnitude of this feedback is reproducible in other climate models. Our results overall demonstrate that regional warming of hot extremes in our climate model can be partially mitigated when using an idealized treatment of climate-effective land management.

  4. Availability of a 5% lidocaine patch used prophylactically for venipuncture- or injection-related pain in children.

    PubMed

    Kim, Cheul-Hong; Yoon, Ji-Uk; Lee, Hyeon-Jung; Shin, Sang-Wook; Yoon, Ji-Young; Byeon, Gyeong-Jo

    2012-08-01

    Venipuncture- or injection-related pain is still major problem during anesthetic induction in children. This study was designed to determine the availability of a 5% lidocaine patch used prophylactically for venipuncture- or injection-related pain during the induction of anesthesia. In a randomized, double-blind study, 72 pediatric patients were allocated to one of two groups: pretreatment with a 5% lidocaine patch (Lidoderm(®), Endo Pharmaceuticals, Chadds Ford, PA, USA) (group A) or pretreatment with a placebo patch (group B). Pain severity was evaluated on the Faces, Legs, Activity, Cry, and Consolability Scale (FLACC) during venipuncture, and a 4-point scale during the injection of rocuronium. The FLACC score during venipuncture was significantly lower for group A than group B (p < 0.001). There was no significant difference in the grades of the 4-point scale observed during the injection of rocuronium between groups A and B. No significant adverse effect was noted for the groups. Although pretreatment with a 5% lidocaine patch was found to be a safe, effective, and simple method of preventing venipuncture pain in children, this method did not reduce drug injection pain during the induction of anesthesia.

  5. Reduction in injection-related HIV risk after 6 months in a low-threshold methadone treatment program.

    PubMed

    Millson, Peggy; Challacombe, Laurel; Villeneuve, Paul J; Strike, Carol J; Fischer, Benedikt; Myers, Ted; Shore, Ron; Hopkins, Shaun

    2007-04-01

    This study assessed injection-related HIV risk behavioral changes among opioid users 6 months after enrollment in low-threshold (harm reduction based) metha-done maintenance treatment (MMT) programs within needle exchange services in Kingston and Toronto, Ontario, Canada. Changes were assessed for all participants (whole cohort), participants who continued to use illicit drugs by any route (drug-using subcohort); and those who continued to inject drugs (injecting subcohort). In this prospective observational cohort study, an interviewer-administered questionnaire examining injection-related HIV risk behaviors was administered to 183 study participants at entry to treatment and 6 months later. Changes in risk behaviors were analyzed using conditional logistic regression which took into account the paired nature of the data. We found that the proportion of participants injecting drugs, sharing needles, sharing drug equipment, indirectly sharing and using shooting galleries declined with follow-up for the whole cohort. Within the drug-using subcohort, there was a decrease in the proportion of individuals who injected drugs, while within the injecting subcohort the sharing of injection equipment and the use of shooting galleries declined. Our findings suggest that low-threshold MMT programs can reduce the risk of HIV without the enforcement of abstinence-based policies.

  6. Do managed care plans reduce racial disparities in preventive care?

    PubMed

    Lin, Chyongchiou Jeng; Musa, Donald; Silverman, Myrna; Degenholtz, Howard B

    2005-02-01

    This study was designed to determine whether managed care plans reduce racial disparities in use of influenza vaccination, mammography, and prostate-specific antigen screening. The study analyzed the use of three types of preventive care in a population-based sample of adults who were 65 years or older and were enrolled in a Medicare managed care (MMC) or fee-for-service (FFS) plan in Allegheny County, Pennsylvania. The study sample included 463 African Americans and 592 whites. Fewer African Americans than whites reported having had an influenza vaccination (64.4% versus 76.5%; p < 0.01) or a prostate-specific antigen test (64% versus 71.2%; p = 0.09) during the previous year. Slightly more African Americans than white women reported having had a mammogram (66.1% versus 63.8%). Logistic regression showed that, regardless of health plan type, African Americans were significantly less likely than whites to have an influenza vaccination (p < 0.05). A MMC plan did not narrow racial differences in preventive care. Reducing disparities may require interventions developed for specific racial/ethnic groups.

  7. Diabetes disease management in Medicare Advantage reduces hospitalizations and costs.

    PubMed

    Rosenzweig, James L; Taitel, Michael S; Norman, Gordon K; Moore, Tim J; Turenne, Wendy; Tang, Pei

    2010-07-01

    To evaluate the effectiveness of a telephonic diabetes disease management intervention in a Medicare Advantage population with comorbid diabetes and coronary artery disease (CAD). Prospective unequal randomization design of 526 members from a Medicare Advantage segment of one region of a large national health plan from May 2005 through April 2007. High-risk and high-cost patients with diabetes and CAD who were enrolled in telephonic diabetes disease management were compared with a randomly selected comparison group receiving usual care. Wilcoxon signed-rank tests were used to compare the groups on all-cause hospital admissions, diabetes-related hospital admissions, all-cause and diabetes-related emergency department (ED) visits, and all-cause medical costs. Changes in self-reported clinical outcomes also were measured in the intervention group. Patients receiving telephonic diabetes disease management had significantly decreased all-cause hospital admissions and diabetes-related hospital admissions (P <.05). The intervention group had decreased all-cause and diabetes-related ED visits, although the difference was not statistically significant. The comparison group had increased ED utilization. The intervention group decreased their all-cause total medical costs by $984.87 per member per year (PMPY) compared with a $4547.06 PMPY increase in the comparison group (P <.05). All clinical measures significantly improved (P <.05) in the intervention group. A disease management program for high-risk patients with diabetes and CAD was effective in reducing hospital inpatient admission and total costs in a Medicare Advantage population.

  8. Management of tropospheric ozone by reducing methane emissions.

    PubMed

    West, J Jason; Fiore, Arlene M

    2005-07-01

    Background concentrations of tropospheric ozone are increasing and are sensitive to methane emissions, yet methane mitigation is currently considered only for climate change. Methane control is shown here to be viable for ozone management. Identified global abatement measures can reduce approximately 10% of anthropogenic methane emissions at a cost-savings, decreasing surface ozone by 0.4-0.7 ppb. Methane controls produce ozone reductions that are widespread globally and are realized gradually (approximately 12 yr). In contrast, controls on nitrogen oxides (NOx) and nonmethane volatile organic compounds (NMVOCs) target high-ozone episodes in polluted regions and affect ozone rapidly but have a smaller climate benefit. A coarse estimate of the monetized global benefits of ozone reductions for agriculture, forestry, and human health (neglecting ozone mortality) justifies reducing approximately 17% of global anthropogenic methane emissions. If implemented, these controls would decrease ozone by -1 ppb and radiative forcing by approximately 0.12 W m(-2). We also find that climate-motivated methane reductions have air quality-related ancillary benefits comparable to those for CO2. Air quality planning should consider reducing methane emissions alongside NOx and NMVOCs, and because the benefits of methane controls are shared internationally, industrialized nations should consider emphasizing methane in the further development of climate change or ozone policies.

  9. Use of integrated malaria management reduces malaria in Kenya.

    PubMed

    Okech, Bernard A; Mwobobia, Isaac K; Kamau, Anthony; Muiruri, Samuel; Mutiso, Noah; Nyambura, Joyce; Mwatele, Cassian; Amano, Teruaki; Mwandawiro, Charles S

    2008-01-01

    and 81% reported buying the nets within the last 5 years. The community also used mosquito reduction measures including, in order of preference, environmental management (35%), mosquito repellent and smoke (31%) insecticide canister sprays (11%), and window and door screens (6%). These methods used by the community comprise an integrated malaria management (IMM) package. Over the last 4 years prior to this study, the malaria cases in the community hospital reduced from about 40% in 2000 to less than 10% by 2004 and by the year 2007 malaria cases decreased to zero. In addition, a one time cross-sectional malaria parasite survey detected no Plasmodium infection in 300 primary school children in the area. Mosquito vector populations were variable in the six villages but were generally lower in villages that did not engage in irrigation activities. The malaria risk as estimated by EIR remained low and varied by village and proximity to irrigation areas. The average EIR in the area was estimated at 0.011 infectious bites per person per day. The usage of a combination of malaria control tools in an integrated fashion by residents of Mwea division might have influenced the decreased malaria cases in the district hospital and in the school children. A vigorous campaign emphasizing IMM should be adopted and expanded in Mwea division and in other areas with different eco-epidemiological patterns of malaria transmission. With sustained implementation and support from community members integrated malaria management can reduce malaria significantly in affected communities in Africa.

  10. The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD.

    PubMed

    Linton, Sabriya L; Celentano, David D; Kirk, Gregory D; Mehta, Shruti H

    2013-10-01

    Few studies have assessed the temporal association between homelessness and injection drug use, and injection-related risk behavior. Among a cohort of 1405 current and former injection drug users in follow-up from 2005 to 2009, we used random intercept models to assess the temporal association between homelessness and subsequent injection drug use, and to determine whether the association between homelessness and sustained injection drug use among active injectors differed from the association between homelessness and relapse among those who stopped injecting. We also assessed the association between homelessness and subsequent injection-related risk behavior among participants who injected drugs consecutively across two visits. Homelessness was categorized by duration: none, <1 month, and ≥1 month. Homelessness was reported on at least one occasion by 532 (38%) participants. The relationship between homelessness and subsequent injection drug use was different for active injectors and those who stopped injecting. Among those who stopped injecting, homelessness was associated with relapse [<1 month: AOR=1.67, 95% CI (1.01, 2.74); ≥1 month: AOR=1.34 95% CI (0.77, 2.33)]. Among active injectors, homelessness was not associated with sustained injection drug use [<1 month: AOR=1.03, 95% CI (0.71, 1.49); ≥1 month: AOR=0.81 95% CI (0.56, 1.17)]. Among those injecting drugs across two consecutive visits, homelessness ≥1 month was associated with subsequent injection-related risk behavior [AOR=1.61, 95% CI (1.06, 2.45)]. Homelessness appears to be associated with relapse and injection-related risk behavior. Strengthening policies and interventions that prevent homelessness may reduce injection drug use and injection-related risk behaviors. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. Case Management Reduces Drinking During Pregnancy among High Risk Women

    PubMed Central

    May, Philip A.; Marais, Anna-Susan; Gossage, J. Phillip; Barnard, Ronel; Joubert, Belinda; Cloete, Marise; Hendricks, Natalie; Roux, Sumien; Blom, Annalien; Steenekamp, Jeanetta; Alexander, Theresa; Andreas, Romena; Human, Suzanne; Snell, Cudore; Seedat, Soraya; Parry, Charles C.; Kalberg, Wendy O.; Buckley, David; Blankenship, Jason

    2014-01-01

    Aim Estimate the efficacy of Case Management (CM) for women at high risk for bearing a child with Fetal Alcohol Spectrum Disorders (FASD). Design Women were recruited from antenatal clinics and engaged in 18 months of CM. Setting A South African community with a subculture of heavy, regular, weekend, recreational drinking and high documented rates of FASD. Participants Forty-one women who were high risk for bearing a child with FASD. Measures Statistical analysis of trends in drinking and other risk factors. Findings At intake 87.8% were pregnant, most had previous alcohol-exposed pregnancies, most/all of their friends drink alcohol (67.5%), and 50.0% had stressful lives. CM was particularly valuable for pregnant women, as statistically significant reductions in alcohol risk were obtained for them in multiple variables: total drinks on weekends after six months of CM (p = .026) and estimated peak blood alcohol concentration (BAC) at six (p < .001) and 18 months (p < .001). For participants completing 18 months of CM, AUDIT scores improved significantly by 6-month follow-up (from 19.8 to 9.7, p = .000), and even though rising at 12 and 18 months, AUDIT scores indicate that problematic drinking remained statistically significantly lower than baseline throughout CM. Happiness scale scores correlated significantly with reduced drinking in most time periods. Conclusions An enduring change in drinking behavior is difficult in this social setting. Yet, CM provided by skilled and empathic case managers reduced maternal drinking at critical times, and therefore, alcohol exposure levels to the fetus. PMID:24729823

  12. Integrated weed management (IWM): will it reduce herbicide use?

    PubMed

    Moss, S R

    2010-01-01

    The Sustainable Use of Pesticides Directive (2009/128/EC), part of the EU Thematic Strategy for Pesticides, requires Integrated Pest Management (IPM) to be actively promoted. A key objective is to give greater priority to non-chemical methods of plant protection to reduce the impact of pesticides on human health and the environment. Integrated Weed Management (IWM) can be considered part of IPM, and many non-chemical methods are available. For example, a recent review of methods for control of Alopecurus myosuroides (black-grass) in winter wheat found the following mean annual levels of control: ploughing 67%; delayed drilling 37%; fallowing 70%; higher seed rates 30%; competitive cultivars 27%. In comparison with herbicides these efficacy levels are mediocre, and A. myosuroides would be classified as resistant (R) or moderately resistant (MR) to all these methods if the criteria used by the Chemicals Regulation Directorate in the UK for assigning ratings to herbicide efficacy were used. It is, therefore, not surprising that farmers are reluctant to embrace IWM and continue to place greater.reliance on herbicides as a more reliable and cost effective method of weed control. While non-chemical methods will not replace herbicides on most farms, reduced reliance on herbicides will be necessary both for practical (increasing resistance, lack of new herbicides) and political reasons (complying with EU legislation). Farmers will use nonchemical control methods when they have a major weed problem, and have no alternative, but they must be encouraged to adopt IWM at an earlier stage. Research into IWM must be relevant and practical, and not simply conducted as some sort of 'academic' exercise. More effective knowledge transfer is vital, and this is a challenge due to the decline in independent, state funded, advisory services in many European countries. The question arises; is it possible to achieve reductions in pesticide use by simply promoting non-chemical methods of

  13. Reducing hospital noise: a review of medical device alarm management.

    PubMed

    Konkani, Avinash; Oakley, Barbara; Bauld, Thomas J

    2012-01-01

    Increasing noise in hospital environments, especially in intensive care units (ICUs) and operating rooms (ORs), has created a formidable challenge for both patients and hospital staff. A major contributing factor for the increasing noise levels in these environments is the number of false alarms generated by medical devices. This study focuses on discovering best practices for reducing the number of false clinical alarms in order to increase patient safety and provide a quiet environment for both work and healing. The researchers reviewed Pub Med, Web of Knowledge and Google Scholar sources to obtain original journal research and review articles published through January 2012. This review includes 27 critically important journal articles that address different aspects of medical device alarms management, including the audibility, identification, urgency mapping, and response time of nursing staff and different solutions to such problems. With current technology, the easiest and most direct method for reducing false alarms is to individualize alarm settings for each patient's condition. Promoting an institutional culture change that emphasizes the importance of individualization of alarms is therefore an important goal. Future research should also focus on the development of smart alarms.

  14. Reducing maladaptive weight management practices: developing a psychoeducational intervention program.

    PubMed

    O'Brien, Karina M; LeBow, Michael D

    2007-04-01

    Previous research has addressed the issues of behavior change and eating disorder prevention among adolescents and young women. The current study was designed to evaluate: (a) whether an 8-week psychoeducational intervention can reduce maladaptive weight-management practices in women (University females, N=24) with sub-clinical levels of eating pathology; and (b) whether its implementation reduces the risk of developing more severe eating pathology across time. Participants were randomly assigned to an experimental (EX) group or a self-monitoring control (SMC) group. Statistically significant changes on measures of eating pathology, including the Eating Attitudes Test-26 [Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. (1982). The Eating Attitudes Test: psychometric features and clinical correlates. Psychological Medicine, 12, 871-878]; Forbidden Food Survey [Ruggerio, L., Williamson, D. A., Davis, C. J., Schlundt, D. G., & Carey, M. P. (1988). Forbidden Food Survey: Measure of bulimic's anticipated emotional reactions to specific foods. Addictive Behaviors, 13, 267-274]; and Bulimia Test-Revised [Thelen, M. H., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revision of the bulimia test: The BULIT-R. Journal of Consulting and Clinical Psychology, 3(1), 119-124] were observed, as were changes in body image, as measured by the Body Shape Questionnaire [Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairburn, C. G. (1987). The development and validation of the body shape questionnaire. International Journal of Eating Disorders, 6(4), 485-494]. Additional significant between-group differences in eating behavior, as measured by daily meal records, were also seen. Participants in the EX group evidenced improvements in scores which were significantly different from those observed in the SMC group. Unfortunately, attrition limited the utility of follow up data.

  15. Accident Precursor Analysis and Management: Reducing Technological Risk Through Diligence

    NASA Technical Reports Server (NTRS)

    Phimister, James R. (Editor); Bier, Vicki M. (Editor); Kunreuther, Howard C. (Editor)

    2004-01-01

    Almost every year there is at least one technological disaster that highlights the challenge of managing technological risk. On February 1, 2003, the space shuttle Columbia and her crew were lost during reentry into the atmosphere. In the summer of 2003, there was a blackout that left millions of people in the northeast United States without electricity. Forensic analyses, congressional hearings, investigations by scientific boards and panels, and journalistic and academic research have yielded a wealth of information about the events that led up to each disaster, and questions have arisen. Why were the events that led to the accident not recognized as harbingers? Why were risk-reducing steps not taken? This line of questioning is based on the assumption that signals before an accident can and should be recognized. To examine the validity of this assumption, the National Academy of Engineering (NAE) undertook the Accident Precursors Project in February 2003. The project was overseen by a committee of experts from the safety and risk-sciences communities. Rather than examining a single accident or incident, the committee decided to investigate how different organizations anticipate and assess the likelihood of accidents from accident precursors. The project culminated in a workshop held in Washington, D.C., in July 2003. This report includes the papers presented at the workshop, as well as findings and recommendations based on the workshop results and committee discussions. The papers describe precursor strategies in aviation, the chemical industry, health care, nuclear power and security operations. In addition to current practices, they also address some areas for future research.

  16. Reducing watershed scale phosphorus export through integrated management practices

    USDA-ARS?s Scientific Manuscript database

    Phosphorus losses from golf course have been documented and are comparable to losses from agriculture and urban areas. Integrated management practices are required to address the problem. An integrated management approach using filter socks and limiting the amount of phosphorus applied to the golf c...

  17. Reduce--recycle--reuse: guidelines for promoting perioperative waste management.

    PubMed

    Laustsen, Gary

    2007-04-01

    The perioperative environment generates large amounts of waste, which negatively affects local and global ecosystems. To manage this waste health care facility leaders must focus on identifying correctable issues, work with relevant stakeholders to promote solutions, and adopt systematic procedural changes. Nurses and managers can moderate negative environmental effects by promoting reduction, recycling, and reuse of materials in the perioperative setting.

  18. Management Can Reduce Contamination Potential of Beef Backgrounding

    USDA-ARS?s Scientific Manuscript database

    Producers who want to “background” beef cattle on karst landscapes face great challenges. This is because without proper management, manure-borne contaminants from backgrounding sites can quickly degrade water quality in karst regions. Western Kentucky University and USDA-ARS reported on three-year ...

  19. Can weight management programs in worksites reduce the obesity epidemic?

    USDA-ARS?s Scientific Manuscript database

    Worksites can potentially be important locations for weight management programs that contribute to curbing the national obesity epidemic. In published studies, weight loss programs targeting overweight and obese employees have been relatively more effective for weight loss than programs for preventi...

  20. Feed management for beef feedlots to reduce air emissions

    USDA-ARS?s Scientific Manuscript database

    This power point presentation gives an overview of air emissions from beef cattle feedyards as well as nutritional and management techniques that might decrease these emissions. Topics include greenhouse gases (methane, nitrous oxide), ammonia, particulate matter and odors. This was presented as on...

  1. Improving Benefits and Reducing Costs: Managing Educational Secondments.

    ERIC Educational Resources Information Center

    McMichael, Paquita; And Others

    1995-01-01

    A (British) educational "secondment" involves resource allocation from one institution to another and new forms of employee accountability and commitment. This article examines management implications of educational secondments, exploring costs and benefits accruing to 50 secondees, their seconding organizations, and those to which they…

  2. Management Science/Industrial Engineering Techniques to Reduce Food Costs.

    ERIC Educational Resources Information Center

    Greenberg, Murray

    This paper examines the contributions of Industrial Engineering and Management Science toward reduction in the cost of production and distribution of food. Food processing firms were requested to respond to a questionnaire which asked for examples of their use of various operations research tools and information on the number of operations…

  3. Reducing the variability of compound management delivery using visual management systems.

    PubMed

    Spencer, Philip; Ratcliffe, Stuart; Cole, Shaun

    2014-04-01

    The globalization and externalization of a pharmaceutical company's research and development (R&D) places considerable demands on its underpinning compound management (CM) capability. More robust CM workflows are needed to support higher demands and cross-continent supply chains. The tracking and visibility of compound orders progressing through CM processes has become crucial to ensure prompt and reliable delivery to customers and project timelines worldwide. AstraZeneca at Alderley Park UK has successfully introduced and integrated a visual management system into its CM processes to support the company's global R&D strategy. A simple, low-cost approach has been employed to track solid processing and solubilization orders. This reduced variability and end-to-end cycle times by decreasing waiting time between processing steps. The visual tracking system has been quick to implement, adaptable to change, and able to be owned and run by delivery teams. Introduction of the visual tracking system has resulted in significant improvements in order processing, both in terms of variability and speed. The percentage of orders processed within 24 h rose from 81.5% to 92.5%, and reductions of 50% and 17.5% in the average processing time were seen for solid dispense and solubilization orders, respectively.

  4. The value of fuel management in reducing wildfire damage

    Treesearch

    Kenneth W. Outcalt; Dale D. Wade

    2000-01-01

    The objective of this study was to test the effectiveness of a regular prescribed burning program to reduce mortality of southern pines when forests are burned by wildfire. The study was installed on the Osceola National Forest in where about 10,000 ha of flatwoods forest type was burned by arson set wildfires under extreme conditions in June 1998. Stands within the...

  5. Comparison of Anxiety Management Training and Desensitization in Reducing Test and Other Anxieties.

    ERIC Educational Resources Information Center

    Deffenbacher, Jerry L.; Shelton, John L.

    1978-01-01

    Effects of systematic desensitization and anxiety management training in reducing test anxiety and generalizing to other anxieties were compared. Both desensitization and anxiety management training produced significant reduction of text anxiety, but by follow-up, anxiety management training produced significantly more test-anxiety reduction on…

  6. Waste management: three R's (reduce, reuse, recycle) reduce waste, save money.

    PubMed

    Kirkby, G

    1993-01-01

    This article outlines the problems of waste disposal in health care facilities and offers practical ways to reduce, reuse, recycle, and compost waste in the health care setting. The author presents data on medical waste, gives alternatives to incineration, and describes recycling practices at various hospitals.

  7. Water engineering. Reducing sewer corrosion through integrated urban water management.

    PubMed

    Pikaar, Ilje; Sharma, Keshab R; Hu, Shihu; Gernjak, Wolfgang; Keller, Jürg; Yuan, Zhiguo

    2014-08-15

    Sewer systems are among the most critical infrastructure assets for modern urban societies and provide essential human health protection. Sulfide-induced concrete sewer corrosion costs billions of dollars annually and has been identified as a main cause of global sewer deterioration. We performed a 2-year sampling campaign in South East Queensland (Australia), an extensive industry survey across Australia, and a comprehensive model-based scenario analysis of the various sources of sulfide. Aluminum sulfate addition during drinking water production contributes substantially to the sulfate load in sewage and indirectly serves as the primary source of sulfide. This unintended consequence of urban water management structures could be avoided by switching to sulfate-free coagulants, with no or only marginal additional expenses compared with the large potential savings in sewer corrosion costs.

  8. Management strategies to reduce risk of postoperative infections.

    PubMed

    Galor, Anat; Goldhardt, Raquel; Wellik, Sarah R; Gregori, Ninel Z; Flynn, Harry W

    2013-12-01

    Postoperative infections, although rare, are still of great concern to the ophthalmologist. The incidence of post-cataract endophthalmitis is low, with a range of .28 per 1,000 to 2.99 per 1000. In addition to intraoperative considerations such as poor wound construction, vitreous loss, topical anesthesia, and prolonged surgical time, other risk factors include preoperative factors such as a diseased ocular surface and systemic immunosuppression. Potential methods of reducing risk of endophthalmitis after anterior segment surgery are discussed and available literature is summarized.

  9. Management strategies to reduce risk of postoperative infections

    PubMed Central

    Galor, Anat; Goldhardt, Raquel; Wellik, Sarah R.; Gregori, Ninel Z.; Flynn, Harry W.

    2013-01-01

    Postoperative infections, although rare, are still of great concern to the ophthalmologist. The incidence of post-cataract endophthalmitis is low, with a range of .28 per 1,000 to 2.99 per 1000. In addition to intraoperative considerations such as poor wound construction, vitreous loss, topical anesthesia, and prolonged surgical time, other risk factors include preoperative factors such as a diseased ocular surface and systemic immunosuppression. Potential methods of reducing risk of endophthalmitis after anterior segment surgery are discussed and available literature is summarized. PMID:24319649

  10. Waste management: how reducing partiality can promote efficient resource allocation.

    PubMed

    Choshen-Hillel, Shoham; Shaw, Alex; Caruso, Eugene M

    2015-08-01

    Two central principles that guide resource-allocation decisions are equity (providing equal pay for equal work) and efficiency (not wasting resources). When these two principles conflict with one another, people will often waste resources to avoid inequity. We suggest that people wish to avoid inequity not because they find it inherently unfair, but because they want to avoid the appearance of partiality associated with it. We explore one way to reduce waste by reducing the perceived partiality of inequitable allocations. Specifically, we hypothesize that people will be more likely to favor an efficient (albeit inequitable) allocation if it puts them in a disadvantaged position than if it puts others in a disadvantaged position. To test this hypothesis, we asked participants to choose between giving some extra resource to one person (thereby creating inequity between this person and equally deserving others) and not giving the resource to anyone (thereby wasting the resource). Six studies, using realistic scenarios and behavioral paradigms, provide robust evidence for a self-disadvantaging effect: Allocators were consistently more likely to create inequity to avoid wasting resources when the resulting inequity would put them at a relative disadvantage than when it would put others at a relative disadvantage. We further find that this self-disadvantaging effect is a direct result of people's concern about appearing partial. Our findings suggest the importance of impartiality even in distributive justice, thereby bridging a gap between the distributive and procedural justice literatures.

  11. Reducing the cognitive workload: Trouble managing power systems

    NASA Technical Reports Server (NTRS)

    Manner, David B.; Liberman, Eugene M.; Dolce, James L.; Mellor, Pamela A.

    1993-01-01

    The complexity of space-based systems makes monitoring them and diagnosing their faults taxing for human beings. Mission control operators are well-trained experts but they can not afford to have their attention diverted by extraneous information. During normal operating conditions monitoring the status of the components of a complex system alone is a big task. When a problem arises, immediate attention and quick resolution is mandatory. To aid humans in these endeavors we have developed an automated advisory system. Our advisory expert system, Trouble, incorporates the knowledge of the power system designers for Space Station Freedom. Trouble is designed to be a ground-based advisor for the mission controllers in the Control Center Complex at Johnson Space Center (JSC). It has been developed at NASA Lewis Research Center (LeRC) and tested in conjunction with prototype flight hardware contained in the Power Management and Distribution testbed and the Engineering Support Center, ESC, at LeRC. Our work will culminate with the adoption of these techniques by the mission controllers at JSC. This paper elucidates how we have captured power system failure knowledge, how we have built and tested our expert system, and what we believe are its potential uses.

  12. Reducing the cognitive workload: Trouble managing power systems

    NASA Astrophysics Data System (ADS)

    Manner, David B.; Liberman, Eugene M.; Dolce, James L.; Mellor, Pamela A.

    1993-12-01

    The complexity of space-based systems makes monitoring them and diagnosing their faults taxing for human beings. Mission control operators are well-trained experts but they can not afford to have their attention diverted by extraneous information. During normal operating conditions monitoring the status of the components of a complex system alone is a big task. When a problem arises, immediate attention and quick resolution is mandatory. To aid humans in these endeavors we have developed an automated advisory system. Our advisory expert system, Trouble, incorporates the knowledge of the power system designers for Space Station Freedom. Trouble is designed to be a ground-based advisor for the mission controllers in the Control Center Complex at Johnson Space Center (JSC). It has been developed at NASA Lewis Research Center (LeRC) and tested in conjunction with prototype flight hardware contained in the Power Management and Distribution testbed and the Engineering Support Center, ESC, at LeRC. Our work will culminate with the adoption of these techniques by the mission controllers at JSC. This paper elucidates how we have captured power system failure knowledge, how we have built and tested our expert system, and what we believe are its potential uses.

  13. Reducing the cognitive workload - Trouble managing power systems

    NASA Technical Reports Server (NTRS)

    Manner, David B.; Liberman, Eugene M.; Dolce, James L.; Mellor, Pamela A.

    1993-01-01

    The complexity of space-based systems makes monitoring them and diagnosing their faults taxing for human beings. When a problem arises, immediate attention and quick resolution is mandatory. To aid humans in these endeavors we have developed an automated advisory system. Our advisory expert system, Trouble, incorporates the knowledge of the power system designers for Space Station Freedom. Trouble is designed to be a ground-based advisor for the mission controllers in the Control Center Complex at Johnson Space Center (JSC). It has been developed at NASA Lewis Research Center (LeRC) and tested in conjunction with prototype flight hardware contained in the Power Management and Distribution testbed and the Engineering Support Center, ESC, at LeRC. Our work will culminate with the adoption of these techniques by the mission controllers at JSC. This paper elucidates how we have captured power system failure knowledge, how we have built and tested our expert system, and what we believe its potential uses are.

  14. Animal management to reduce phosphorus losses to the environment.

    PubMed

    Knowlton, K F; Radcliffe, J S; Novak, C L; Emmerson, D A

    2004-01-01

    Water quality in the United States is threatened by contamination with nutrients, primarily nitrogen and phosphorus. Animal manure can be a valuable resource for farmers, providing nutrients, improving soil structure, and increasing vegetative cover to decrease erosion potential. At the same time, application of manure nutrients in excess of crop requirements can result in environmental contamination. Environmental concerns with P are primarily associated with pollution of surface water (streams, lakes, rivers). This pollution may be caused by runoff of P when application to land is in excess of crop requirements. Increased specialization and concentration of livestock and crop production has led to the net export of nutrients from major crop-producing areas of the country to areas with a high concentration of animal agriculture. Concentrated animal agriculture has been identified as a significant source of P contamination of surface water. Areas facing the dilemma of an economically important livestock industry concentrated in an environmentally sensitive area have few options. If agricultural practices continue as they have in the past, continued damage to water resources and a loss of fishing and recreational activity are inevitable. If agricultural productivity is decreased, however, the maintenance of a stable farm economy, a viable rural economy, and a reliable domestic food supply are seriously threatened. Decreasing the P content of manure through nutrition is a powerful, cost-effective approach to reducing P losses from livestock farms and will help farmers meet increasingly stringent environmental regulations. This paper reviews opportunities available to reduce the P content of livestock manure, including more accurate interpretation of the published P requirements of animals, improved diet formulation and group-feeding strategies to more precisely meet requirements, and approaches to improve availability of feed P for monogastric and ruminant species.

  15. Falls and balance confidence in persons with and without injection-related venous ulcers.

    PubMed

    Pieper, Barbara; Templin, Thomas N; Goldberg, Allon; DiNardo, Ellen; Wells, Margaret

    2013-01-01

    With aging of injection users and the high occurrence of venous disease in their legs, falls are a potential health problem. We examined falls and balance confidence in persons with (VU+) and without (VU-) injection-related venous ulcers (VUs). This study used a cross-sectional, retrospective, comparative design with 31 participants VU+ and 30 VU- recruited in a medical clinic. Participants' legs were assessed for clinical manifestations of venous disease. Participants completed background and fall questionnaires and the Activities-specific Balance Confidence (ABC) Scale. Participants included 35 men and 26 women (mean age = 54 years); 93% were African American. Falling in the past year was reported by 65% of patients VU+ and 40% VU- (P = 0.048); 29 of these patients fell 2 or more times in the past year. Higher scores on the ABC Scale (N = 61) were significantly related to fewer falls (r = -0.68). Activities-specific Balance Confidence scores were lower/worse for the patients VU+ (P = 0.039). Area under the receiver operating curve for patients VU+ was significant; we found area under the curve of 0.84 and a cutoff score of 80.3% for ABC predictive of recurrent fallers with sensitivity of 84% and specificity of 83%. The ABC test had an internal consistency reliability of 0.97. Persons VU+ reported worse balance confidence and more falls than those without these ulcers. The ABC test was related to falls. With aging of injection users and increased occurrence of VUs, examining balance confidence and falls is crucial in long-term patient safety.

  16. Management Options For Reducing The Release Of Antibiotics And Antibiotic Resistance Genes To The Environment

    EPA Science Inventory

    Background: There is growing concern worldwide about the role of polluted soil and water - 77 environments in the development and dissemination of antibiotic resistance. 78 Objective: To identify management options for reducing the spread of antibiotics and 79 antibiotic resist...

  17. Management Options For Reducing The Release Of Antibiotics And Antibiotic Resistance Genes To The Environment

    EPA Science Inventory

    Background: There is growing concern worldwide about the role of polluted soil and water - 77 environments in the development and dissemination of antibiotic resistance. 78 Objective: To identify management options for reducing the spread of antibiotics and 79 antibiotic resist...

  18. Creating Access to Invisible Special Collections: Using Participatory Management to Reduce a Backlog

    ERIC Educational Resources Information Center

    Lundy, M. Winslow; Hollis, Deborah R.

    2004-01-01

    The University of Colorado at Boulder Libraries used participatory management to reduce a special collections backlog. Without an increase in budget or staffing, technical and public services departments designed a pilot project to redeploy internal human resources in a collaborative manner. The process of backlog management is discussed.

  19. How to reduce injuries to residual trees during stand management activities.

    Treesearch

    Paul E. Aho; Gary Fiddler; Gregory M. Filip

    1983-01-01

    Losses of trees and tree volume that result from decay initiated by mechanical injuries during stand management activities in the western United States are substantial. They can be reduced through improved logging methods and careful planning of other forest management activities.

  20. Creating Access to Invisible Special Collections: Using Participatory Management to Reduce a Backlog

    ERIC Educational Resources Information Center

    Lundy, M. Winslow; Hollis, Deborah R.

    2004-01-01

    The University of Colorado at Boulder Libraries used participatory management to reduce a special collections backlog. Without an increase in budget or staffing, technical and public services departments designed a pilot project to redeploy internal human resources in a collaborative manner. The process of backlog management is discussed.

  1. Sleep Quality: A Pilot Study Comparing Patients With and Without Injection-Related Venous Ulcers.

    PubMed

    Pieper, Barbara; Templin, Thomas N

    2016-01-01

    The purposes of this study were to (a) compare sleep quality of persons with and without injection-related venous ulcers (VU) and (b) examine associations between global sleep quality with age, sex, comorbidities, pain, nutrition, physical health rating, fatigue, emotional problems, health-related quality of life, attitude toward physical activity, and number of ulcers. This study used a cross-sectional design. The participants included 31 patients with VU and 30 without VU (men [n = 35] and women; mean age = 54 years) who were attending an indigent clinic for wound care or general health. Participants were recruited from an urban clinic when they came for primary care or wound care. Questionnaires were administered at that time and included the Pittsburgh Sleep Quality Index (PSQI), Mini Nutrition Assessment, Patient Reported Outcomes Measurement Information System (PROMIS) questions about general physical health, fatigue, emotional problems, and quality of life, Brief Pain Inventory worst pain rating, Positive Attitude and Motivation for Physical Activity Scale, wound assessment, and demographic factors. The 2 groups did not differ on the PSQI in terms of time going to bed, minutes to fall asleep, time awakening, hours slept, and time in bed. Those with VU compared to without VU took more medications to help sleep (P≤ .03). There were no significant differences in PSQI correlations across groups. All study variables except age, gender, and quality of life were significantly related to Global sleep disturbance score. A higher number of comorbid conditions, worse pain, poorer nutrition, poor physical health rating, greater fatigue, more emotional problems, and poor attitude toward physical activity were related to greater sleep disturbances for all participants. Both groups had mean Global PSQI scores greater than 5 (with VU = 7.83 and without VU = 8.2), indicating sleep problems. Study findings suggest that sleep disturbances may be a concern in persons with VU

  2. Restructuring materiel management functions: a method for prioritizing changes and reducing costs.

    PubMed

    Craig, K W

    1992-02-01

    The success of any manager depends highly on the ability to seize on opportunities that will achieve the organization's goals. Hospitals are currently searching for ways to reduce costs while maintaining or enhancing the quality of services. Quality services are increasingly being defined as those that are most responsive to customer needs. It is important, as hospital management restructures materiel systems or methods of operation for reduced costs, to focus on the user departments as the customers. The consolidation of materiel management activity should not be seen as a loss of control at the user department level. Instead it can be seen as a new way of providing service with higher quality. User departments should see concrete benefits on a weekly basis, including reduced time spent on materiel management functions; increased planning of purchasing, inventory, and distribution functions; and assistance in meeting restricted supply budgets.

  3. Managing a subsidized predator population: Reducing common raven predation on desert tortoises

    USGS Publications Warehouse

    Boarman, W.I.

    2003-01-01

    Human communities often are an inadvertent source of food, water, and other resources to native species of wildlife. Because these resources are more stable and predictable than those in a natural environment, animals that subsist on them are able to increase in numbers and expand their range, much to the detriment of their competitors and species they prey upon. In the Mojave Desert, common ravens (Corvus corax) have benefited from human-provided resources to increase in population size precipitously in recent years. This trend has caused concern because ravens prey on juvenile desert tortoises (Gopherus agassizii), a federally threatened species. In this paper, I discuss management strategies to reduce raven predation on desert tortoises. The recommendations fall into three categories: (1) managing raven populations by reducing access to anthropogenic resources; (2) removing offending ravens or other birds in specially targeted tortoise management zones; and (3) continuing research on raven ecology, raven behavior, and methods of reducing raven predation on tortoises. I also recommend approaching the problem within an adaptive management framework: management efforts should first be employed as scientific experiments - with replicates and controls - to yield an unbiased assessment of their effectiveness. Furthermore, these strategies should be implemented in concert with actions that reduce other causes of desert tortoise mortality to aid the long-term recovery of their populations. Overall, the approaches outlined in this paper are widely applicable to the management of subsidized predators, particularly where they present a threat to a declining species of prey.

  4. Commentary: Exploiting the overlap: using utilization management to reduce medical malpractice.

    PubMed

    Dulworth, Sherrie

    2003-01-01

    This report presents a practical way in which hospitals can reduce medical malpractice exposure that is related to omissions and delays in care. We illustrate our approach using the results of a risk/medical management study performed at an acute-care hospital. Traditional risk management (RM) often focuses retrospectively on adverse events and may miss opportunities to prevent errors related to omissions and delays in care. Close-to-real-time utilization management (UM) activity offers ready potential to improve quality and reduce medical malpractice--but only if UM can work synergistically with RM. It is our conclusion that hospitals can implement systematic processes to identify and intervene in patterns of omissions and delays and improve the communication and synergy among stakeholders and thereby improve patient safety and reduce their medical malpractice risks.

  5. Does Water Management Reduce uncertainty of Projected Climate Change Impacts on River Discharge?

    NASA Astrophysics Data System (ADS)

    Pohle, I.; Koch, H.; Gaedeke, A.; Hinz, C.; Grünewald, U.

    2015-12-01

    Climate change impact studies are associated with error propagation and amplification of uncertainties through model chains. Water management, especially reservoir management, reduces discharge variability. In this study we investigated how water management influences uncertainty propagation of climate change scenarios. We applied a model ensemble of (i) the regional climate model STAR (STAR 0K: no further climate change, STAR 2K and 3K: increase of mean annual temperature by 2 K and 3 K resp.; each scenario is represented by 100 realizations), (ii) the hydrological models SWIM and EGMO, and (iii) the water management model WBalMo. The study was performed in the two neighbouring catchments of the Schwarze Elster River (Germany) and the Spree River (Germany and Czech Republic). These catchments have similar climate, topography and land use, but differ in their water management. The Spree River has a higher reservoir capacity, more withdrawals and discharges from water users and more water transfers. The projected natural runoff in both catchments is similar. Compared to STAR 0K, the natural runoff decreases remarkably in the other climate scenarios. The uncertainties related to the climate projection are propagated through the hydrological model. In the Schwarze Elster River catchment, these uncertainties are slightly increased by the water management model, whereas in the Spree River catchment, due to a higher reservoir capacity and more water transfers, interannual variability and uncertainty of managed discharge are strongly moderated by water management. The results of this study imply that generally, effective water management can reduce uncertainty related to climate change impacts on river discharge. Catchments with a high storage ratio are less vulnerable to changing climate conditions. This underlines the role of water management in coping with climate change impacts. Yet, due to decreasing reservoir volumes in drought periods, reservoir management alone

  6. Aircraft Thrust/Power Management can Save Defense Fuel, Reduce Engine Maintenance Costs, and Improve Readiness.

    DTIC Science & Technology

    1982-07-29

    reduce maintenance costs. Iii’ (See p. 8.) - I The services also lack effective thrust/power coPv management programs. Thrust/power management...variances to determine the causes and take corrective action if warranted. 14 The Navy established a research and development activity at the Naval Air...stated that while funding is avail- able to conduct research , implementation of the most costly ideas must compete with other priorities for limited

  7. Utilizing an Energy Management System with Distributed Resources to Manage Critical Loads and Reduce Energy Costs

    DTIC Science & Technology

    2014-09-01

    Systems with Electric Power Systems,” IEEE std 1547.4–2011, IEEE , 2011. [3] Department of the Navy, “Department of the Navy’s Energy Program for...Providing Improved Power Quality in Microgrids,” IEEE Industry Applications Magazine , pp. 34–43, September– October 2014. [27] A. Julian, N. Peck...and G. Oriti, “ Power electronics enabled energy management systems,” in Proceedings of IEEE Applied Power Electronics Conference, Long Beach, CA

  8. Defense Management: How Do We Manage in an Era of Reduced Budgets?

    DTIC Science & Technology

    1990-05-01

    efficiently manage defense in an era of budget constraint and shifting security threat ? -- Does history provide any applicable lessons or insights? -- What...of defense is needed and certain levels of modernization are prudent. --- Defense policy must be based on a realistic analysis of threats to national...Multi-year funding, increased time-on-station, and base closure are a few examples. Any reform will be resisted if viewed as a threat to an organization

  9. Reduced exercise capacity in persons with Down syndrome: cause, effect, and management.

    PubMed

    Mendonca, Goncalo V; Pereira, Fernando D; Fernhall, Bo

    2010-12-08

    Persons with Down syndrome (DS) have reduced peak and submaximal exercise capacity. Because ambulation is one predictor of survival among adults with DS, a review of the current knowledge of the causes, effects, and management of reduced exercise capacity in these individuals would be important. Available data suggest that reduced exercise capacity in persons with DS results from an interaction between low peak oxygen uptake (VO(2peak)) and poor exercise economy. Of several possible explanations, chronotropic incompetence has been shown to be the primary cause of low VO(2peak) in DS. In contrast, poor exercise economy is apparently dependent on disturbed gait kinetics and kinematics resulting from joint laxity and muscle hypotonia. Importantly, there is enough evidence to suggest that such low levels of physical fitness (reduced exercise capacity and muscle strength) limit the ability of adults with DS to perform functional tasks of daily living. Consequently, clinical management of reduced exercise capacity in DS seems important to ensure that these individuals remain productive and healthy throughout their lives. However, few prospective studies have examined the effects of structured exercise training in this population. Existent data suggest that exercise training is beneficial for improving exercise capacity and physiological function in persons with DS. This article reviews the current knowledge of the causes, effects, and management of reduced exercise capacity in DS. This review is limited to the acute and chronic responses to submaximal and peak exercise intensities because data on supramaximal exercise capacity of persons with DS have been shown to be unreliable.

  10. Diversity in forest management to reduce wildfire losses: implications for resilience

    Treesearch

    Susan Charnley; Thomas A. Spies; Ana M. G. Barros; Eric M. White; Keith A. Olsen

    2017-01-01

    This study investigates how federal, state, and private corporate forest owners in a fire-prone landscape of southcentral Oregon manage their forests to reduce wildfire hazard and loss to high-severity wildfire. We evaluate the implications of our findings for concepts of social–ecological resilience. Using interview data, we found a high degree of "response...

  11. Security Officer's Role in Reducing Inmate Problem Behaviors: A Program Based on Contingency Management.

    ERIC Educational Resources Information Center

    Ellis, Janet

    1993-01-01

    Describes guard-designed and implemented contingency-management work squad training program for administratively segregated prison inmates with histories of violent and assaultive behavior. Notes that participation in the work squad program sharply reduced frequency of violent and assaultive behavior for 8 of 10 offender-participants whose…

  12. Best management practices for reducing nutrient loads in a sub-watershed of Chesapeake Bay area

    USDA-ARS?s Scientific Manuscript database

    Water quality improvement in the Chesapeake Bay is a grave concern. An initiative to reduce the nutrient loads to stream has been undertaken to attain a target total maximum daily load (TMDL) at Chesapeake Bay. A general guideline with a set of best management practices (BMPs) has been in place for ...

  13. Best management practices for reducing nutrient loads in a sub-watershed of Chesapeake Bay

    USDA-ARS?s Scientific Manuscript database

    Water quality improvement in the Chesapeake Bay is a grave concern. An initiative to reduce the nutrient loads to stream has been undertaken to attain a target total maximum daily load (TMDL) at Chesapeake Bay. A general guideline with a set of best management practices (BMPs) has been in place for ...

  14. Retaining Educational Fundraisers: Reducing Turnover by Investing in Human Capital Management

    ERIC Educational Resources Information Center

    Thomas, Christy

    2010-01-01

    This article outlines an approach to reducing gift officer turnover during comprehensive campaigns by investing in the human capital management (HCM) program. While many universities have begun to create HCM programs, I suggest creating a position specifically focused on the retention of gift offices to ensure that universities and non-profits can…

  15. Retaining Educational Fundraisers: Reducing Turnover by Investing in Human Capital Management

    ERIC Educational Resources Information Center

    Thomas, Christy

    2010-01-01

    This article outlines an approach to reducing gift officer turnover during comprehensive campaigns by investing in the human capital management (HCM) program. While many universities have begun to create HCM programs, I suggest creating a position specifically focused on the retention of gift offices to ensure that universities and non-profits can…

  16. A "Mental-Health-at-the-Workplace" Educational Workshop Reduces Managers' Stigma Toward Depression.

    PubMed

    Hamann, Johannes; Mendel, Rosmarie; Reichhart, Tatjana; Rummel-Kluge, Christine; Kissling, Werner

    2016-01-01

    Stigma and discrimination are important factors hindering people with mental health conditions to stay employed or successfully make their careers. We surveyed 580 German managers before and after visiting a "mental-health-at-the-workplace" educational workshop using the Depression Stigma Scale. The workshop significantly reduced stigma toward depression. Managers at baseline already exhibited lower stigma toward depression compared with the general population. In addition, female gender and higher education predicted lower stigma, which is in line with findings from other studies. We conclude that an educational workshop giving practical guidance regarding "mental-health-at-the-workplace" reduces managers' stigma toward depression and improves knowledge regarding depression, its course, and its treatment.

  17. Source reduction in Florida's salt marshes: management to reduce pesticide use and enhance the resource.

    PubMed

    Carlson, Douglas B

    2006-09-01

    Source reduction as part of an integrated pest management program is a cornerstone of the American Mosquito Control Association's Pesticide Environmental Stewardship Program Strategy Document to reduce pesticide risk. Since the early 1980s, Florida has made important strides in implementing environmentally sound source reduction strategies in salt marshes while managing them for both mosquito control and natural resource enhancement. The political mechanism for this progress has been interagency cooperation through the Florida Coordinating Council on Mosquito Control and its Subcommittee on Managed Marshes. Challenges in accomplishing source reduction continue because both public and private lands are involved. Public lands include those owned by federal (e.g., U.S. Fish and Wildlife Service, National Park Service), state (Florida Department of Environmental Protection), and local governments, and they have a diversity of management objectives. This diversity adds to the challenge facing mosquito control agencies in providing mosquito control services while protecting and enhancing the environment.

  18. Supply chain management of health commodities for reducing global disease burden.

    PubMed

    Chukwu, Otuto Amarauche; Ezeanochikwa, Valentine Nnaemeka; Eya, Benedict Ejikeme

    Reducing global disease burden requires improving access to medicines, thus the need for efficient and effective supply chain management for medicines. The Nigerian government came up with new policies on Mega Drug Distribution Centres and National Drug Distribution Guidelines to improve access to quality medicines with pharmacists having a key role to play. However, pharmacists in Nigeria seem not to be aware and adequately equipped to handle the medicines supply chain. This article aimed at assessing the awareness and readiness of Nigerian pharmacists on supply chain management practices for improving access to medicines. Pharmacists in Nigeria's Capital were randomly sampled. Semi-structured questionnaires were administered. Descriptive statistics was used in data analysis. P values less than 0.05 were considered to be significant. 29.3%, 20.7% and 53.7% were not aware of supply chain management, National Drug Distribution Guidelines and Mega Drug Distribution Centres, respectively. 85.46% do not have a copy of the National Drug Distribution Guidelines. 78% were not aware that Mega Drug Distribution Centres are already operational. 35.4% have never been involved in any supply chain management practice. 69.5% often experience stock out of vital and essential medicines, of which 85.2% were in hospitals. 15.9% were successful in managing their facility's supply chains. 84.1% opined that pharmacists in Nigeria are not yet ready to handle the medicines supply chain. Findings showed limited awareness and readiness on supply chain management of medicines. This may be due to inadequate supply chain management skills and infrastructure, poor financing, lack of accountability and poor management. Tackling these as well as pharmacists showing more interest in the country's health policies and obtaining necessary postgraduate certifications will lead to improvements. This will improve access to quality medicines and thus help in the fight to reduce disease burden both

  19. Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

    PubMed Central

    Cox, Jonathan MS; Steel, Nicholas; Clark, Allan B; Kumaravel, Bharathy; Bachmann, Max O

    2013-01-01

    Background Ninety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. Aim To assess the impact of three referral-management centres (RMCs) and two internal peer-review approaches to referral management on hospital outpatient attendance rates. Design and setting A retrospective time-series analysis of 376 000 outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. Method The age-standardised GP-referred first outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. Results Referral management was not associated with a reduction in the outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). Conclusion Referral-management schemes did not reduce outpatient attendance rates. RMCs were more expensive than internal peer review. PMID:23735409

  20. Management options for reducing the release of antibiotics and antibiotic resistance genes to the environment.

    PubMed

    Pruden, Amy; Larsson, D G Joakim; Amézquita, Alejandro; Collignon, Peter; Brandt, Kristian K; Graham, David W; Lazorchak, James M; Suzuki, Satoru; Silley, Peter; Snape, Jason R; Topp, Edward; Zhang, Tong; Zhu, Yong-Guan

    2013-08-01

    There is growing concern worldwide about the role of polluted soil and water environments in the development and dissemination of antibiotic resistance. Our aim in this study was to identify management options for reducing the spread of antibiotics and antibiotic-resistance determinants via environmental pathways, with the ultimate goal of extending the useful life span of antibiotics. We also examined incentives and disincentives for action. We focused on management options with respect to limiting agricultural sources; treatment of domestic, hospital, and industrial wastewater; and aquaculture. We identified several options, such as nutrient management, runoff control, and infrastructure upgrades. Where appropriate, a cross-section of examples from various regions of the world is provided. The importance of monitoring and validating effectiveness of management strategies is also highlighted. Finally, we describe a case study in Sweden that illustrates the critical role of communication to engage stakeholders and promote action. Environmental releases of antibiotics and antibiotic-resistant bacteria can in many cases be reduced at little or no cost. Some management options are synergistic with existing policies and goals. The anticipated benefit is an extended useful life span for current and future antibiotics. Although risk reductions are often difficult to quantify, the severity of accelerating worldwide morbidity and mortality rates associated with antibiotic resistance strongly indicate the need for action.

  1. Management Options for Reducing the Release of Antibiotics and Antibiotic Resistance Genes to the Environment

    PubMed Central

    Pruden, Amy; Amézquita, Alejandro; Collignon, Peter; Brandt, Kristian K.; Graham, David W.; Lazorchak, James M.; Suzuki, Satoru; Silley, Peter; Snape, Jason R.; Topp, Edward; Zhang, Tong; Zhu, Yong-Guan

    2013-01-01

    Background: There is growing concern worldwide about the role of polluted soil and water environments in the development and dissemination of antibiotic resistance. Objective: Our aim in this study was to identify management options for reducing the spread of antibiotics and antibiotic-resistance determinants via environmental pathways, with the ultimate goal of extending the useful life span of antibiotics. We also examined incentives and disincentives for action. Methods: We focused on management options with respect to limiting agricultural sources; treatment of domestic, hospital, and industrial wastewater; and aquaculture. Discussion: We identified several options, such as nutrient management, runoff control, and infrastructure upgrades. Where appropriate, a cross-section of examples from various regions of the world is provided. The importance of monitoring and validating effectiveness of management strategies is also highlighted. Finally, we describe a case study in Sweden that illustrates the critical role of communication to engage stakeholders and promote action. Conclusions: Environmental releases of antibiotics and antibiotic-resistant bacteria can in many cases be reduced at little or no cost. Some management options are synergistic with existing policies and goals. The anticipated benefit is an extended useful life span for current and future antibiotics. Although risk reductions are often difficult to quantify, the severity of accelerating worldwide morbidity and mortality rates associated with antibiotic resistance strongly indicate the need for action. PMID:23735422

  2. Evaluation of vegetable production management practices to reduce the ecological risk of pesticides.

    PubMed

    Rice, Pamela J; Hapeman, Cathleen J; McConnell, Laura L; Sadeghi, Ali M; Teasdale, John R; Coffman, C Benjamin; McCarty, Gregory W; Abdul-Baki, Aref A; Starr, James L

    2007-11-01

    The ability of agricultural management practices to reduce the ecological risks of pesticides was evaluated. Risk quotients, a mathematical description of the relationship between exposure and toxicity, and hazard ratings, a rank of the potential risk of pesticides to aquatic environments, were calculated for conventional and alternative cultivation practices for tomatoes: Poly-Bare, raised beds covered with polyethylene mulch with bare-soil furrows; Poly-Rye, raised beds covered with polyethylene mulch with cereal rye (Secale cereale) grown in the furrows; and Vetch, raised beds and furrows planted with hairy vetch seed (Vicia villosa). Evaluations were conducted using measured pesticide concentrations in runoff at the edge-of-field and estimated environmental concentrations in an adjacent creek and a theoretical pond receiving the runoff. Runoff from Poly-Bare presented the greatest risk to ecosystem health and to sensitive organisms, whereas the use of Vetch minimized these risks. Previous studies have shown that harvest yields were maintained and that runoff volume, soil loss, and off-site transport of pesticides measured in runoff were reduced using the alternative management practices (Poly-Rye and Vetch). Together, these results indicate that the alternative management practices (Poly-Rye and Vetch) have a less adverse impact on the environment than the conventional management practice (Poly-Bare) while providing growers with an acceptable economic return. In addition, the present study demonstrates the need to consider the management practice when assessing the potential risks and hazards for certain pesticides.

  3. Searching for management approaches to reduce HAI transmission (SMART): a study protocol.

    PubMed

    McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia J; Walker, Daniel M; Aldrich, Alison M; Sova, Lindsey N; Gaughan, Alice A; Slevin, Caitlin M; Hebert, Courtney; Hade, Erinn; Buck, Jacalyn; Grove, Michele; Huerta, Timothy R

    2017-06-28

    Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)-including culture and management strategies-to proactively support clinical teams. Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an

  4. Acute Concussion Management with Remove-Reduce/Educate/Adjust-Accommodate/Pace (REAP).

    PubMed

    Kirelik, Susan B; McAvoy, Karen

    2016-02-01

    With increased concussion awareness and significantly increased numbers of emergency department (ED) visits for pediatric concussion, a seamless process of managing a patient with a concussion can begin in the ED. This article demonstrates the effectiveness of the Remove-Reduce/Educate/Adjust-Accommodate/Pace (REAP) concussion management program in the evaluation, management, and return to play of an acutely concussed pediatric patient. The REAP program was developed in Colorado and promotes a multidisciplinary team approach to concussion management. The team consists of parents, teachers, athletic personnel, and clinicians. The patient described in this case report had concussion management initiated in the ED. He was able to successfully return to sports, having recovered from his concussion with the guidance of the Center for Concussion (Centennial, Colorado) staff utilizing the REAP model of care and the currently recommended graduated return-to-play process. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Busy EDs are often the initial point of contact for school-aged patients with concussion. We present a program that we believe represents a good model of patient care with concussion management implemented in the ED and carried through to clearance of the patient. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Does recyclable separation reduce the cost of municipal waste management in Japan?

    PubMed

    Chifari, Rosaria; Lo Piano, Samuele; Matsumoto, Shigeru; Tasaki, Tomohiro

    2017-02-01

    Municipal solid waste (MSW) management is a system involving multiple sub-systems that typically require demanding inputs, materials and resources to properly process generated waste throughput. For this reason, MSW management is generally one of the most expensive services provided by municipalities. In this paper, we analyze the Japanese MSW management system and estimate the cost elasticity with respect to the waste volumes at three treatment stages: collection, processing, and disposal. Although we observe economies of scale at all three stages, the collection cost is less elastic than the disposal cost. We also examine whether source separation at home affects the cost of MSW management. The empirical results show that the separate collection of the recyclable fraction leads to reduced processing costs at intermediate treatment facilities, but does not change the overall waste management cost. Our analysis also reveals that the cost of waste management systems decreases when the service is provided by private companies through a public tender. The cost decreases even more when the service is performed under the coordination of adjacent municipalities.

  6. The use of contingency management to reduce cigarette smoking among college students.

    PubMed

    Correia, Christopher J; Benson, Trisha A

    2006-05-01

    The current study tested the feasibility of using contingency management to reduce cigarette smoking among college students. Eighty-eight undergraduate smokers were enrolled in a 3-week ABA study. During the baseline weeks, participants earned noncontingent monetary payments for attending data collection sessions. During the intervention week, participants earned monetary payments contingent on demonstrating recent abstinence. Participants were randomly assigned to either a low- or a high-reinforcer magnitude condition that controlled the amount of money that could be earned during the intervention week. Cigarette smoking was significantly reduced during the intervention week relative to the baseline weeks, and greater reductions were achieved under the high-reinforcer magnitude condition. These results suggest that cigarette smoking among college students is responsive to contingency management procedures.

  7. Working to reduce the effects of discrimination: Identity management strategies in organizations.

    PubMed

    Shih, Margaret; Young, Maia J; Bucher, Amy

    2013-04-01

    Despite efforts to dispel discrimination, workplace discrimination still occurs. We introduce two classes of identity management strategies individuals use to mitigate the negative consequences of discrimination: identity switching (i.e., deemphasizing target identities and recategorizing to a more positively valued identity) and identity redefinition (i.e., stereotype reassociation and regeneration). Organizations adopting a color-blind approach may make it more difficult for individuals to use identity switching because the policies deemphasize differences in social identities. In contrast, organizations adopting a multicultural approach may make it more difficult for individuals to use identity redefinition. Multicultural approaches, applied superficially, may celebrate group differences that might actually reinforce culturally dominant stereotypes. We explore the likelihood that individuals will adopt each strategy given these organizational approaches to diversity. We outline steps organizations can take to reduce the need for identity management strategies and to facilitate identity management when necessary.

  8. Reducing Health Cost: Health Informatics and Knowledge Management as a Business and Communication Tool

    NASA Astrophysics Data System (ADS)

    Gyampoh-Vidogah, Regina; Moreton, Robert; Sallah, David

    Health informatics has the potential to improve the quality and provision of care while reducing the cost of health care delivery. However, health informatics is often falsely regarded as synonymous with information management (IM). This chapter (i) provides a clear definition and characteristic benefits of health informatics and information management in the context of health care delivery, (ii) identifies and explains the difference between health informatics (HI) and managing knowledge (KM) in relation to informatics business strategy and (iii) elaborates the role of information communication technology (ICT) KM environment. This Chapter further examines how KM can be used to improve health service informatics costs, and identifies the factors that could affect its implementation and explains some of the reasons driving the development of electronic health record systems. This will assist in avoiding higher costs and errors, while promoting the continued industrialisation of KM delivery across health care communities.

  9. Concussion sideline management intervention for rugby union leads to reduced concussion claims.

    PubMed

    Gianotti, Simon; Hume, Patria A

    2007-01-01

    The effectiveness of a concussion management education programme (CMEP) in rugby in reducing the number and cost of concussion/brain injury (CBI) moderate to serious claims (MSC) was assessed. A RugbySmart educational video and a sideline concussion check (SCC) tool comprised the CMEP. Over 30,000 SCC, providing information on management of suspected concussion among community level rugby players prior to seeking medical treatment, were distributed from July 2003 to June 2005. Each year approximately 10,000 coaches and 2,000 referees participated in RugbySmart. From 2003 to 2005 new rugby CBI MSC reduced by 10.7% (actual) and 58.2% (forecast). Rugby player numbers, new non-sport CBI MSC and new sport MSC all increased by 13.6%, 16.9% and 24.6% respectively in the same period. The median number of days between CBI injury and the player seeking medical treatment decreased from six days to four days. Cost savings after CMEP were 690 USD dollars, 690 (actual) to 3,354,780 USD dollars (forecast). The two-year cost of CMEP was 54,810 USD dollars returning 12.60 USD dollars (actual) and 61.21 USD dollars (forecast) for every 1 USD dollar invested (ROI). CMEP provided community coaches and managers with education on minimum best practice for managing suspected concussion, contributed towards ROI and savings for CBI MSC in rugby.

  10. Management Strategies Aiming to Improve Horse Welfare Reduce Embryonic Death Rates in Mares.

    PubMed

    Malschitzky, E; Pimentel, A M; Garbade, P; Jobim, Mim; Gregory, R M; Mattos, R C

    2015-08-01

    The objective of this retrospective study was to evaluate the effect of management strategies aiming to improve animal well-being on pregnancy and embryonic death (ED) rates. Breeding records of a cohort of 1206 Thoroughbred mares brought to a stallion station facility, to be bred with the stallions housed there, were evaluated during ten breeding seasons. Mares were blocked according to management strategies in two groups: Stress and Relax. Strategies used to improve animal well-being (Relax group) were as follows: stopping the teasing routine, reducing or eliminating stall confinement, reducing the number of mares per group and maintaining herd stability during the breeding season. In barren mares, the pregnancy rate was higher in the Relax group (91.8%) when compared to the observed in Stress group (84.7%). However, no difference in pregnancy rates were observed (Stress = 85.2% vs. Relax = 86.2) in foaling mares. ED rate was higher in barren and foaling mares of the Stress group mares (25.5% and 26.8%, respectively) compared with the Relax group (16.1% and 14.7%, respectively). No significant differences were observed on foal heat pregnancy rate between groups; yet, the embryo loss on foal heat was significant reduced in Relax mares (Relax = 8.7% vs Stress = 24.5%). In conclusion, management strategies aimed to reduce social stress can reduce early pregnancy losses and the average cycles per pregnancy, improving reproductive performance in mares.

  11. Integrating modeling, monitoring, and management to reduce critical uncertainties in water resource decision making.

    PubMed

    Peterson, James T; Freeman, Mary C

    2016-12-01

    Stream ecosystems provide multiple, valued services to society, including water supply, waste assimilation, recreation, and habitat for diverse and productive biological communities. Managers striving to sustain these services in the face of changing climate, land uses, and water demands need tools to assess the potential effectiveness of alternative management actions, and often, the resulting tradeoffs between competing objectives. Integrating predictive modeling with monitoring data in an adaptive management framework provides a process by which managers can reduce model uncertainties and thus improve the scientific bases for subsequent decisions. We demonstrate an integration of monitoring data with a dynamic, metapopulation model developed to assess effects of streamflow alteration on fish occupancy in a southeastern US stream system. Although not extensive (collected over three years at nine sites), the monitoring data allowed us to assess and update support for alternative population dynamic models using model probabilities and Bayes rule. We then use the updated model weights to estimate the effects of water withdrawal on stream fish communities and demonstrate how feedback in the form of monitoring data can be used to improve water resource decision making. We conclude that investment in more strategic monitoring, guided by a priori model predictions under alternative hypotheses and an adaptive sampling design, could substantially improve the information available to guide decision-making and management for ecosystem services from lotic systems.

  12. Reducing Lake Erie's Harmful Algal Blooms: Projection and Adoption of Management Plans

    NASA Astrophysics Data System (ADS)

    Martin, J.; Aloysius, N.; Howard, G.; Kalcic, M. M.; Wilson, R. S.; Scavia, D.; Roe, B.

    2016-12-01

    In early 2016, the United States and Canada formally agreed to reduce phosphorus inputs to Lake Erie by 40% to reduce the severity of annual Harmful Algal Blooms (HABs). These blooms have become more severe, with record events occurring in 2011 and 2015, and have compromised public safety, shut down drinking water supplies, and negatively impacted the economy of the western Lake Erie basin. Now, key questions revolve around the ability to reach the 40% reduction, required management changes, and resources to support these changes. This presentation will highlight interdisciplinary research to compare the amount and types of practices needed for this reduction to the current and projected levels of adoption. Economic resources to support these management changes are also compared with the financial support from the general public to improve Lake Erie water quality. Multiple models of the Maumee watershed identified management plans and adoption rates needed to reach the reduction targets. For example, one successful scenario estimated necessary adoption rates of 50% for subsurface application of fertilizer on row crops, 58% for cover crops, and 78% for buffer strips. Current adoption is below these levels, but future projections based on farmer surveys shows these levels are possible. Public support is necessary to generate the funding to support cost sharing and other programs aimed at increasing adoption of recommended practices. Comparing results from willingness-to-pay surveys of the general public with the estimated need for these management plans shows a gap in resources to support these levels of adoption. In general, these results show that accelerated adoption of management plans is needed compared to past adoption rates, but that these rates are possible based on likely adoption rates. Projected support from the general public indicates it will be challenging to fund these rates of adoption, especially during climate changes that may require even greater

  13. Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions.

    PubMed

    Allaudeen, Nazima; Vashi, Anita; Breckenridge, Julia S; Haji-Sheikhi, Farnoosh; Wagner, Sarah; Posley, Keith A; Asch, Steven M

    The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016. We performed a Lean-based multidisciplinary initiative beginning with a rapid process improvement workshop to evaluate current processes, identify root causes of delays, and develop countermeasures. Frontline staff developed standard work for each phase of the ED stay. Units developed a daily management system to reinforce, evaluate, and refine standard work. The primary outcome was the change in ED LOS for medicine admissions pre- and postintervention. ED LOS at the intervention site was compared with other similar VA facilities as controls over the same time period using a difference-in-differences approach. ED LOS for medicine admissions reduced 26.4%, from 8.7 to 6.4 hours. Difference-in-differences analysis showed that ED LOS for combined medicine and surgical admissions decreased from 6.7 to 6.0 hours (-0.7 hours, P = .003) at the intervention site compared with no change (5.6 hours, P = .2) at the control sites. We utilized Lean management to significantly reduce ED LOS for medicine admissions. Specifically, the development and management of standard work were key to sustaining these results.

  14. The medical management of intestinal failure: methods to reduce the severity.

    PubMed

    Nightingale, Jeremy M D

    2003-08-01

    A new definition of intestinal failure is of reduced intestinal absorption so that macronutrient and/or water and electrolyte supplements are needed to maintain health or growth. Severe intestinal failure is when parenteral nutrition and/or fluid are needed and mild intestinal failure is when oral supplements or dietary modification suffice. Treatment aims to reduce the severity of intestinal failure. In the peri-operative period avoiding the administration of excessive amounts of intravenous saline (9 g NaCl/l) may prevent a prolonged ileus. Patients with intermittent bowel obstruction may be managed with a liquid or low-residue diet. Patients with a distal bowel enterocutaneous fistula may be managed with an enteral feed absorbed by the proximal small bowel while no oral intake may be needed for a proximal bowel enterocutaneous fistula. Patients undergoing high-dose chemotherapy can usually tolerate jejunal feeding. Rotating antibiotic courses may reduce small bowel bacterial overgrowth in patients with chronic intestinal pseudoobstruction. Restricting oral hypotonic fluids, sipping a glucose-saline solution (Na concentration of 90-120 mmol/l) and taking anti-diarrhoeal or anti-secretory drugs, reduces the high output from a jejunostomy. This treatment allows most patients with a jejunostomy and > 1 m functioning jejunum remaining to manage without parenteral support. Patients with a short bowel and a colon should consume a diet high in polysaccharides, as these compounds are fermented in the colon, and low in oxalate, as 25% of the oxalate will develop as calcium oxalate renal stones. Growth factors normally produced by the colon (e.g. glucagon-like peptide-2) to induce structural jejunal adaptation have been given in high doses to patients with a jejunostomy and do marginally increase the daily energy absorption.

  15. Increasing value and reducing waste in biomedical research regulation and management.

    PubMed

    Al-Shahi Salman, Rustam; Beller, Elaine; Kagan, Jonathan; Hemminki, Elina; Phillips, Robert S; Savulescu, Julian; Macleod, Malcolm; Wisely, Janet; Chalmers, Iain

    2014-01-11

    After identification of an important research question and selection of an appropriate study design, waste can arise from the regulation, governance, and management of biomedical research. Obtaining regulatory and governance approval has become increasingly burdensome and disproportionate to the conceivable risks to research participants. Regulation and governance involve interventions that are assumed to be justified in the interests of patients and the public, but they can actually compromise these interests. Inefficient management of the procedural conduct of research is wasteful, especially if it results in poor recruitment and retention of participants in well designed studies addressing important questions. These sources of waste can be minimised if the following four recommendations are addressed. First, regulators should use their influence to reduce other causes of waste and inefficiency in research. Second, regulators and policy makers should work with researchers, patients, and health professionals to streamline and harmonise the laws, regulations, guidelines, and processes that govern whether and how research can be done, and ensure that they are proportionate to the plausible risks associated with the research. Third, researchers and research managers should increase the efficiency of recruitment, retention, data monitoring, and data sharing in research through use of research designs known to reduce inefficiencies, and further research should be done to learn how efficiency can be increased. Finally, everyone, particularly those responsible for health-care systems, should promote integration of research into everyday clinical practice. Regulators and researchers should monitor adherence to each of these recommendations and publish metrics.

  16. Increasing value and reducing waste in biomedical research regulation and management

    PubMed Central

    Salman, Rustam Al-Shahi; Beller, Elaine; Kagan, Jonathan; Hemminki, Elina; Phillips, Robert S; Savulescu, Julian; Macleod, Malcolm; Wisely, Janet; Chalmers, Iain

    2014-01-01

    After identification of an important research question and selection of an appropriate study design, waste can arise from the regulation, governance, and management of biomedical research. Obtaining regulatory and governance approval has become increasingly burdensome and disproportionate to the conceivable risks to research participants. Regulation and governance involve interventions that are assumed to be justified in the interests of patients and the public, but they can actually compromise these interests. Inefficient management of the procedural conduct of research is wasteful, especially if it results in poor recruitment and retention of participants in well designed studies addressing important questions. These sources of waste can be minimised if the following four recommendations are addressed. First, regulators should use their influence to reduce other causes of waste and inefficiency in research. Second, regulators and policy makers should work with researchers, patients, and health professionals to streamline and harmonise the laws, regulations, guidelines, and processes that govern whether and how research can be done, and ensure that they are proportionate to the plausible risks associated with the research. Third, researchers and research managers should increase the efficiency of recruitment, retention, data monitoring, and data sharing in research through use of research designs known to reduce inefficiencies, and further research should be done to learn how efficiency can be increased. Finally, everyone, particularly those responsible for health-care systems, should promote integration of research into everyday clinical practice. Regulators and researchers should monitor adherence to each of these recommendations and publish metrics. PMID:24411646

  17. Evaluation of management strategies for reducing nitrogen loadings to four US estuaries.

    PubMed

    Whitall, D; Castro, M; Driscoll, C

    2004-10-15

    In this study we used the Watershed Assessment Tool for Evaluating Reduction Strategies for Nitrogen (WATERSN) model to evaluate a variety of management strategies for reducing nitrogen (N) loads to four US east coast estuaries: Casco Bay, Long Island Sound, Chesapeake Bay and Pamlico Sound. These management strategies encompass reductions in atmospheric emissions and deposition of N from sources including, fossil fuel burning utility emissions and mobile NO(x) emissions, N treatment in wastewater and controls on agricultural N inputs. We find that in primarily urban watersheds biological removal of N in wastewater treatment produces the greatest reduction in N loading (32-57% reductions), while in less urban watersheds, reductions in agricultural loading are more effective (5-56% reductions) in decreasing N loads to coastal ecosystems. Because anthropogenic N inputs are derived from a variety of sources, we also examined an integrated scenario targeting all major N sources; this resulted in 35-58% reductions in N loading. Nitrogen pollution originates from multiple sources and is transported through several media (air, soil, water); a major challenge of the development of N management strategies will be the control of multiple sources to effectively reduce N loads to estuaries.

  18. The role of risk management in reducing costs and increasing patient safety.

    PubMed

    Wendin, S Robert

    2006-01-01

    In the last few years risk managers have been very frustrated with the high costs, or sheer unavailability, of medical malpractice insurance. The frustration is very understandable, given the rising financial costs of litigation for medical negligence. This presentation will aim to recommend a way out of this conundrum which works equally well regardless of whether the prevailing litigation environment be high or low, or one which is a fault-based or no-fault based compensation system, or whether a conventional insurance, self-insurance, or pooled risk insurance scheme. This paper will seek further to recommend that it's time risk managers took more responsibility themselves for reducing medical errors and optimising their control of risk. By understanding the concept of Total Cost of Risk, risk managers would be able to reduce losses, relying less on the insurance market, and accept responsibility for risk themselves, and, as a result, lowering insurance premiums in the process as the risk will have been taken away from insurance underwriters.

  19. A Critical Asthma Standardized Clinical and Management Plan Reduces Duration of Critical Asthma Therapy.

    PubMed

    Wong, Jackson; Agus, Michael S D; Graham, Dionne A; Melendez, Elliot

    2017-02-01

    Reduction of critical asthma management time can reduce intensive care utilization. The goal of this study was to determine whether a Critical Asthma Standardized Clinical Assessment and Management Plan (SCAMP) can decrease length of critical asthma management time. This retrospective study compared critical asthma management times in children managed before and after implementation of a Critical Asthma SCAMP. The SCAMP used an asthma severity score management scheme to guide stepwise escalation and weaning of therapies. The SCAMP guided therapy until continuous albuterol nebulization (CAN) was weaned to intermittent albuterol every 2 hours (q2h). Because the SCAMP was part of a quality improvement initiative in which all patients received a standardized therapy, informed consent was waived. The study was conducted in Medicine ICU and Intermediate Care Units in a tertiary care freestanding children's hospital. Children ≥2 years of age who had CAN initiated in the emergency department and were admitted to the Division of Medicine Critical Care with status asthmaticus were included. The time to q2h dosing from initiation of CAN was compared between the baseline and SCAMP cohorts. Adverse events were compared. The Mann-Whitney test was used for analysis; P values <.05 were considered statistically significant. There were 150 baseline and 123 SCAMP patients eligible for analysis. There was a decrease in median time to q2h dosing after the SCAMP (baseline, 21.6 hours [interquartile range, 3.2-32.3 hours]; SCAMP, 14.2 hours [interquartile range, 9.0-23.1 hours]; P < .01). There were no differences in adverse events or readmissions. A Critical Asthma SCAMP was effective in decreasing time on continuous albuterol. Copyright © 2017 by the American Academy of Pediatrics.

  20. Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

    PubMed Central

    2011-01-01

    Introduction Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. Methods The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality. Results Among 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results. Conclusions This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies. PMID:21251331

  1. DEVELOPMENT OF A BRIEF SUBSTANCE USE SENSATION SEEKING SCALE: VALIDATION AND PREDICTION OF INJECTION-RELATED BEHAVIORS

    PubMed Central

    Werb, Dan; Richardson, Chris; Buxton, Jane; Shoveller, Jeannie; Wood, Evan; Kerr, Thomas

    2015-01-01

    Sensation seeking, a personality trait, has been shown to predict engagement in high-risk behaviors. However, little is known regarding the impact of sensation seeking on substance use among street youth. We therefore sought to modify a sensation seeking scale (SSS) for use among this population. Street youth from the Vancouver-based At-Risk Youth Study (n = 226) completed the modified SSS. Exploratory and confirmatory factor analysis (EFA/CFA) were undertaken to establish the scale’s dimensionality and internal validity. The association between SSS score and injection-related behaviors was tested using generalized estimating equation (GEE) analysis. EFA results indicated scale unidimensionality. The comparative fit index (CFI) suggested acceptable fit (CFI = 0.914). In multivariate analysis, sensation seeking was independently associated with injection drug use, crystal methamphetamine use, polysubstance use, and binge drug use (all p < 0.05). Our findings provide preliminary support for the use of the modified SSS among street youth. PMID:25119056

  2. A multidisciplinary team case management approach reduces the burden of frequent asthma admissions.

    PubMed

    Burke, Hannah; Davis, Jenny; Evans, Sian; Flower, Laura; Tan, Andrew; Kurukulaaratchy, Ramesh J

    2016-07-01

    Up to 10% of asthmatics have "difficult asthma"; however, they account for 80% of asthma-related expenditure and run the highest risk of acute severe exacerbations. An estimated 75% of admissions for asthma are avoidable. Guidelines advise that these patients be managed by an experienced specialist multidisciplinary team (MDT). We aimed to assess the impact of a case management strategy delivered via specialist MDTs on acute healthcare utilisation of patients with frequent asthma admissions. An MDT (consultant, specialist nurse, physiotherapist and psychologist) case management strategy was introduced in 2010 at University Hospital Southampton Foundation Trust (Southampton, UK) to support patients with frequent asthma admissions during admission and then in clinic. To assess efficacy, we systematically searched the hospital database for patients acutely admitted for asthma on two or more occasions in 2010, 2011 and 2012. Data were collected retrospectively covering patient demographics, admission details, asthma severity and comorbidity. From 2010 to 2012, 84 patients were admitted on two or more occasions per year (80% female, mean body mass index 31 kg·m(-2) and 55% psychological comorbidity). After introducing an MDT approach repeat asthma admissions fell by 33% from 127 in 2010 to 84 in 2012 (p=0.0004). In addition, bed days fell by 52% from 895 in 2010 to 430 in 2010 (p=0.015). An MDT case management approach significantly reduces hospitalisation in difficult asthma patients with prior frequent admission.

  3. A multidisciplinary team case management approach reduces the burden of frequent asthma admissions

    PubMed Central

    Burke, Hannah; Davis, Jenny; Evans, Sian; Flower, Laura; Tan, Andrew

    2016-01-01

    Up to 10% of asthmatics have “difficult asthma”; however, they account for 80% of asthma-related expenditure and run the highest risk of acute severe exacerbations. An estimated 75% of admissions for asthma are avoidable. Guidelines advise that these patients be managed by an experienced specialist multidisciplinary team (MDT). We aimed to assess the impact of a case management strategy delivered via specialist MDTs on acute healthcare utilisation of patients with frequent asthma admissions. An MDT (consultant, specialist nurse, physiotherapist and psychologist) case management strategy was introduced in 2010 at University Hospital Southampton Foundation Trust (Southampton, UK) to support patients with frequent asthma admissions during admission and then in clinic. To assess efficacy, we systematically searched the hospital database for patients acutely admitted for asthma on two or more occasions in 2010, 2011 and 2012. Data were collected retrospectively covering patient demographics, admission details, asthma severity and comorbidity. From 2010 to 2012, 84 patients were admitted on two or more occasions per year (80% female, mean body mass index 31 kg·m−2 and 55% psychological comorbidity). After introducing an MDT approach repeat asthma admissions fell by 33% from 127 in 2010 to 84 in 2012 (p=0.0004). In addition, bed days fell by 52% from 895 in 2010 to 430 in 2010 (p=0.015). An MDT case management approach significantly reduces hospitalisation in difficult asthma patients with prior frequent admission. PMID:27730207

  4. Reducing job insecurity and increasing performance ratings: does impression management matter?

    PubMed

    Huang, Guo-hua; Zhao, Helen Hailin; Niu, Xiong-ying; Ashford, Susan J; Lee, Cynthia

    2013-09-01

    Prior research on job insecurity has demonstrated its detrimental effects on both employees and the organization, yet no research has detailed how people actively deal with it. Drawing from proactivity research, this article argues that job insecurity prompts a proactive use of impression management tactics in the workplace. The effectiveness of these tactics depends on the level of supervisory liking for the employee and the attributions supervisors make regarding the employee's motives for the impression management behaviors (i.e., for the good of the organization or for self-interest). A 3-wave survey study of 271 Chinese employees and their supervisors showed that employees experiencing job insecurity in Time 1 reported using a variety of tactics to impress their supervisors at Time 2 and that these tactics curbed the affect associated with job insecurity and enhanced supervisor rated performance, through supervisor's liking and attributed motives. The relationship between impression management and increased supervisor-rated performance was moderated by supervisor attributions; the relationship between impression management and reduced affective job insecurity depended on supervisor liking. PsycINFO Database Record (c) 2013 APA, all rights reserved

  5. Tension between reducing sea-level rise and global warming through solar-radiation management

    NASA Astrophysics Data System (ADS)

    Irvine, P. J.; Sriver, R. L.; Keller, K.

    2012-02-01

    Geoengineering using solar-radiation management (SRM) is gaining interest as a potential strategy to reduce future climate change impacts. Basic physics and past observations suggest that reducing insolation will, on average, cool the Earth. It is uncertain, however, whether SRM can reduce climate change stressors such as sea-level rise or rates of surface air temperature change. Here we use an Earth system model of intermediate complexity to quantify the possible response of sea levels and surface air temperatures to projected climate forcings and SRM strategies. We find that SRM strategies introduce a potentially strong tension between the objectives to reduce (1) the rate of temperature change and (2) sea-level rise. This tension arises primarily because surface air temperatures respond faster to radiative forcings than sea levels. Our results show that the forcing required to stop sea-level rise could cause a rapid cooling with a rate similar to the peak business-as-usual warming rate. Furthermore, termination of SRM was found to produce warming rates up to five times greater than the maximum rates under the business-as-usual CO2 scenario, whereas sea-level rise rates were only 30% higher. Reducing these risks requires a slow phase-out of many decades and thus commits future generations.

  6. Nursing students' time management, reducing stress and gaining satisfaction: a grounded theory study.

    PubMed

    Mirzaei, Tayebeh; Oskouie, Fatemeh; Rafii, Forough

    2012-03-01

    In the course of their studies, nursing students must learn many skills and acquire the knowledge required for their future profession. This study investigates how Iranian nursing students manage their time according to the circumstances and obstacles of their academic field. Research was conducted using the grounded theory method. Twenty-one nursing students were purposefully chosen as participants. Data was collected through semi-structured interviews and analyzed using the method suggested by Corbin and Strauss. One of the three processes that the nursing students used was "unidirectional time management." This pattern consists of accepting the nursing field, overcoming uncertainty, assessing conditions, feeling stress, and trying to reduce stress and create satisfaction. It was found that students allotted most of their time to academic tasks in an attempt to overcome their stress. The findings of this study indicate the need for these students to have time for the extra-curricular activities and responsibilities that are appropriate to their age.

  7. Effectiveness of Print Education at Reducing Urban Mosquito Infestation through Improved Resident-Based Management

    PubMed Central

    Bodner, Danielle; LaDeau, Shannon L.; Biehler, Dawn; Kirchoff, Nicole; Leisnham, Paul T.

    2016-01-01

    Improving resident-based management and knowledge of mosquitoes is often an integral component of integrated mosquito management, especially in urban landscapes with considerable mosquito habitat on privately owned lands. This study tested the effectiveness of print education materials at reducing urban mosquito exposure through improving resident knowledge of, and attitudes towards, mosquitoes and mosquito management in Washington DC, USA. There was a specific focus on the removal of water-filled containers that are utilized by the developmental stages of the two most common vector species in the region, Aedes albopictus and Culex pipiens. Households in six neighborhoods that varied in socio-economic status were administered knowledge, attitude, and practice (KAP) surveys in 2010 and 2012, and had their yards surveyed for container habitats and immature mosquitoes (larvae and pupae) in 2010, 2011, and 2012. Half the households (intervention, n = 120) received education materials in 2011 and 2012 to yield a before-after control-intervention (BACI) design. Unexpectedly, residents in intervention households were more likely to show decreased concern for mosquito-borne illnesses than residents in control households, which did not receive materials. Moreover, there was a greater probability that control households reduced containers in 2012 than intervention households, particularly when they had low numbers of baseline (2010) containers. Irrespective of control, reductions in containers were associated with decreased abundances of immature mosquitoes. Overall, our findings suggest that print education materials may have unintended negative effects on resident attitudes and household management of mosquito production. We recommend that mosquito control agencies need to carefully consider their content of print messages and the effectiveness of strategies that passively convey information with little or no engagement with control professionals. PMID:27171195

  8. Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia.

    PubMed

    Iles, Ross Anthony; Wyatt, M; Pransky, G

    2012-12-01

    This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A 'quasi experimental' pre-post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318-$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67-0.88). Medical costs and weekly benefits costs were also lower after the intervention (p < 0.05). Reduction in claims costs were noted across industry types, injury location and most employer sizes. The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.

  9. Reduced gravity and ground testing of a two-phase thermal management system for large spacecraft

    NASA Technical Reports Server (NTRS)

    Hill, D. G.; Hsu, K.; Parish, R.; Dominick, J.

    1988-01-01

    Experiments were performed aboard the NASA-JSC KC-135 aircraft to study the effect of reduced gravity on two-phase (liquid/vapor) flow and condensation. A prototype two-phase thermal management system for a large spacecraft was tested. Both visual observation and photography of the flow regimes were made. Ground test simulations of the KC-135 flight tests were conducted for comparison purposes. Two-phase pressure drops were predictable by the Heat Transfer Research Institute (HTRI) method, or the Friedel correlation.

  10. Damage-reducing measures to manage flood risks in a changing climate

    NASA Astrophysics Data System (ADS)

    Kreibich, Heidi; Bubeck, Philip; Van Vliet, Mathijs; De Moel, Hans

    2014-05-01

    Damage due to floods has increased during the last few decades, and further increases are expected in several regions due to climate change and a growing vulnerability. To address the projected increase in flood risk, a combination of structural and non-structural flood risk mitigation measures is considered as a promising adaptation strategy. Such a combination takes into account that flood defence systems may fail, and prepare for unexpected crisis situations via land-use planning, building construction, evacuation and disaster response. Non-structural flood risk mitigation measures like shielding with water shutters or sand bags, building fortification or safeguarding of hazardous substances are often voluntary: they demand self-dependent action by the population at risk (Bubeck et al. 2012; 2013). It is believed that these measures are especially effective in areas with frequent flood events and low flood water levels, but some types of measures showed a significant damage-reducing effect also during extreme flood events, such as the Elbe River flood in August 2002 in Germany (Kreibich et al. 2005; 2011). Despite the growing importance of damage-reducing measures, information is still scarce about factors that motivate people to undertake such measures, the state of implementation of various non-structural measures in different countries and their damage reducing effects. Thus, we collected information and undertook an international review about this topic in the framework of the Dutch KfC project "Climate proof flood risk management". The contribution will present an overview about the available information on damage-reducing measures and draw conclusions for practical flood risk management in a changing climate. References: Bubeck, P., Botzen, W. J. W., Suu, L. T. T., Aerts, J. C. J. H. (2012): Do flood risk perceptions provide useful insights for flood risk management? Findings from central Vietnam. Journal of Flood Risk Management, 5, 4, 295-302 Bubeck, P

  11. Wind erosion reduces soil organic carbon sequestration falsely indicating ineffective management practices

    NASA Astrophysics Data System (ADS)

    Chappell, Adrian; Baldock, Jeffrey A.

    2016-09-01

    Improved management of agricultural land has the potential to reduce greenhouse gas emissions and to reduce atmospheric CO2 via soil carbon sequestration. However, SOC stocks are reduced by soil erosion which is commonly omitted from calculations of crop production, C cycling, C sequestration and C accounting. We used fields from the wind eroded dryland cropping region of Western Australia to demonstrate the global implications for C sequestration and C accounting of omitting soil erosion. For the fields we previously estimated mean net (1950s-1990) soil erosion of 1.2 ± 1.0 t ha-1 y-1. The mean net (1990-2013) soil erosion increased by nearly four times to 4.4 ± 2.1 t ha-1 y-1. Conservation agriculture has evidently not reduced wind erosion in this region. The mean net (1990-2013) SOC erosion was up to 0.2 t C ha-1 y-1 across all sampled fields and similar to measured sequestration rates in the region (up to 0.5 t C ha-1 y-1; 10 years) for many management practices recommended for building SOC stocks. The minimum detectable change (MDC; 10 years) of SOC without erosion was up to 0.2 t C ha-1 y-1 whilst the MDC of SOC with erosion was up to 0.4 t C ha-1 y-1. These results illustrate the generally applicable outcome: (i) if SOC erosion is equal to (or greater than) the increase in SOC due to management practices, the change will not be detectable (or a loss will be evident); (ii) without including soil erosion in SOC sequestration calculations, the monitoring of SOC stocks will lead to, at best the inability to detect change and, at worst the false impression that management practices have failed to store SOC. Furthermore, continued omission of soil erosion in crop production, C accounting and C sequestration will most likely undermine confidence in policy designed to encourage adoption of C farming and the attendant benefits for soil stewardship and food security.

  12. Management of patients with reduced oral aperture and mandibular hypomobility (trismus) and implications for operative dentistry.

    PubMed

    Garnett, M J; Nohl, F S; Barclay, S C

    2008-02-09

    Reduced oral aperture and mandibular mobility/trismus are relatively common conditions that can be encountered in patients attending general dental practice, community dental practice and district general or dental teaching hospitals. All dental specialties may see patients with these conditions, and regardless of which environment or specialty, both patient and clinician may experience significant problems. The purpose of this opinion-based paper is to identify and review the causes of such conditions, to review the development of problems encountered for patients and clinicians, and to identify options to treat or manage the conditions.

  13. Vegetation management for reducing mortality of ponderosa pine seedlings from Thomomys spp

    USGS Publications Warehouse

    Barnes, V.G.; Anthony, M.; ,

    1995-01-01

    The effects of vegetation management on Mazama pocket gopher activity and damage to ponderosa pine seedlings were studied using atrazine herbicide to alter the habitat. Atrazine treatments were applied to a large treatment unit and observed effects were compared to an untreated control unit. The greatly reduced forb and grass cover on the treated unit was associated with a corresponding decrease in pocket gopher activity. Times until seedlings first incurred gopher damage and overall survival of two cohorts of seedlings were greatly increased on the treated unit.

  14. Does better disease management in primary care reduce hospital costs? Evidence from English primary care.

    PubMed

    Dusheiko, Mark; Gravelle, Hugh; Martin, Stephen; Rice, Nigel; Smith, Peter C

    2011-09-01

    We apply cross-sectional and panel data methods to a database of 5 million patients in 8000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions. Copyright © 2011 Elsevier B.V. All rights reserved.

  15. Managing delegation in the FDA: reducing delay in new-drug review.

    PubMed

    Olson, Mary K

    2004-06-01

    This article examines the effects of the user fee reform on the speed of drug review in the U.S. Food and Drug Administration. The results show that even after controlling for increased agency resources, the reform reduced review times among new-drug approvals by 34 percent (95 percent confidence interval, 11 to 51 percent, p = .01). The results suggest that increased agency resources alone cannot explain the reductions in drug-review times. Evidence suggests that other reform-specific factors facilitated the change. Such factors may include the agency's desire to obtain program renewal and secure future fee revenues as well as heightened industry monitoring. Additional results show that there were significant increases in the speed of review for novel drugs in the reform era and for drugs in certain classes that have historically experienced longer delays. The results suggest that the user fee reform has helped politicians manage delegation and reduce delay in new-drug review.

  16. Incentivizing the Public to Support Invasive Species Management: Eurasian Milfoil Reduces Lakefront Property Values

    PubMed Central

    Olden, Julian D.; Tamayo, Mariana

    2014-01-01

    Economic evaluations of invasive species are essential for providing comprehensive assessments of the benefits and costs of publicly-funded management activities, yet many previous investigations have focused narrowly on expenditures to control spread and infestation. We use hedonic modeling to evaluate the economic effects of Eurasian milfoil (Myriophyllum spicatum) invasions on lakefront property values of single-family homes in an urban-suburban landscape. Milfoil often forms dense canopies at the water surface, diminishing the value of ecosystem services (e.g., recreation, fishing) and necessitating expensive control and management efforts. We compare 1,258 lakeshore property sale transactions (1995–2006) in 17 lakes with milfoil and 24 un-invaded lakes in King County, Washington (USA). After accounting for structural (e.g., house size), locational (e.g., boat launch), and environmental characteristics (e.g., water clarity) of lakes, we found that milfoil has a significant negative effect on property sales price ($94,385 USD lower price), corresponding to a 19% decline in mean property values. The aggregate cost of milfoil invading one additional lake in the study area is, on average, $377,542 USD per year. Our study illustrates that invasive aquatic plants can significantly impact property values (and associated losses in property taxes that reduce local government revenue), justifying the need for management strategies that prevent and control invasions. We recommend coordinated efforts across Lake Management Districts to focus institutional support, funding, and outreach to prevent the introduction and spread of milfoil. This effort will limit opportunities for re-introduction from neighboring lakes and incentivize private landowners and natural resource agencies to commit time and funding to invasive species management. PMID:25333619

  17. Incentivizing the public to support invasive species management: eurasian milfoil reduces lakefront property values.

    PubMed

    Olden, Julian D; Tamayo, Mariana

    2014-01-01

    Economic evaluations of invasive species are essential for providing comprehensive assessments of the benefits and costs of publicly-funded management activities, yet many previous investigations have focused narrowly on expenditures to control spread and infestation. We use hedonic modeling to evaluate the economic effects of Eurasian milfoil (Myriophyllum spicatum) invasions on lakefront property values of single-family homes in an urban-suburban landscape. Milfoil often forms dense canopies at the water surface, diminishing the value of ecosystem services (e.g., recreation, fishing) and necessitating expensive control and management efforts. We compare 1,258 lakeshore property sale transactions (1995-2006) in 17 lakes with milfoil and 24 un-invaded lakes in King County, Washington (USA). After accounting for structural (e.g., house size), locational (e.g., boat launch), and environmental characteristics (e.g., water clarity) of lakes, we found that milfoil has a significant negative effect on property sales price ($94,385 USD lower price), corresponding to a 19% decline in mean property values. The aggregate cost of milfoil invading one additional lake in the study area is, on average, $377,542 USD per year. Our study illustrates that invasive aquatic plants can significantly impact property values (and associated losses in property taxes that reduce local government revenue), justifying the need for management strategies that prevent and control invasions. We recommend coordinated efforts across Lake Management Districts to focus institutional support, funding, and outreach to prevent the introduction and spread of milfoil. This effort will limit opportunities for re-introduction from neighboring lakes and incentivize private landowners and natural resource agencies to commit time and funding to invasive species management.

  18. Urinary Incontinence Management Costs are Reduced Following Burch or Sling Surgery for Stress Incontinence

    PubMed Central

    Subak, Leslee L.; Goode, Patricia S.; Brubaker, Linda; Kusek, John W.; Schembri, Mr. Michael; Lukacz, Emily S.; Kraus, Stephen R.; Chai, Toby C.; Norton, Peggy; Tennstedt, Sharon L.

    2014-01-01

    Objective To estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence (UI) management costs at 24 months post-operatively and identify predictors of change in cost among women enrolled in a randomized trial comparing these procedures. Methods Resources used for UI management (supplies, laundry, dry cleaning) were self-reported by 491 women at baseline and 24 months post-surgery and total out-of-pocket costs for UI management (in 2012 US dollars) were estimated. Data from the two surgical groups were combined to examine change in cost for UI management over 24 months. Univariate and bivariate changes in cost were analyzed using Wilcoxon signed rank test. Predictors of change in cost were examined using multivariate mixed models. Results At baseline mean (±SD) age of participants was 53±10 years, and frequency of weekly UI episodes was 23±21. Weekly UI episodes decreased by 86% at 24 months (P<0.001). Mean weekly cost was $16.60±$27 (median $9.39) at baseline and $4.57±$15 (median $0.10) at 24 months (P<0.001), a decrease of 72%. In multivariate analyses, cost decreased by $3.38±$0.77 per week for each decrease of 1 UI episode per day (P<0.001) and was strongly associated with greater improvement in UDI and IIQ scores (P<0.001) and decreased 24-hour pad weight (P<0.02). Conclusion Following Burch or fascial sling surgery, UI management cost at 24 months decreased by 72% ($625 per woman per year) and was strongly associated with decreasing UI frequency. Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures. PMID:24631433

  19. Reducing nitrogen loss with managed drainage and polymer-coated urea.

    PubMed

    Nash, Patrick; Nelson, Kelly; Motavalli, Peter

    2015-01-01

    Continuous corn ( L.) production during dry years combined with high N fertilizer rates can have a high potential for NO-N loss through tile drainage water. Claypan soils can further increase the potential for NO-N loss through tile drainage water due to the claypan layer that restricts N leaching below the tile drains. The objective of this 4-yr study was to determine whether use of managed subsurface drainage (MD) in combination with a controlled-release N fertilizer could reduce the annual amount of NO-N loss through tile drainage water compared with free subsurface tile drainage (FD) with a noncoated urea application. Due to dry conditions over the summer and fall months, MD reduced the annual amount of water drained by at least 73% compared with FD in two of the four crop years. Low N loss and reduced corn N uptake possibly resulted in carry-over N and high soil N concentrations throughout the study, which may have limited the effect of N fertilizer source on annual NO-N loss in the tile drainage water. Use of MD reduced annual NO-N loss in the tile drainage water by 78 to 85% in two of the four years. High NO-N loss reduction with MD compared with FD was largely due to dry growing season conditions in combination with wet conditions over the noncropping period.

  20. The efficiency of asset management strategies to reduce urban flood risk.

    PubMed

    ten Veldhuis, J A E; Clemens, F H L R

    2011-01-01

    In this study, three asset management strategies were compared with respect to their efficiency to reduce flood risk. Data from call centres at two municipalities were used to quantify urban flood risks associated with three causes of urban flooding: gully pot blockage, sewer pipe blockage and sewer overloading. The efficiency of three flood reduction strategies was assessed based on their effect on the causes contributing to flood risk. The sensitivity of the results to uncertainty in the data source, citizens' calls, was analysed through incorporation of uncertainty ranges taken from customer complaint literature. Based on the available data it could be shown that increasing gully pot blockage is the most efficient action to reduce flood risk, given data uncertainty. If differences between cause incidences are large, as in the presented case study, call data are sufficient to decide how flood risk can be most efficiently reduced. According to the results of this analysis, enlargement of sewer pipes is not an efficient strategy to reduce flood risk, because flood risk associated with sewer overloading is small compared to other failure mechanisms.

  1. Reducing Heart Failure Hospital Readmissions: A Systematic Review of Disease Management Programs

    PubMed Central

    Gorthi, Janardhana; Hunter, Claire B.; Mooss, Ayran N.; Alla, Venkata M.; Hilleman, Daniel E.

    2014-01-01

    The recent enactment of the Patient Protection and Affordable Care Act which established the federal Hospital Readmissions Reduction Program (HRRP) has accelerated efforts to develop heart failure (HF) disease management programs (DMPs) that reduce readmissions in patients hospitalized for HF. This systematic review identified randomized controlled trials of HF DMPs which included home care, outpatient clinic interventions, structured telephone support, and non-invasive and invasive telemonitoring. These different types of DMPs have been associated with conflicting results. No specific type of DMP has produced consistent benefit in reducing HF hospitalizations. Although probably effective at reducing readmissions, home visits and outpatient clinic interventions have substantial limitations including cost and accessibility. Telemanagement has the potential to reach a large number of patients at a reasonable cost. Structured telephone support follow-up has been shown to significantly reduce HF readmissions, but does not significantly reduce all-cause mortality or all-cause hospitalization. A meta-analysis of 11 non-invasive telemonitoring studies demonstrated significant reductions in all-cause mortality and HF hospitalizations. Invasive telemonitoring is a potentially effective means of reducing HF hospitalizations, but only one study using pulmonary artery pressure monitoring was able to demonstrate a reduction in HF hospitalizations. Other studies using invasive hemodynamic monitoring have failed to demonstrate changes in rates of readmission or mortality. The efficacy of HF DMPs is associated with inconsistent results. Our review should not be interpreted to indicate that HF DMPs are universally ineffective. Rather, our data suggest that one approach applied to a broad spectrum of different patient types may produce an erratic impact on readmissions and clinical outcomes. HF DMPs should include the flexibility to meet the individualized needs of specific patients

  2. Waste Management Strategy for Dismantling Waste to Reduce Costs for Power Plant Decommissioning - 13543

    SciTech Connect

    Larsson, Arne; Lidar, Per; Bergh, Niklas; Hedin, Gunnar

    2013-07-01

    -necks in the process causes increased space requirements and will have negative impact on the project schedule, which increases not only the cost but also the dose exposure to personnel. For these reasons it is critical to create a process that transfers material into conditioned waste ready for disposal as quickly as possible. To a certain extent the decommissioning program should be led by the waste management process. With the objective to reduce time for handling of dismantled material at site and to efficiently and environmental-friendly use waste management methods (clearance for re-use followed by clearance for recycling), the costs for the plant decommissioning could be reduced as well as time needed for performing the decommissioning project. Also, risks for delays would be reduced with a well-defined handling scheme which limits surprises. Delays are a major cost driver for decommissioning projects. (authors)

  3. Effectiveness of managed gene flow in reducing genetic divergence associated with captive breeding

    PubMed Central

    Waters, Charles D; Hard, Jeffrey J; Brieuc, Marine S O; Fast, David E; Warheit, Kenneth I; Waples, Robin S; Knudsen, Curtis M; Bosch, William J; Naish, Kerry A

    2015-01-01

    Captive breeding has the potential to rebuild depressed populations. However, associated genetic changes may decrease restoration success and negatively affect the adaptive potential of the entire population. Thus, approaches that minimize genetic risks should be tested in a comparative framework over multiple generations. Genetic diversity in two captive-reared lines of a species of conservation interest, Chinook salmon (Oncorhynchus tshawytscha), was surveyed across three generations using genome-wide approaches. Genetic divergence from the source population was minimal in an integrated line, which implemented managed gene flow by using only naturally-born adults as captive broodstock, but significant in a segregated line, which bred only captive-origin individuals. Estimates of effective number of breeders revealed that the rapid divergence observed in the latter was largely attributable to genetic drift. Three independent tests for signatures of adaptive divergence also identified temporal change within the segregated line, possibly indicating domestication selection. The results empirically demonstrate that using managed gene flow for propagating a captive-reared population reduces genetic divergence over the short term compared to one that relies solely on captive-origin parents. These findings complement existing studies of captive breeding, which typically focus on a single management strategy and examine the fitness of one or two generations. PMID:26640521

  4. Effectiveness of managed gene flow in reducing genetic divergence associated with captive breeding.

    PubMed

    Waters, Charles D; Hard, Jeffrey J; Brieuc, Marine S O; Fast, David E; Warheit, Kenneth I; Waples, Robin S; Knudsen, Curtis M; Bosch, William J; Naish, Kerry A

    2015-12-01

    Captive breeding has the potential to rebuild depressed populations. However, associated genetic changes may decrease restoration success and negatively affect the adaptive potential of the entire population. Thus, approaches that minimize genetic risks should be tested in a comparative framework over multiple generations. Genetic diversity in two captive-reared lines of a species of conservation interest, Chinook salmon (Oncorhynchus tshawytscha), was surveyed across three generations using genome-wide approaches. Genetic divergence from the source population was minimal in an integrated line, which implemented managed gene flow by using only naturally-born adults as captive broodstock, but significant in a segregated line, which bred only captive-origin individuals. Estimates of effective number of breeders revealed that the rapid divergence observed in the latter was largely attributable to genetic drift. Three independent tests for signatures of adaptive divergence also identified temporal change within the segregated line, possibly indicating domestication selection. The results empirically demonstrate that using managed gene flow for propagating a captive-reared population reduces genetic divergence over the short term compared to one that relies solely on captive-origin parents. These findings complement existing studies of captive breeding, which typically focus on a single management strategy and examine the fitness of one or two generations.

  5. Identification and Prioritization of Management Practices to Reduce Methylmercury Exports from Wetlands and Irrigated Agricultural Lands

    NASA Astrophysics Data System (ADS)

    McCord, Stephen A.; Heim, Wesley A.

    2015-03-01

    The Sacramento-San Joaquin Delta's (Delta) beneficial uses for humans and wildlife are impaired by elevated methylmercury (MeHg) concentrations in fish. MeHg is a neurotoxin that bioaccumulates in aquatic food webs. The total maximum daily load (TMDL) implementation plan aimed at reducing MeHg in Delta fish obligates dischargers to conduct MeHg control studies. Over 150 stakeholders collaborated to identify 24 management practices (MPs) addressing MeHg nonpoint sources (NPS) in three categories: biogeochemistry (6), hydrology (14), and soil/vegetation (4). Land uses were divided into six categories: permanently and seasonally flooded wetlands, flooded and irrigated agricultural lands, floodplains, and brackish-fresh tidal marshes. Stakeholders scored MPs based on seven criteria: scientific certainty, costs, MeHg reduction potential, spatial applicability, technical capacity to implement, negative impacts to beneficial uses, and conflicting requirements. Semi-quantitative scoring for MPs applicable to each land use (totaling >400 individual scores) led to consensus-based prioritization. This process relied on practical experience from diverse and accomplished NPS stakeholders and synthesis of 17 previous studies. Results provide a comprehensive, stakeholder-driven prioritization of MPs for wetland and irrigated agricultural land managers. Final prioritization highlights the most promising MPs for practical application and control study, and a secondary set of MPs warranting further evaluation. MPs that address hydrology and soil/vegetation were prioritized because experiences were positive and implementation appeared more feasible. MeHg control studies will need to address the TMDL conundrum that MPs effective at reducing MeHg exports could both exacerbate MeHg exposure and contend with other management objectives on site.

  6. Comparing badger (Meles meles) management strategies for reducing tuberculosis incidence in cattle.

    PubMed

    Smith, Graham C; McDonald, Robbie A; Wilkinson, David

    2012-01-01

    Bovine tuberculosis (bTB), caused by Mycobacterium bovis, continues to be a serious economic problem for the British cattle industry. The Eurasian badger (Meles meles) is partly responsible for maintenance of the disease and its transmission to cattle. Previous attempts to manage the disease by culling badgers have been hampered by social perturbation, which in some situations is associated with increases in the cattle herd incidence of bTB. Following the licensing of an injectable vaccine, we consider the relative merits of management strategies to reduce bTB in badgers, and thereby reduce cattle herd incidence. We used an established simulation model of the badger-cattle-TB system and investigated four proposed strategies: business as usual with no badger management, large-scale proactive badger culling, badger vaccination, and culling with a ring of vaccination around it. For ease of comparison with empirical data, model treatments were applied over 150 km(2) and were evaluated over the whole of a 300 km(2) area, comprising the core treatment area and a ring of approximately 2 km. The effects of treatment were evaluated over a 10-year period comprising treatment for five years and the subsequent five year period without treatment. Against a background of existing disease control measures, where 144 cattle herd incidents might be expected over 10 years, badger culling prevented 26 cattle herd incidents while vaccination prevented 16. Culling in the core 150 km(2) plus vaccination in a ring around it prevented about 40 cattle herd breakdowns by partly mitigating the negative effects of culling, although this approach clearly required greater effort. While model outcomes were robust to uncertainty in parameter estimates, the outcomes of culling were sensitive to low rates of land access for culling, low culling efficacy, and the early cessation of a culling strategy, all of which were likely to lead to an overall increase in cattle disease.

  7. Identification and prioritization of management practices to reduce methylmercury exports from wetlands and irrigated agricultural lands.

    PubMed

    McCord, Stephen A; Heim, Wesley A

    2015-03-01

    The Sacramento-San Joaquin Delta's (Delta) beneficial uses for humans and wildlife are impaired by elevated methylmercury (MeHg) concentrations in fish. MeHg is a neurotoxin that bioaccumulates in aquatic food webs. The total maximum daily load (TMDL) implementation plan aimed at reducing MeHg in Delta fish obligates dischargers to conduct MeHg control studies. Over 150 stakeholders collaborated to identify 24 management practices (MPs) addressing MeHg nonpoint sources (NPS) in three categories: biogeochemistry (6), hydrology (14), and soil/vegetation (4). Land uses were divided into six categories: permanently and seasonally flooded wetlands, flooded and irrigated agricultural lands, floodplains, and brackish-fresh tidal marshes. Stakeholders scored MPs based on seven criteria: scientific certainty, costs, MeHg reduction potential, spatial applicability, technical capacity to implement, negative impacts to beneficial uses, and conflicting requirements. Semi-quantitative scoring for MPs applicable to each land use (totaling >400 individual scores) led to consensus-based prioritization. This process relied on practical experience from diverse and accomplished NPS stakeholders and synthesis of 17 previous studies. Results provide a comprehensive, stakeholder-driven prioritization of MPs for wetland and irrigated agricultural land managers. Final prioritization highlights the most promising MPs for practical application and control study, and a secondary set of MPs warranting further evaluation. MPs that address hydrology and soil/vegetation were prioritized because experiences were positive and implementation appeared more feasible. MeHg control studies will need to address the TMDL conundrum that MPs effective at reducing MeHg exports could both exacerbate MeHg exposure and contend with other management objectives on site.

  8. Comparing Badger (Meles meles) Management Strategies for Reducing Tuberculosis Incidence in Cattle

    PubMed Central

    Smith, Graham C.; McDonald, Robbie A.; Wilkinson, David

    2012-01-01

    Bovine tuberculosis (bTB), caused by Mycobacterium bovis, continues to be a serious economic problem for the British cattle industry. The Eurasian badger (Meles meles) is partly responsible for maintenance of the disease and its transmission to cattle. Previous attempts to manage the disease by culling badgers have been hampered by social perturbation, which in some situations is associated with increases in the cattle herd incidence of bTB. Following the licensing of an injectable vaccine, we consider the relative merits of management strategies to reduce bTB in badgers, and thereby reduce cattle herd incidence. We used an established simulation model of the badger-cattle-TB system and investigated four proposed strategies: business as usual with no badger management, large-scale proactive badger culling, badger vaccination, and culling with a ring of vaccination around it. For ease of comparison with empirical data, model treatments were applied over 150 km2 and were evaluated over the whole of a 300 km2 area, comprising the core treatment area and a ring of approximately 2 km. The effects of treatment were evaluated over a 10-year period comprising treatment for five years and the subsequent five year period without treatment. Against a background of existing disease control measures, where 144 cattle herd incidents might be expected over 10 years, badger culling prevented 26 cattle herd incidents while vaccination prevented 16. Culling in the core 150 km2 plus vaccination in a ring around it prevented about 40 cattle herd breakdowns by partly mitigating the negative effects of culling, although this approach clearly required greater effort. While model outcomes were robust to uncertainty in parameter estimates, the outcomes of culling were sensitive to low rates of land access for culling, low culling efficacy, and the early cessation of a culling strategy, all of which were likely to lead to an overall increase in cattle disease. PMID:22761746

  9. Nurse case management and housing interventions reduce allergen exposures: the Milwaukee randomized controlled trial.

    PubMed

    Breysse, Jill; Wendt, Jean; Dixon, Sherry; Murphy, Amy; Wilson, Jonathan; Meurer, John; Cohn, Jennifer; Jacobs, David E

    2011-01-01

    We examined the impact of a combination of home environmental interventions and nurse case management services on total settled dust loadings and on allergen concentrations in the homes of asthmatic children. METHODS Using a randomized longitudinal controlled trial study design, we randomly assigned homes of asthmatic children in Milwaukee to either a control (n = 64) or an intervention (n = 57) group. Control group homes received a visual assessment, education, bed/pillow dust mite encasings, and treatment of lead-based paint hazards. The intervention group received these same services plus nurse case management that included tailored, individual asthma action plans, provision of minor home repairs, home cleaning using special vacuuming and wet washing, and integrated pest management. Dust vacuum samples were collected from measured surface areas of floors in the TV room, kitchen, and child's bedroom at baseline and at three-, six-, and 12-month follow-up visits. Dust loading (mass per surface area) is a means of measuring total dust and the total amount of allergen present. For the intervention group, geometric mean dust loadings declined significantly from baseline (39 milligrams per square foot [mg/ft2]) to postintervention (11 mg/ft2) (p < 0.001). Baseline dust loading, treatment group, visit, and season were significant predictors of follow-up dust loadings. Mean post-intervention dust loadings were 72% higher in the control group. The total amount of allergen in settled house dust declined significantly following the intervention because total dust loading declined; the concentration of allergens in settled dust did not change significantly. The combination of nurse case management and home environmental interventions promotes collaboration between health and housing professionals and is effective in reducing exposures to allergens in settled dust.

  10. Nurse Case Management and Housing Interventions Reduce Allergen Exposures: The Milwaukee Randomized Controlled Trial

    PubMed Central

    Breysse, Jill; Wendt, Jean; Dixon, Sherry; Murphy, Amy; Wilson, Jonathan; Meurer, John; Cohn, Jennifer; Jacobs, David E.

    2011-01-01

    Objective We examined the impact of a combination of home environmental interventions and nurse case management services on total settled dust loadings and on allergen concentrations in the homes of asthmatic children. Methods Using a randomized longitudinal controlled trial study design, we randomly assigned homes of asthmatic children in Milwaukee to either a control (n=64) or an intervention (n=57) group. Control group homes received a visual assessment, education, bed/pillow dust mite encasings, and treatment of lead-based paint hazards. The intervention group received these same services plus nurse case management that included tailored, individual asthma action plans, provision of minor home repairs, home cleaning using special vacuuming and wet washing, and integrated pest management. Dust vacuum samples were collected from measured surface areas of floors in the TV room, kitchen, and child's bedroom at baseline and at three-, six-, and 12-month follow-up visits. Dust loading (mass per surface area) is a means of measuring total dust and the total amount of allergen present. Results For the intervention group, geometric mean dust loadings declined significantly from baseline (39 milligrams per square foot [mg/ft2]) to post-intervention (11 mg/ft2) (p<0.001). Baseline dust loading, treatment group, visit, and season were significant predictors of follow-up dust loadings. Mean post-intervention dust loadings were 72% higher in the control group. The total amount of allergen in settled house dust declined significantly following the intervention because total dust loading declined; the concentration of allergens in settled dust did not change significantly. Conclusion The combination of nurse case management and home environmental interventions promotes collaboration between health and housing professionals and is effective in reducing exposures to allergens in settled dust. PMID:21563716

  11. Nurse-led risk assessment/management clinics reduce predicted cardiac morbidity and mortality in claudicants.

    PubMed

    Hatfield, Josephine; Gulati, Sumit; Abdul Rahman, Morhisham N A; Coughlin, Patrick A; Chetter, Ian C

    2008-12-01

    Nurse-led assessment/management of risk factors is effective in many chronic medical conditions. We aimed to evaluate whether this finding was true for patients with intermittent claudication and to analyze its impact on patient-reported quality of life and predicted mortality due to coronary heart disease. We prospectively studied a series of 78 patients (51 men; median age, 65 years [IQR: 56-74 years]), diagnosed with intermittent claudication and referred to a nurse-led risk assessment/management clinic (NLC) from a consultant-led vascular surgical clinic. The NLC used clinical care pathways to manage antiplatelet medication, smoking cessation, hyperlipidemia, hypertension, and diabetes and to provide exercise advice. All patients were reassessed at a 3 months. Medication compliance, smoking status, fasting lipid profiles, blood pressure, and HbA1c were recorded. Disease-specific quality of life was assessed using King's College VascuQoL and predicted cardiac morbidity and mortality were calculated using the PROCAM and Framingham risk scores. We found that NLC enrollment produced an antiplatelet and a statin compliance of 100%, a smoking cessation rate of 17% (9 patients) and significant improvements in total cholesterol (median, 5.2-4.5 mmol/l), LDL (median, 3.1-2.5 mmol/l) and triglyceride (median, 1.7-1.4 mmol/l) levels. Significant disease-specific quality of life improvements and significant reduction in both the PROCAM (14% to 10%) and Framingham (14% to 11%) coronary risk scores were observed. Providing care at NLCs for claudicants is effective in assessing and managing risk factors, improves disease-specific quality of life and reduces predicted morbidity and mortality due to coronary heart disease.

  12. Reducing nitrate loss in tile drainage water with cover crops and water-table management systems.

    PubMed

    Drury, C F; Tan, C S; Welacky, T W; Reynolds, W D; Zhang, T Q; Oloya, T O; McLaughlin, N B; Gaynor, J D

    2014-03-01

    Nitrate lost from agricultural soils is an economic cost to producers, an environmental concern when it enters rivers and lakes, and a health risk when it enters wells and aquifers used for drinking water. Planting a winter wheat cover crop (CC) and/or use of controlled tile drainage-subirrigation (CDS) may reduce losses of nitrate (NO) relative to no cover crop (NCC) and/or traditional unrestricted tile drainage (UTD). A 6-yr (1999-2005) corn-soybean study was conducted to determine the effectiveness of CC+CDS, CC+UTD, NCC+CDS, and NCC+UTD treatments for reducing NO loss. Flow volume and NO concentration in surface runoff and tile drainage were measured continuously, and CC reduced the 5-yr flow-weighted mean (FWM) NO concentration in tile drainage water by 21 to 38% and cumulative NO loss by 14 to 16% relative to NCC. Controlled tile drainage-subirrigation reduced FWM NO concentration by 15 to 33% and cumulative NO loss by 38 to 39% relative to UTD. When CC and CDS were combined, 5-yr cumulative FWM NO concentrations and loss in tile drainage were decreased by 47% (from 9.45 to 4.99 mg N L and from 102 to 53.6 kg N ha) relative to NCC+UTD. The reductions in runoff and concomitant increases in tile drainage under CC occurred primarily because of increases in near-surface soil hydraulic conductivity. Cover crops increased corn grain yields by 4 to 7% in 2004 increased 3-yr average soybean yields by 8 to 15%, whereas CDS did not affect corn or soybean yields over the 6 yr. The combined use of a cover crop and water-table management system was highly effective for reducing NO loss from cool, humid agricultural soils. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  13. Evaluation of individual and combined management practices to reduce the off-site transport of pesticides from golf course turf.

    PubMed

    Rice, Pamela J; Horgan, Brian P; Hamlin, Jennifer L

    2017-04-01

    The detection of pesticides, associated with turfgrass management, in storm runoff and surface waters of urban watersheds has raised concerns regarding their source, potential environmental effects and a need for strategies to reduce their inputs. In previous research we discovered that hollow tine core cultivation (HTCC) was more effective than other management practices for reducing the off-site transport of pesticides with runoff from creeping bentgrass turf managed as a golf course fairway. This was primarily the result of enhanced infiltration and reduced runoff volumes associated with turf managed with hollow tines. In this study we evaluated the addition of verticutting (VC) to HTCC (HTCC+VC) in an attempt to further enhance infiltration and mitigate the off-site transport of pesticides with runoff from managed turf. Overall, greater or equal quantities of pesticides were transported with runoff from plots managed with HTCC+VC compared to HTCC or VC alone. For the pesticides evaluated HTCCreduced availability of recently exposed soil sorptive sites produced from the HTCC. Results of this research provides guidance to golf course managers on selection of management practices that assure quality turf while minimizing off-site transport of pesticides, improving pesticide efficacy and the environmental stewardship of managed biological systems.

  14. Development of a brief substance use sensation seeking scale: validation and prediction of injection-related behaviors.

    PubMed

    Werb, Dan; Richardson, Chris; Buxton, Jane; Shoveller, Jeannie; Wood, Evan; Kerr, Thomas

    2015-02-01

    Sensation seeking, a personality trait, has been shown to predict engagement in high-risk behaviors. However, little is known regarding the impact of sensation seeking on substance use among street youth. We therefore sought to modify a sensation seeking scale (SSS) for use among this population. Street youth from the Vancouver-based At-Risk Youth Study (n = 226) completed the modified SSS. Exploratory and confirmatory factor analysis (EFA/CFA) were undertaken to establish the scale's dimensionality and internal validity. The association between SSS score and injection-related behaviors was tested using generalized estimating equation analysis. EFA results indicated scale unidimensionality. The comparative fit index (CFI) suggested acceptable fit (CFI = 0.914). In multivariate analysis, sensation seeking was independently associated with injection drug use, crystal methamphetamine use, polysubstance use, and binge drug use (all p < 0.05). Our findings provide preliminary support for the use of the modified SSS among street youth.

  15. Improving Learning Results and Reducing Cognitive Load through 3D Courseware on Color Management and Inspection Instruction

    ERIC Educational Resources Information Center

    Hsiung, Liang-Yuan; Lai, Mu-Hui

    2013-01-01

    This study intends to solve the problem that schools in Taiwan lack of the equipment for color management and inspection instruction and seek ways to improve learning results and reduce cognitive load. The researchers developed 3D courseware for color management and inspection through a research and development process. To further scrutinize the…

  16. Reducing Overheating-Induced Failures Via Performance-Aware CPU Power Management.

    SciTech Connect

    Hsu, C.-H.; Feng, W. C.

    2005-01-01

    Cluster end-users and administrators have become more cognizant of the fact that large-scale commodity clusters fail quite frequently, and the main source of these failures is hardware (e.g., processors) with the primary cause being heat. This situation is expected to worsen with even larger-scale clusters powered by faster (and/or multicore) processors. In this paper, we propose a power-management algorithm that addresses heat-related reliability for processors by controlling their clock speeds in a performance-aware manner. This approach is complementary to existing approaches such as exotic cooling and fault-tolerant technologies in that it proactively deals with power and cooling issues before they become a problem. Our preliminary experimental work demonstrates that our approach can easily be applied commodity processors and can reduce heat generation by 30% on average with minimal effect on performance when running the SPEC benchmarks.

  17. Managing sedentary behavior to reduce the risk of diabetes and cardiovascular disease.

    PubMed

    Dempsey, Paddy C; Owen, Neville; Biddle, Stuart J H; Dunstan, David W

    2014-01-01

    Modern human environments are vastly different from those of our forebears. Rapidly advancing technology in transportation, communications, workplaces, and home entertainment confer a wealth of benefits, but increasingly come with costs to human health. Sedentary behavior-too much sitting as distinct from too little physical activity-contributes adversely to cardiometabolic health outcomes and premature mortality. Findings from observational epidemiology have been synthesized in meta-analyses, and evidence is now shifting into the realm of experimental trials with the aim of identifying novel mechanisms and potential causal relationships. We discuss recent observational and experimental evidence that makes a compelling case for reducing and breaking up prolonged sitting time in both the primary prevention and disease management contexts. We also highlight future research needs, the opportunities for developing targeted interventions, and the potential of population-wide initiatives designed to address too much sitting as a health risk.

  18. Can Artificial Reef Wrecks Reduce Diver Impacts on Shipwrecks? The Management Dimension

    NASA Astrophysics Data System (ADS)

    Edney, Joanne; Spennemann, Dirk H. R.

    2015-08-01

    Managers have been advocating the use of artificial reef wrecks to diversify the experiences of recreational divers and thereby reduce the well-known impact on reefs. To examine whether artificial reef wrecks can serve as substitutes for historic shipwrecks this paper discusses the attitude of Australian divers to wreck diving in general and to artificial reef wrecks in particular. While the overwhelming majority of divers surveyed accepted the need for control, the experienced divers were less interested in artificial reef wrecks and less prepared to tolerate controls over their perceived freedom to dive wrecks. We present projections that show that this legacy issue will have largely resolved itself by 2025 due to attrition and natural ageing.

  19. Reducing time delays in the management of ischemic stroke patients in Northern Italy.

    PubMed

    Vidale, Simone; Arnaboldi, Marco; Bezzi, Giacomo; Bono, Giorgio; Grampa, Giampiero; Guidotti, Mario; Perrone, Patrizia; Salmaggi, Andrea; Zarcone, Davide; Zoli, Alberto; Agostoni, Elio

    2016-07-15

    Thrombolysis represents the best therapy for ischemic stroke but the main limitation of its administration is time. The avoidable delay is a concept reflecting the effectiveness of management pathway. For this reason, we projected a study concerning the detection of main delays with following introduction of corrective factors. In this paper we describe the results after these corrections. Consecutive patients admitted for ischemic stroke during a 3-months period to 35 hospitals of a macro-area of Northern Italy were enrolled. Each time of management was registered, identifying three main intervals: pre-hospital, in-hospital and total times. Previous corrective interventions were: 1.increasing of population awareness to use the Emergency Medical Service (EMS); 2.pre-notification of Emergency Department; 3.use of high urgency codes; 4.use of standardised operational algorithm. Statistical analysis was conducted using time-to-event analysis and Cox proportional hazard regression. 1084 patients were enrolled. EMS was alerted for 56.3% of subjects, mainly in females and severe strokes (p<0.001). Thrombolytic treatment was performed in 4.7% of patients. Median pre-hospital and in-hospital times were 113 and 105min, while total time was 240. High urgency codes at transport contributed to reduce pre-hospital and in-hospital time (p<0.05). EMS use and high urgency codes promoted thrombolysis. Treatment within 4.5hours from symptom onset was performed in 14% of patients more than the first phase of study. The implementation of an organizational system based on EMS and concomitant high urgency codes use was effective to reduce avoidable delay and to increase thrombolysis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization?

    PubMed

    Rasekaba, T M; Williams, E; Hsu-Hage, B

    2009-01-01

    Chronic obstructive pulmonary disease (COPD) imposes a costly burden on healthcare. Pulmonary rehabilitation (PR) is the best practice to better manage COPD to improve patient outcomes and reduce acute hospital care utilization. To evaluate the impact of a once-weekly, eight-week multidisciplinary PR program as an integral part of the COPD chronic disease management (CDM) Program at Kyabram District Health Services. The study compared two cohorts of COPD patients: CDM-PR Cohort (4-8 weeks) and Opt-out Cohort (0-3 weeks) between February 2006 and March 2007. The CDM-PR Program involved multidisciplinary patient education and group exercise training. Nonparametric statistical tests were used to compare acute hospital care utilization 12 months before and after the introduction of CDM-PR. The number of patients involved in the CDM-PR Cohort was 29 (n = 29), and that in the Opt-out Cohort was 24 (n = 24). The CDM-PR Cohort showed significant reductions in cumulative acute hospital care utilization indicators (95% emergency department presentations, 95% inpatient admissions, 99% length of stay; effect sizes = 0.62-0.66, P < 0.001) 12 months after the introduction of the CDM Program; in contrast, changes in the cumulative indicators were statistically insignificant for the Opt-out Cohort (emergency department presentations decreased by 5%, inpatient admissions decreased by 12%, length of stay increased by 30%; effect size = 0.14-0.40, P > 0.05). Total costs associated with the hospital care utilization decreased from $130,000 to $7,500 for the CDM-PR Cohort and increased from $77,700 to $101,200 for the Opt-out Cohort. Participation in the CDM-PR for COPD patients can significantly reduce acute hospital care utilization and associated costs in a small rural health service.

  1. Pharmacist-physician co-management of hypertension reduces 24-hour ambulatory blood pressures

    PubMed Central

    Weber, Cynthia A.; Ernst, Michael E.; Sezate, Genesis S.; Zheng, Shimin; Carter, Barry L.

    2010-01-01

    Background Pharmacist-physician co-management of hypertension has been shown to improve office blood pressures (BP). We sought to describe the effect of such a model on 24-hour ambulatory BPs. Methods We performed a prospective, cluster-randomised controlled clinical trial in 179 patients with uncontrolled hypertension from five primary care clinics in Iowa City, Iowa. Patients were randomized by clinic to receive pharmacist-physician collaborative management of hypertension (intervention) or usual care (control) for a 9-month period. In the intervention group, pharmacists helped patients identify barriers to BP control, counselled on lifestyle and dietary modifications, and adjusted antihypertensive therapy in collaboration with the patient’s primary care provider. Patients were seen by pharmacists a minimum every 2 months. Ambulatory BP was obtained at baseline and study end. Results Baseline and end of study ambulatory BP profiles were evaluated for 175 patients. Ambulatory BPs were reduced to a greater extent in the intervention compared to control group (daytime ΔSBP [SD] 15.2[11.5] vs 5.5[13.5], p<0.001; nighttime ΔSBP [SD] 12.2[14.8] vs 3.4[13.3], p<0.001; 24-hour ΔSBP [SD] 14.1[11.3] vs 5.5[12.5], p<0.001). More patients in the intervention group had BP controlled at the end of the study (75% vs 50.7%, p<0.001) as defined by overall 24-hour ambulatory BP monitoring. Conclusions Pharmacist-physician collaborative management of hypertension achieved consistent and significantly greater reduction in 24-hour BP and a high rate of BP control. PMID:20937921

  2. Ability, incentives, and management feedback: organizational change to reduce pressure ulcers in a nursing home.

    PubMed

    Rosen, Jules; Mittal, Vikas; Degenholtz, Howard; Castle, Nick; Mulsant, Benoit H; Hulland, Shelley; Nace, David; Rubin, Fred

    2006-03-01

    Quality improvement (QI) processes in nursing homes are highly variable and often ineffective. This study evaluated an innovative QI process to reduce pressure ulcers (PUs) in a nursing home with a high rate of PUs. This was a 48-week, longitudinal study comparing the incidence of PUs during 12-week baseline and intervention and post-intervention periods. Not-for-profit, 136-bed nursing home in urban Western Pennsylvania. All residents and all staff at the nursing home participated in this study. The intervention consisted of 3 components: Ability enhancement, incentivization, and management feedback. To enhance ability, all staff members completed a computer-based interactive video education program on PU prevention and were mandated to use penlights to promote early detection. Incentivization included $75 for each staff member if the desired reduction in PU incidence was achieved. Management feedback provided real-time information of staff"s adherence to the mandated training. Outcome measures consisted of staff's adherence to mandated training and the incidence of new PUs during the baseline period compared to the intervention and post-intervention periods. Management responded to noncompliance with training with both rewards and stepped discipline. Adherence to protocol, as measured by training compliance, was 100%. There was a significant reduction (P < .05) in the incidence of stage 2 or worse PUs during the intervention period. During the post-intervention periods, the effect was lost. An innovative QI initiative resulted in a significant decrease in PUs in 1 facility. This intervention was not sustainable when the 3 components of the QI intervention were no longer actively maintained.

  3. Social risk management--reducing disparities in risk, vulnerability and poverty equitably.

    PubMed

    Ruger, Jennifer Prah

    2008-03-01

    Hurricane Katrina, which struck the Gulf Coast on August 29, 2005 and took 1,000 lives or more, was the third deadliest storm to hit the United States, falling behind only the Galveston Hurricane of 1900 and the 1928 Okeechobee Hurricane. It is New Orleans' worst natural disaster in its nearly 300-year history. The storm left hundreds of thousands without access to shelter, food, water, clothing and basic sanitation. The human suffering and health consequences are immeasurable. Dissatisfaction with the federal, national and local governments' planning and response is widespread. Many believe that the system discriminated cruelly by race and class against those in greatest need. The storm revealed serious flaws in disaster relief and preparedness structures, which require major reform. As an alternative, this article proposes a social risk management system to provide both universal risk protection and an efficient, more equitable approach to managing and reducing disparities in vulnerability. While one must realize that incremental rather than comprehensive reform of the system is most likely and most politically feasible, Katrina's horrific consequences and revealed inequities necessitate an alternative model.

  4. Surveillance Recommendations in Reducing Risk of and Optimally Managing Breast Cancer-Related Lymphedema

    PubMed Central

    Ostby, Pamela L.; Armer, Jane M.; Dale, Paul S.; Van Loo, Margaret J.; Wilbanks, Cassie L.; Stewart, Bob R.

    2014-01-01

    Breast cancer survivors are at increased risk for the development of breast cancer-related lymphedema (BCRL), a chronic, debilitating, and disfiguring condition that is progressive and requires lifelong self-management of symptoms. It has been reported that over 40% of the 2.5 million breast cancer survivors in the United States may meet the criteria for BCRL during their lifetimes. Ongoing surveillance, beginning with pre-operative assessment, has been effective in identifying subclinical lymphedema (LE). A prospective model for surveillance is necessary in order to detect BCRL at an early stage when there is the best chance to reduce risk or slow progression. Physical methods for monitoring and assessment, such as circumferential arm measures, perometry, bioimpedance; exercise programs; prophylactic and early-intervention compression garments; and referral for complete decongestive therapy are all interventions to consider in the development of a BCRL surveillance program. In addition, supportive-educative programs and interactive engagement for symptom self-management should also be implemented. The importance of interdisciplinary collaboration is integral to the success of an effective personalized medicine program in breast cancer-related lymphedema surveillance. PMID:25563360

  5. Reducing errors in the management of hyperbilirubinaemia: validating a software application.

    PubMed

    Balaguer, A; Quiroga-González, R; Camprubí, M; Milá-Farnés, M; Escribano, J; Girabent-Farrés, M

    2009-01-01

    To verify the usefulness and reliability of a software tool we developed to help to apply the American Academy of Pediatrics (AAP) Guidelines 2004 on hyperbilirubinaemia according to the infant's age in hours and their clinical risk factors. Randomised, cross-over, controlled trial with 20 simulated clinical cases comparing the "manual" application of the guidelines with our software application. Fifteen doctors (eight final-year residents and seven consultants) from two hospitals in Spain. Major errors (defined a priori as any deviation from the AAP guidelines that involve a risk of morbidity or mortality for the patient), minor errors (those that cause discomfort and/or, in extremely rare cases, morbidity) and time spent. Fifteen doctors each managed 20 simulated cases, half by using the guidelines alone and half using the software tool. Without the software application, 42 "minor" errors were made. With it, only 25 errors were made. "Major" errors also decreased from 10 to 2 with the software. As a group, the residents benefited most; they made an average of 1.8 errors fewer per 10 cases. Use of the software reduced the time taken by the residents to resolve the cases, although the mean reduction in time was not significant for the group of consultants. The use of simulated clinical cases revealed many errors in the routine management of hyperbilirubinaemia. The software helped clinicians make fewer errors and saved time for residents, but not consultants.

  6. Can arbuscular mycorrhiza and fertilizer management reduce phosphorus runoff from paddy fields?

    PubMed

    Zhang, Shujuan; Wang, Li; Ma, Fang; Zhang, Xue; Li, Zhe; Li, Shiyang; Jiang, Xiaofeng

    2015-07-01

    Our study sought to assess how much phosphorus (P) runoff from paddy fields could be cut down by fertilizer management and inoculation with arbuscular mycorrhizal fungi. A field experiment was conducted in Lalin River basin, in the northeast China: six nitrogen-phosphorus-potassium fertilizer levels were provided (0, 20%, 40%, 60%, 80%, and 100% of the recommended fertilizer supply), with or without inoculation with Glomus mosseae. The volume and concentrations of particle P (PP) and dissolved P (DP) were measured for each runoff during the rice growing season. It was found that the seasonal P runoff, including DP and PP, under the local fertilization was 3.7 kg/ha, with PP, rather than DP, being the main form of P in runoff water. Additionally, the seasonal P runoff dropped only by 8.9% when fertilization decreased by 20%; rice yields decreased with declining fertilization. We also found that inoculation increased rice yields and decreased P runoff at each fertilizer level and these effects were lower under higher fertilization. Conclusively, while rice yields were guaranteed arbuscular mycorrhizal inoculation and fertilizer management would play a key role in reducing P runoff from paddy fields.

  7. Water cycle and its management for plant habitats at reduced pressures

    NASA Technical Reports Server (NTRS)

    Rygalov, Vadim Y.; Fowler, Philip A.; Wheeler, Raymond M.; Bucklin, Ray A.

    2004-01-01

    Experimental and mathematical models were developed for describing and testing temperature and humidity parameters for plant production in bioregenerative life support systems. A factor was included for analyzing systems operating at low (10-101.3 kPa) pressure to reduce gas leakage and structural mass (e.g., inflatable greenhouses for space application). The expected close relationship between temperature and relative humidity was observed, along with the importance of heat exchanger coil temperature and air circulation rate. The presence of plants in closed habitats results in increased water flux through the system. Changes in pressure affect gas diffusion rates and surface boundary layers, and change convective transfer capabilities and water evaporation rates. A consistent observation from studies with plants at reduced pressures is increased evapotranspiration rates, even at constant vapor pressure deficits. This suggests that plant water status is a critical factor for managing low-pressure production systems. The approach suggested should help space mission planners design artificial environments in closed habitats.

  8. Surgical Management of Adult Reducible Atlantoaxial Dislocation, Basilar Invagination and Chiari Malformation with Syringomyelia.

    PubMed

    Shuhui, Gong; Jiagang, Liu; Haifeng, Chen; Hao, Zhao Bo; Qing, Huang Si

    To analyze retrospectively the surgical management of reducible atlantoaxial dislocation (AAD), basilar invagination (BI) and Chiari malformation (CHM) with syringomyelia through a single-stage posterior approach. Forty-three patients with reducible AAD, BI and CHM with syringomyelia underwent surgery from January 2009 to January 2013. Intraoperative restoration followed by posterior decompression and plate-rod placement with occipital cortical screws and C2/C3 lateral mass cortical screws fixation devices were used in all patients. Results were recorded both pre- and postoperatively and these outcome measures included Nurick grading (NG) and radiology findings (atlantodental interval (ADI), space available for the spinal cord (SAC), interval between odontoid and Chamberlain's line (IOC), and the cervicomedullary angle (CMA)). Forty (93%) of the 43 patients were followed up. Thirty-six (90%) patients' symptoms improved and four (10%) stabilized. No patients became progressively worse. The difference between preoperative and postoperative Nurick grades was statistically significant. All patients achieved restoration, including thirty (75%) patients had full restoration and ten (25%) had part restoration. The size of syringomyelia was obviously decreased in 32 (80%) patients and stable in 8 (20%) patients. All radiology findings (ADI, IOC, SAC, CMA) showed significant changes from pre- to postoperative (p < 0.01). Intraoperative distraction, extension combined posterior decompression with use of plate-rod-screws occipitocervical fusion device is an effective method to treat AAD, BI and CHM with syringomyelia.

  9. Reduced biological control and enhanced chemical pest management in the evolution of fungus farming in ants

    PubMed Central

    Fernández-Marín, Hermógenes; Zimmerman, Jess K.; Nash, David R.; Boomsma, Jacobus J.; Wcislo, William T.

    2009-01-01

    To combat disease, most fungus-growing ants (Attini) use antibiotics from mutualistic bacteria (Pseudonocardia) that are cultured on the ants' exoskeletons and chemical cocktails from exocrine glands, especially the metapleural glands (MG). Previous work has hypothesized that (i) Pseudonocardia antibiotics are narrow-spectrum and control a fungus (Escovopsis) that parasitizes the ants' fungal symbiont, and (ii) MG secretions have broad-spectrum activity and protect ants and brood. We assessed the relative importance of these lines of defence, and their activity spectra, by scoring abundance of visible Pseudonocardia for nine species from five genera and measuring rates of MG grooming after challenging ants with disease agents of differing virulence. Atta and Sericomyrmex have lost or greatly reduced the abundance of visible bacteria. When challenged with diverse disease agents, including Escovopsis, they significantly increased MG grooming rates and expanded the range of targets. By contrast, species of Acromyrmex and Trachymyrmex maintain abundant Pseudonocardia. When challenged, these species had lower MG grooming rates, targeted primarily to brood. More elaborate MG defences and reduced reliance on mutualistic Pseudonocardia are correlated with larger colony size among attine genera, raising questions about the efficacy of managing disease in large societies with chemical cocktails versus bacterial antimicrobial metabolites. PMID:19324734

  10. Kraft mill effluent survey: progress toward best management practices for reducing effects on fish reproduction.

    PubMed

    Kovacs, Tibor G; Martel, Pierre H; O'Connor, Brian I; Parrott, Joanne L; McMaster, Mark E; Van Der Kraak, Glen J; MacLatchy, Deborah L; van den Heuvel, Michael R; Hewitt, L Mark

    2011-06-01

    Pulp and paper mill effluents have been linked to effects on fish reproduction for more than 25 years. To date, the causes of these effects and remedial strategies have eluded investigators. Recent work has shown that the degree of reproductive effect caused by a mill effluent is related to the overall organic content. If verified, this could lead to breakthroughs for best management practices (BMPs). For this study, the effluents from seven kraft mills were assessed for their ability to reduce egg production in fathead minnow (Pimephales promelas) in the laboratory. At the same time, the effluents were analyzed for three parameters thought to be good indicators of organic losses: biochemical oxygen demand (BOD), methyl-substituted 2-cyclopentenones (cellulose degradation products), and a gas chromatographic (GC) profile index, which integrates the total area of the chromatographic peaks of solvent-extracted effluents using low-resolution mass spectrometry. The results showed that the degree to which the effluents reduced egg production increased with increased organic losses as characterized by BOD and the GC profile index. Therefore, these parameters could be used to guide BMPs at kraft mills according to specific targets: BOD < 20 mg/L and GC profile index equivalent to effluent with BOD of 20 mg/L. Such targets should be achievable by good in-plant control of organic losses and optimized effluent biotreatment systems.

  11. Reducing the risk of violence towards remote area nurses: a violence management toolbox.

    PubMed

    McCullough, Kylie M; Lenthall, Sue; Williams, Anne M; Andrew, Lesley

    2012-12-01

    To explore the knowledge of a panel of experts to develop possible ways of minimising the risk of occupational violence towards remote area nurses. The Delphi method using open-ended questionnaires and an online survey to measure support for suggested control measures. Remote area nursing posts across Australia. A panel of expert remote area nurses (n = 10) from geographically diverse regions. Identified and described measures with the potential to reduce the risk of violence. A 'toolbox' of strategies was suggested in recognition of the complex nature of occupational violence within the remote health context. Job-specific education included de-escalation techniques, risk assessment and cultural safety training. Professional support included access to counselling and debriefing services. Organisational responsibilities included: adequate staffing to provide backup, policies and procedures and action from management when hazards are identified. Community collaboration with the health service in developing orientation programs, safety plans and addressing violence within the community was also recommended. A variety of strategies were identified that could be used to reduce the risk of occupational violence towards remote health care staff. Further development and assessment of this 'toolbox' of strategies is recommended to address the high incidence of violence towards remote health professionals in Australia and overseas. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  12. Water cycle and its management for plant habitats at reduced pressures

    NASA Technical Reports Server (NTRS)

    Rygalov, Vadim Y.; Fowler, Philip A.; Wheeler, Raymond M.; Bucklin, Ray A.

    2004-01-01

    Experimental and mathematical models were developed for describing and testing temperature and humidity parameters for plant production in bioregenerative life support systems. A factor was included for analyzing systems operating at low (10-101.3 kPa) pressure to reduce gas leakage and structural mass (e.g., inflatable greenhouses for space application). The expected close relationship between temperature and relative humidity was observed, along with the importance of heat exchanger coil temperature and air circulation rate. The presence of plants in closed habitats results in increased water flux through the system. Changes in pressure affect gas diffusion rates and surface boundary layers, and change convective transfer capabilities and water evaporation rates. A consistent observation from studies with plants at reduced pressures is increased evapotranspiration rates, even at constant vapor pressure deficits. This suggests that plant water status is a critical factor for managing low-pressure production systems. The approach suggested should help space mission planners design artificial environments in closed habitats.

  13. Reducing soil erosion and nutrient loss on sloping land under crop-mulberry management system.

    PubMed

    Fan, Fangling; Xie, Deti; Wei, Chaofu; Ni, Jiupai; Yang, John; Tang, Zhenya; Zhou, Chuan

    2015-09-01

    Sloping croplands could result in soil erosion, which leads to non-point source pollution of the aquatic system in the Three Gorges Reservoir Region. Mulberry, a commonly grown cash plant in the region, is traditionally planted in contour hedgerows as an effective management practice to control soil erosion and non-point source pollution. In this field study, surface runoff and soil N and P loss on sloping land under crop-mulberry management were investigated. The experiments consisted of six crop-mulberry treatments: Control (no mulberry hedgerow with mustard-corn rotation); T1 (two-row contour mulberry with mustard-corn rotation); T2 (three-row contour mulberry with mustard-corn rotation); T3 (border mulberry and one-row contour mulberry with mustard-corn rotation); T4 (border mulberry with mustard-corn rotation); T5 (two-row longitudinal mulberry with mustard). The results indicated that crop-mulberry systems could effectively reduce surface runoff and soil and nutrient loss from arable slope land. Surface runoff from T1 (342.13 m(3) hm(-2)), T2 (260.6 m(3) hm(-2)), T3 (113.13 m(3) hm(-2)), T4 (114 m(3) hm(-2)), and T5 (129 m(3) hm(-2)) was reduced by 15.4, 35.6, 72.0, 71.8, and 68.1%, respectively, while soil loss from T1 (0.21 t hm(-2)), T2 (0.13 t hm(-2)), T3 (0.08 t hm(-2)), T4 (0.11 t hm(-2)), and T5 (0.12 t hm(-2)) was reduced by 52.3, 70.5, 81.8, 75.0, and 72.7%, respectively, as compared with the control. Crop-mulberry ecosystem would also elevate soil N by 22.3% and soil P by 57.4%, and soil nutrient status was contour-line dependent.

  14. Modeling of Solar Radiation Management: A comparison of simulations using reduced solar constant and stratospheric aerosols

    NASA Astrophysics Data System (ADS)

    Kalidindi, Sirisha; Bala, Govindasamy; Modak, Angshuman; Caldeira, Ken

    2014-05-01

    The climatic effects of Solar Radiation Management (SRM) geoengineering have been often modeled by simply reducing the solar constant. This is most likely valid only for space sunshades and not for atmosphere and surface based SRM methods. In this study, a global climate model is used to test if the climate response to SRM by stratospheric aerosols and uniform solar constant reduction are equivalent. Our analysis shows that when global mean warming from a doubling of CO2 is nearly cancelled by both these methods, they are equivalent when important surface and tropospheric climate variables are considered. However, a difference of 1 K in the global mean stratospheric (61-9.8 hPa) temperature is simulated between the two SRM methods. Further, while the global mean surface diffuse radiation increases by about 15-20% and direct radiation decreases by about 8% in the case of sulphate aerosol SRM method, both direct and diffuse radiation decrease by similar fractional amounts (~ -1.5%) when solar constant is reduced. Though the contribution from shaded leaves to gross primary productivity (GPP) increases by 6% in aerosol SRM because of increased diffuse light this increase is almost offset by a 7% decline in sunlit contribution due to reduced direct light. Hence, in the aerosol SRM there is a slight net reduction (~ 1%) in total GPP which is close to the decrease due to solar constant reduction. Based on our results we conclude that the climate states produced by a reduction in solar constant and addition of aerosols into the stratosphere can be considered almost equivalent except for two important aspects: stratospheric temperature change and the partitioning of direct versus diffuse radiation reaching the surface.

  15. Implications of chronic wasting disease, cougar predation, and reduced recruitment for elk management

    USGS Publications Warehouse

    Sargeant, G.A.; Weber, D.C.; Roddy, D.E.

    2011-01-01

    Emerging diseases and expanding carnivore populations may have profound implications for ungulate harvest management and population regulation. To better understand effects of chronic wasting disease (CWD) and cougar (Puma concolor) predation, we studied mortality and recruitment of elk (Cervus elaphus) at Wind Cave National Park (WICA) during 2005-2009. We marked 202 elk (83 subadult M and 119 subadult and ad F) with Global Positioning System (GPS) collars, observed 28 deaths during 74,220 days of monitoring, and investigated 42 additional deaths of unmarked elk found dead. Survival rates were similar for males and females and averaged 0.863 (SE = 0.025) annually. Leading causes of mortality included hunting (0.065, SE = 0.019), CWD (0.034, SE = 0.012), and cougar predation (0.029, SE = 0.012). Marked elk killed by hunters and cougars typically were in good physical condition and not infected with CWD. Effects of mortality on population growth were exacerbated by low rates of pregnancy (subadults = 9.5%, SE = 6.6%; ad = 76.9%, SE = 4.2%) and perinatal survival (0.49, SE = 0.085 from 1 Feb to 1 Sep). Chronic wasting disease, increased predation, and reduced recruitment reduced the rate of increase for elk at WICA to approximately ?? = 1.00 (SE = 0.027) during the past decade. Lower rates of increase are mitigating effects of elk on park vegetation, other wildlife, and neighboring lands and will facilitate population control, but may reduce opportunities for elk hunting outside the park. ?? 2011 The Wildlife Society.

  16. Comprehensive pain management protocol reduces children's memory of pain at discharge from the pediatric ED.

    PubMed

    Crocker, Patrick J; Higginbotham, Eric; King, Benjamin T; Taylor, Diane; Milling, Truman J

    2012-07-01

    reduction at any point. Protocolized pain management reduces patients' memory of pain during PED visits but may not affect parental memory of perceived pain or parent- and patient-reported pain at discharge. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Reduced-Order Models for Load Management in the Power Grid

    NASA Astrophysics Data System (ADS)

    Alizadeh, Mahnoosh

    In recent years, considerable research efforts have been directed towards designing control schemes that can leverage the inherent flexibility of electricity demand that is not tapped into in today's electricity markets. It is expected that these control schemes will be carried out by for-profit entities referred to as aggregators that operate at the edge of the power grid network. While the aggregator control problem is receiving much attention, more high-level questions of how these aggregators should plan their market participation, interact with the main grid and with each other, remain rather understudied. Answering these questions requires a large-scale model for the aggregate flexibility that can be harnessed from the a population of customers, particularly for residences and small businesses. The contribution of this thesis towards this goal is divided into three parts: In Chapter 3, a reduced-order model for a large population of heterogeneous appliances is provided by clustering load profiles that share similar degrees of freedom together. The use of such reduced-order model for system planning and optimal market decision making requires a foresighted approximation of the number of appliances that will join each cluster. Thus, Chapter 4 provides a systematic framework to generate such forecasts for the case of Electric Vehicles, based on real-world battery charging data. While these two chapters set aside the economic side that is naturally involved with participation in demand response programs and mainly focus on the control problem, Chapter 5 is dedicated to the study of optimal pricing mechanisms in order to recruit heterogeneous customers in a demand response program in which an aggregator can directly manage their appliances' load under their specified preferences. Prices are proportional to the wholesale market savings that can result from each recruitment event.

  18. Reducing N losses through surface runoff from rice-wheat rotation by improving fertilizer management.

    PubMed

    Cao, Yansheng; Sun, Huifeng; Liu, Yaqin; Fu, Zishi; Chen, Guifa; Zou, Guoyan; Zhou, Sheng

    2017-02-01

    To better understand N runoff losses from rice-wheat rotation and demonstrate the effectiveness of improved fertilizer management in reducing N runoff losses, a field study was conducted for three consecutive rice-wheat rotations. Nitrogen losses through surface runoff were measured for five treatments, including CK without N application, C200, C300 simulating the conventional practices, CO200, and CO300. Optimum N rate was applied for C200 and CO200, and 30% of chemical fertilizer was substituted with organic fertilizer for CO200 and CO300 with respect to C200 and C300, respectively. Rice season had higher runoff coefficients than wheat season. Approximately 52% of total N was lost as NH4(+)-N in rice season, ranging from 21 to 83%, and in wheat season, the proportion of NO3(-)-N in total N averaged 53% with a variation from 38 to 67%. The N treatments lost less total N in rice season (1.67-10.7 kg N ha(-1)) than in wheat season (1.72-17.1 kg N ha(-1)). These suggested that a key to controlling N runoff losses from rice-wheat rotation was to limit NO3(-)-N accumulation in wheat season. In both seasons, N runoff losses for C200 and CO300 were lower than those for C300. CO200 better cut N losses than C200 and CO300, with 64 and 57% less N in rice and wheat seasons than C300, respectively. Compared with the conventional practices, optimum N inputs integrated with co-application of organic and chemical fertilizers could reduce N runoff losses with a better N balance under rice-wheat rotation.

  19. Health management with reduced antibiotic use - the U.S. experience.

    PubMed

    Baker, Rodney

    2006-01-01

    Since World War II the use of antimicrobial products associated with food animal production has increased. Antimicrobials along with evolving production practices have significantly increased throughput, animal welfare, and improved health. Concerns surrounding the growing significance of emerging and in some cases rapidly disseminating antibiotic (antimicrobial) resistant bacterial pathogens among human and livestock populations has stimulated a reassessment of this application. The negative publicity has led many consumers and activist groups to believe that protein derived from food animals grown in the absence of those drugs is safer than products derived from the conventionally reared. There is a general fear that antimicrobial usage in agriculture threatens the sustainability of human therapeutic agents and the public wellbeing. The issue has gradually emerged from "fringe group paranoia" to mainstream - finally impacting consumer choices. Antimicrobial resistance concerns have stimulated a significant reaction by the US animal agriculture industry. Numerous pig production entities, large and small, have attempted to create additional pork product value by developing niche marketing opportunities. Thus far most of the subtherapeutic in-feed antimicrobial reduction has been voluntary in the US. Two production areas have developed where reduced usage occurs. First is the growth of antibiotic free production (ABF) and second is an increased use of treatment levels which avoids subtherapeutic criticism. The bulk of this article is directed at new production practices, pig health management, disease elimination, and biosecurity efforts that result from early industry attempts at reduced or excluded antimicrobial pig production. Raising antimicrobial (antibiotic) free (ABF) pork from birth is challenging for a variety of reasons. Some of these challenges can be cost effectively dealt with while others are difficult if not impossible to control in modern production

  20. Integrated nutrient management (INM) for sustaining crop productivity and reducing environmental impact: a review.

    PubMed

    Wu, Wei; Ma, Baoluo

    2015-04-15

    The increasing food demands of a growing human population and the need for an environmentally friendly strategy for sustainable agricultural development require significant attention when addressing the issue of enhancing crop productivity. Here we discuss the role of integrated nutrient management (INM) in resolving these concerns, which has been proposed as a promising strategy for addressing such challenges. INM has multifaceted potential for the improvement of plant performance and resource efficiency while also enabling the protection of the environment and resource quality. This review examines the concepts, objectives, procedures and principles of INM. A comprehensive literature search revealed that INM enhances crop yields by 8-150% compared with conventional practices, increases water-use efficiency, and the economic returns to farmers, while improving grain quality and soil health and sustainability. Model simulation and fate assessment further reveal that reactive nitrogen (N) losses and GHG (greenhouse gas) emissions are reduced substantially under advanced INM practices. Lower inputs of chemical fertilizer and therefore lower human and environmental costs (such as intensity of land use, N use, reactive N losses and GHG emissions) were achieved under advanced INM practices without compromising crop yields. Various approaches and perspectives for further development of INM in the near future are also proposed and discussed. Strong and convincing evidence indicates that INM practice could be an innovative and environmentally friendly strategy for sustainable agriculture worldwide.

  1. Longitudinal annoyance responses to a road traffic noise management strategy that reduced heavy vehicles at night.

    PubMed

    Brown, A L

    2015-01-01

    A traffic management strategy was designed to reduce trucks using an urban corridor. The intervention had potential to affect night-time truck flows, but did not target truck traffic in the day, or vehicles other than trucks at any hour. A two-year long panel study measured the community's response to this intervention, using five repeated measurements of response. There were significant reductions in the panel's response to noise, both for night-time annoyance and for interference with activities. This was remarkable given that noise monitoring showed that the intervention produced no change in conventional traffic noise indicators. However, there were measureable changes in the number of articulated truck movements at night, and the benefit can be attributed to reduction in the number of noise events from heavy vehicles. The parallel tracking of changes in reported noise effects and the numbers of heavy vehicles in the night hours in this longitudinal study provides strong support to the notion that noise effects at night depend on the number of noise events experienced, not only on the overall level of traffic noise. The latter appear to be unresponsive indicators by which to assess the noise-effect benefit of heavy vehicle reduction strategies.

  2. A bespoke management package can reduce levels of injurious pecking in loose-housed laying hen flocks.

    PubMed

    Lambton, S L; Nicol, C J; Friel, M; Main, D C J; McKinstry, J L; Sherwin, C M; Walton, J; Weeks, C A

    2013-04-20

    This study investigated the protective effects of an on-farm management package designed to reduce injurious pecking (IP) in loose-housed laying hens. A systematic review of scientific literature generated 46 potentially protective management strategies. Bespoke management packages were designed for treatment flocks (TF) using these management strategies. IP in 53 TFs was compared with IP in 47 control flocks (CF) where the management package was not employed. Scoring of plumage damage (PD) and observations of gentle and severe feather pecking (GFP; SFP), and vent and cannibalistic pecking (VP) were completed, and management strategy use was recorded, at 20, 30 and 40 weeks of age. Differences between treatment and CF were examined using multilevel modelling. Compared with CF, TF employed more management strategies (P<0.001), had lower PD (P=0.003) and SFP (P=0.019). Regardless of treatment or control flock status, the more of the 46 management strategies that were employed the lower was the PD (P=0.004), GFP (P=0.021), SFP (P=0.043), mortality at 40 weeks (P=0.025), and the likelihood of VP (P=0.021). Therefore, the provision of a bespoke management package was protective against the majority of forms of IP in commercial laying hen flocks.

  3. Self-management support and other alternatives to reduce the burden of asthma and chronic obstructive pulmonary disease.

    PubMed

    Reddel, H K; Jenkins, C R; Partridge, M R

    2014-12-01

    While pharmacotherapy is important in the management of asthma and chronic obstructive pulmonary disease, it is also important to consider additional interventions that can further reduce the burden of ill health for patients, their families and the health care system. In this review, the evidence in favour of self-management support that leads to successful self-care by the patient is reviewed, and the key components of successful strategies are outlined; areas where more research is needed are identified. In addition to self-management support, other methods of delivering care, such as telemonitoring, admission avoidance, assisted discharge schemes and use of lay educators, are reviewed.

  4. Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy.

    PubMed

    Menezes, Esme V; Yakoob, Mohammad Yawar; Soomro, Tanya; Haws, Rachel A; Darmstadt, Gary L; Bhutta, Zulfiqar A

    2009-05-07

    An estimated two-thirds of the world's 3.2 million stillbirths occur antenatally, prior to labour, and are often overlooked in policy and programs. Poorly recognised, untreated or inadequately treated maternal infections such as syphilis and malaria, and maternal conditions including hypertensive disorders, are known risk factors for stillbirth. We undertook a systematic review of the evidence for 16 antenatal interventions with the potential to prevent stillbirths. We searched a range of sources including PubMed and the Cochrane Library. For interventions with prior Cochrane reviews, we conducted additional meta-analyses including eligible newer randomised controlled trials following the Cochrane protocol. We focused on interventions deliverable at the community level in low-/middle-income countries, where the burden of stillbirths is greatest. Few of the studies we included reported stillbirth as an outcome; most that did were underpowered to assess this outcome. While Cochrane reviews or meta-analyses were available for many interventions, few focused on stillbirth or perinatal mortality as outcomes, and evidence was frequently conflicting. Several interventions showed clear evidence of impact on stillbirths, including heparin therapy for certain maternal indications; syphilis screening and treatment; and insecticide-treated bed nets for prevention of malaria. Other interventions, such as management of obstetric intrahepatic cholestasis, maternal anti-helminthic treatment, and intermittent preventive treatment of malaria, showed promising impact on stillbirth rates but require confirmatory studies. Several interventions reduced known risk factors for stillbirth (e.g., anti-hypertensive drugs for chronic hypertension), yet failed to show statistically significant impact on stillbirth or perinatal mortality rates. Periodontal disease emerged as a clear risk factor for stillbirth but no interventions have reduced stillbirth rates. Evidence for some newly recognised

  5. Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy

    PubMed Central

    Menezes, Esme V; Yakoob, Mohammad Yawar; Soomro, Tanya; Haws, Rachel A; Darmstadt, Gary L; Bhutta, Zulfiqar A

    2009-01-01

    Background An estimated two-thirds of the world's 3.2 million stillbirths occur antenatally, prior to labour, and are often overlooked in policy and programs. Poorly recognised, untreated or inadequately treated maternal infections such as syphilis and malaria, and maternal conditions including hypertensive disorders, are known risk factors for stillbirth. Methods We undertook a systematic review of the evidence for 16 antenatal interventions with the potential to prevent stillbirths. We searched a range of sources including PubMed and the Cochrane Library. For interventions with prior Cochrane reviews, we conducted additional meta-analyses including eligible newer randomised controlled trials following the Cochrane protocol. We focused on interventions deliverable at the community level in low-/middle-income countries, where the burden of stillbirths is greatest. Results Few of the studies we included reported stillbirth as an outcome; most that did were underpowered to assess this outcome. While Cochrane reviews or meta-analyses were available for many interventions, few focused on stillbirth or perinatal mortality as outcomes, and evidence was frequently conflicting. Several interventions showed clear evidence of impact on stillbirths, including heparin therapy for certain maternal indications; syphilis screening and treatment; and insecticide-treated bed nets for prevention of malaria. Other interventions, such as management of obstetric intrahepatic cholestasis, maternal anti-helminthic treatment, and intermittent preventive treatment of malaria, showed promising impact on stillbirth rates but require confirmatory studies. Several interventions reduced known risk factors for stillbirth (e.g., anti-hypertensive drugs for chronic hypertension), yet failed to show statistically significant impact on stillbirth or perinatal mortality rates. Periodontal disease emerged as a clear risk factor for stillbirth but no interventions have reduced stillbirth rates

  6. Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study.

    PubMed

    Vallance, Kate; Stockwell, Tim; Pauly, Bernie; Chow, Clifton; Gray, Erin; Krysowaty, Bonnie; Perkin, Kathleen; Zhao, Jinhui

    2016-05-09

    Managed alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing. MAPs provide controlled access to alcohol usually alongside accommodation, meals, and other supports. Patterns of alcohol consumption and related harms among MAP participants and controls from a homeless shelter in Thunder Bay, Ontario, were investigated in 2013. Structured interviews were conducted with 18 MAP and 20 control participants assessed as alcohol dependent with most using non-beverage alcohol (NBA). Qualitative interviews were conducted with seven participants and four MAP staff concerning perceptions and experiences of the program. Program alcohol consumption records were obtained for MAP participants, and records of police contacts and use of health services were obtained for participants and controls. Some participants' liver function test (LFT) results were available for before and after MAP entry. Compared with periods off the MAP, MAP participants had 41 % fewer police contacts, 33 % fewer police contacts leading to custody time (x (2) = 43.84, P < 0.001), 87 % fewer detox admissions (t = -1.68, P = 0.06), and 32 % fewer hospital admissions (t = -2.08, P = 0.03). MAP and control participants shared similar characteristics, indicating the groups were broadly comparable. There were reductions in nearly all available LFT scores after MAP entry. Compared with controls, MAP participants had 43 % fewer police contacts, significantly fewer police contacts (-38 %) that resulted in custody time (x (2) = 66.10, P < 0.001), 70 % fewer detox admissions (t = -2.19, P = 0.02), and 47 % fewer emergency room presentations. NBA use was significantly less frequent for MAP participants versus controls (t = -2.34, P < 0.05). Marked but non-significant reductions were observed in the number of participants self-reporting alcohol-related harms in the domains of home life, legal issues, and

  7. Reduced Population Control of an Insect Pest in Managed Willow Monocultures

    PubMed Central

    Dalin, Peter; Kindvall, Oskar; Björkman, Christer

    2009-01-01

    Background There is a general belief that insect outbreak risk is higher in plant monocultures than in natural and more diverse habitats, although empirical studies investigating this relationship are lacking. In this study, using density data collected over seven years at 40 study sites, we compare the temporal population variability of the leaf beetle Phratora vulgatissima between willow plantations and natural willow habitats. Methodology/Principal Findings The study was conducted in 1999–2005. The density of adult P. vulgatissima was estimated in the spring every year by a knock-down sampling technique. We used two measures of population variability, CV and PV, to compare temporal variations in leaf beetle density between plantation and natural habitat. Relationships between density and variability were also analyzed to discern potential underlying processes behind stability in the two systems. The results showed that the leaf beetle P. vulgatissima had a greater temporal population variability and outbreak risk in willow plantations than in natural willow habitats. We hypothesize that the greater population stability observed in the natural habitat was due to two separate processes operating at different levels of beetle density. First, stable low population equilibrium can be achieved by the relatively high density of generalist predators observed in natural stands. Second, stable equilibrium can also be imposed at higher beetle density due to competition, which occurs through depletion of resources (plant foliage) in the natural habitat. In willow plantations, competition is reduced mainly because plants grow close enough for beetle larvae to move to another plant when foliage is consumed. Conclusion/Significance To our knowledge, this is the first empirical study confirming that insect pest outbreak risk is higher in monocultures. The study suggests that comparative studies of insect population dynamics in different habitats may improve our ability to

  8. Practical Pest Management Strategies to Reduce Pesticide Runoff for Argentine Ant (Hymenoptera: Formicidae) Control.

    PubMed

    Greenberg, Les; Rust, Michael K; Richards, Jaben; Wu, Xiaoqin; Kabashima, John; Wilen, Cheryl; Gan, Jay; Choe, Dong-Hwan

    2014-12-01

    The purpose of this study was to involve pest management professionals in the design of application techniques and strategies that would be efficacious and also reduce insecticide runoff. Our study involved measuring both the efficacy of treatments for the Argentine ant, Linepithema humile (Mayr), and the concurrent runoff of fipronil and pyrethroids. Two collaborating companies used low-impact protocols for controlling ants while minimizing runoff. Protocol 1 involved bimonthly treatments, while Protocol 2 was monthly. Both protocols involved an initial treatment with a fipronil spray around the foundation. At the garage door-driveway interface, the fipronil application was done as a pin stream for Protocol 1, and as a crack and crevice application in the expansion joint near the garage for Protocol 2. Protocol 1 replaced most pyrethroid sprays with bifenthrin granules placed around bushes and away from the driveway. For the next treatment on day 63, Protocol 1 also included cyfluthrin spray treatments around the house foundation and crack and crevice applications around the edge of the driveway. For the first treatment in Protocol 2, the fipronil spray was supplemented with spot treatments of cyfluthrin. For subsequent Protocol 2 treatments, botanical insecticides were applied. For weeks 1 and 2 posttreatment combined, Protocol 1 had significantly higher reductions in ant numbers compared with Protocol 2. Thereafter there were no significant differences between the protocols. Runoff of bifenthrin from the granules used with Protocol 1 was much lower than in previous trials involving bifenthrin sprays. Day 1 fipronil runoff for Protocol 2 was significantly lower than that for Protocol 1. This difference may be because of the crack and crevice application applied in Protocol 2. Cyfluthrin runoff was minimal for Protocol 2, which involved spot treatments to supplement the fipronil on day 1, or the botanical insecticides for subsequent treatments. Protocol 1 had a

  9. Efficacy of management algorithm for reducing need for sphincterotomy in chronic anal fissures.

    PubMed

    Sinha, R; Kaiser, A M

    2012-06-01

    Lateral internal sphincterotomy is the most effective treatment for chronic anal fissure (CAF), but carries a risk of faecal incontinence. We aimed to analyse efficacy and acceptance of a treatment algorithm in reducing the rate of necessary sphincterotomies. Patients with CAF seen from 2001 to 2010 were retrospectively analysed. All patients were offered all steps of the algorithm nitroglycerine (NTG) → Botox (BTX) → surgery, unless symptoms or patient preference demanded a more aggressive treatment. Patients were followed up in clinic, and treatment was advanced if a step either failed or caused intolerable side effects. Two hundred and nine patients were included in the analysis. Mean duration of symptoms was 25.6 months and mean follow up 16 months. One hundred and 41 patients started on NTG, 36 on BTX, and 31 went straight to surgery. One patient opted for no treatment. Symptoms persisted in 58 (41.1%) of 141 NTG patients. Forty-five (31.9% of NTG subset) were advanced to BTX and 13 (9.2% of subset) to surgery. Of the 81 (36 primary + 45 secondary) BTX patients (38.8% of the total), only 11 (13.6% of subset) required surgery. A total of 55 (31 primary + 24 secondary; 26.3%) patients needed surgery: two (3.6%) fissures did not heal, one patient developed an abscess, 14 (25.5%) had prolonged wound healing and two (3.6%) developed a recurrent fissure after the sphincterotomy had healed. Our algorithm is effective in CAF and the majority of patients respond to conservative management. Only 26.3% of all patients require surgery, which is effective but also carries some temporary morbidity. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  10. Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?

    PubMed

    Lo, H-Y; Yang, S-L; Lin, H-H; Bai, K-J; Lee, J-J; Lee, T-I; Chiang, C-Y

    2016-03-01

    The Bureau of National Health Insurance (NHI) has implemented a pay-for-performance (p4p) programme for diabetes mellitus (DM) in Taiwan. To investigate whether patients with DM enrolled in the p4p programme (DM-p4p) are less likely to develop tuberculosis (TB) and whether they have a better outcome than patients with DM not enrolled in the p4p programme (DM-non-p4p) if they do develop TB. A random sample of 79,471 DM-p4p, 100,000 DM-non-p4p and 100,000 non-diabetic patients (non-DM) was obtained from the 2008-2009 NHI database, and the patients were matched with the National TB Registry to determine whether they had developed TB by the end of 2010. The average annual incidence of TB was respectively 259.9 (95%CI 230.2-293.4), 137.5 (95%CI 116.4-162.5) and 74.1 (95%CI 59.0-93.0) per 100,000 population among DM-non-p4p, DM-p4p and non-DM patients. The relative risk of death over treatment success was 1.79 (95%CI 1.05-3.04) among DM-non-p4p and 1.69 (95%CI 0.84-3.40) among non-DM patients, relative to DM-p4p patients. Enhanced case management of DM reduced risk and improved outcomes of TB among patients with DM.

  11. Reducing six-month inpatient psychiatric recidivism and costs through case management.

    PubMed

    Kolbasovsky, Andrew; Reich, Leonard; Meyerkopf, Neil

    2010-01-01

    The objective of this study is to determine the reduction in inpatient psychiatric recidivism and costs associated with an intensive case management (ICM) program among high-risk adults with chronic mental health conditions. An intent-to-treat, historical control design was used to examine utilization differences between 306 intervention group (IG) members eligible to receive ICM services and a cohort of 290 baseline group (BG) members over a six-month outcome period. Members were identified retrospectively using identical criteria during one year prior to implementation of the program. The six-month recidivism rate for BG members was 49.67% compared to 22.07% among IG members. Forward stepwise regression results indicated a significant main effect for the ICM intervention on inpatient psychiatric costs. Inpatient psychiatric costs for the six-month outcome period were $4,982.90 lower per member in the IG group. Additional models demonstrated that the ICM intervention was associated with significantly lower inpatient substance abuse costs and psychiatric emergency department costs. There were no statistically significant increases in utilization associated with the ICM intervention. After factoring in program costs, it is estimated that the ICM services contributed to almost $1,500,000 in cost savings over the six-month outcome period. The ICM intervention was associated with significant reductions in inpatient, psychiatric six-month readmission rates and associated costs among adult members who are at elevated risk of inpatient, psychiatric recidivism. The intervention, enrollment process, and measurement strategies can be adapted for use by health plans looking to reduce psychiatric costs.

  12. Integrating land cover modeling and adaptive management to conserve endangered species and reduce catastrophic fire risk

    USGS Publications Warehouse

    Breininger, David; Duncan, Brean; Eaton, Mitchell J.; Johnson, Fred; Nichols, James

    2014-01-01

    Land cover modeling is used to inform land management, but most often via a two-step process, where science informs how management alternatives can influence resources, and then, decision makers can use this information to make decisions. A more efficient process is to directly integrate science and decision-making, where science allows us to learn in order to better accomplish management objectives and is developed to address specific decisions. Co-development of management and science is especially productive when decisions are complicated by multiple objectives and impeded by uncertainty. Multiple objectives can be met by the specification of tradeoffs, and relevant uncertainty can be addressed through targeted science (i.e., models and monitoring). We describe how to integrate habitat and fuel monitoring with decision-making focused on the dual objectives of managing for endangered species and minimizing catastrophic fire risk. Under certain conditions, both objectives might be achieved by a similar management policy; other conditions require tradeoffs between objectives. Knowledge about system responses to actions can be informed by developing hypotheses based on ideas about fire behavior and then applying competing management actions to different land units in the same system state. Monitoring and management integration is important to optimize state-specific management decisions and to increase knowledge about system responses. We believe this approach has broad utility and identifies a clear role for land cover modeling programs intended to inform decision-making.

  13. Integrating Land Cover Modeling and Adaptive Management to Conserve Endangered Species and Reduce Catastrophic Fire Risk

    NASA Technical Reports Server (NTRS)

    Breininger, David; Duncan, Brean; Eaton, Mitchell; Johnson, Fred; Nichols, James

    2014-01-01

    Land cover modeling is used to inform land management, but most often via a two-step process where science informs how management alternatives can influence resources and then decision makers can use this to make decisions. A more efficient process is to directly integrate science and decision making, where science allows us to learn to better accomplish management objectives and is developed to address specific decisions. Co-development of management and science is especially productive when decisions are complicated by multiple objectives and impeded by uncertainty. Multiple objectives can be met by specification of tradeoffs, and relevant uncertainty can be addressed through targeted science (i.e., models and monitoring). We describe how to integrate habitat and fuels monitoring with decision making focused on dual objectives of managing for endangered species and minimizing catastrophic fire risk. Under certain conditions, both objectives might be achieved by a similar management policy, but habitat trajectories suggest tradeoffs. Knowledge about system responses to actions can be informed by applying competing management actions to different land units in the same system state and by ideas about fire behavior. Monitoring and management integration is important to optimize state-specific management decisions and increase knowledge about system responses. We believe this approach has broad utility for and cover modeling programs intended to inform decision making.

  14. Design of Experiments with Multiple Independent Variables: A Resource Management Perspective on Complete and Reduced Factorial Designs

    ERIC Educational Resources Information Center

    Collins, Linda M.; Dziak, John J.; Li, Runze

    2009-01-01

    An investigator who plans to conduct an experiment with multiple independent variables must decide whether to use a complete or reduced factorial design. This article advocates a resource management perspective on making this decision, in which the investigator seeks a strategic balance between service to scientific objectives and economy.…

  15. The Slope of Change: An Environmental Management Approach to Reduce Drinking on a Day of Celebration at a US College

    ERIC Educational Resources Information Center

    Marchell, Timothy C.; Lewis, Deborah D.; Croom, Katherine; Lesser, Martin L.; Murphy, Susan H.; Reyna, Valerie F.; Frank, Jeremy; Staiano-Coico, Lisa

    2013-01-01

    Objective: This research extends the literature on event-specific environmental management with a case study evaluation of an intervention designed to reduce student drinking at a university's year-end celebration. Participants: Cornell University undergraduates were surveyed each May from 2001 through 2009. Sample sizes ranged from 322 to 1,973.…

  16. Evaluation of individual and combined management practices to reduce the off-site transport of pesticides from golf course turf

    USDA-ARS?s Scientific Manuscript database

    The detection of pesticides, associated with turfgrass management, in storm runoff and surface waters of urban watersheds has raised concerns regarding their source, potential environmental effects and a need for strategies to reduce their inputs. In previous research we discovered that hollow tine ...

  17. The Slope of Change: An Environmental Management Approach to Reduce Drinking on a Day of Celebration at a US College

    ERIC Educational Resources Information Center

    Marchell, Timothy C.; Lewis, Deborah D.; Croom, Katherine; Lesser, Martin L.; Murphy, Susan H.; Reyna, Valerie F.; Frank, Jeremy; Staiano-Coico, Lisa

    2013-01-01

    Objective: This research extends the literature on event-specific environmental management with a case study evaluation of an intervention designed to reduce student drinking at a university's year-end celebration. Participants: Cornell University undergraduates were surveyed each May from 2001 through 2009. Sample sizes ranged from 322 to 1,973.…

  18. Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations.

    PubMed

    Lavery, Lawrence A; Wunderlich, Robert P; Tredwell, Jeffrey L

    2005-10-01

    To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p<0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p<0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p<0.05). A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.

  19. Environmental Management: A Comprehensive Strategy for Reducing Alcohol and Other Drug Use on College Campuses.

    ERIC Educational Resources Information Center

    DeJong, William; Vince-Whitman, Cheryl; Colthurst, Tom; Cretella, Maggie; Gilbreath, Michael; Rosati, Michael; Zweig, Karen

    This guide presents a comprehensive strategy, called "environmental management," for alcohol and other drug (AOD) prevention in institutions of higher education. The environmental management approach utilizes, in addition to educational programs, changes in the physical, social, economic, and legal environment accomplished through a…

  20. Reducing environmental noise impacts: A USAREUR noise-management program handbook. Final report

    SciTech Connect

    Feather, T.D.; Shekell, T.K.

    1991-06-01

    Noise pollution is a major environmental problem faced by the U.S. Army in Europe. Noise-related complaints from German citizens can escalate into intense political issues in German communities. This in turn hampers efficient operation of military training and often times threatens the Army's mission. In order to remedy these problems, USAREUR has developed a noise management program. A successful noise management program will limit the impact of unavoidable noise on the populace. This report, a component of the noise management program, is a reference document for noise management planning. It contains guidelines and rules-of-thumb for noise management. This document contains procedures which operation and training level personnel can understand and apply in their day to day noise management planning. Noise mitigation tips are given. Basic technical information that will aid in understanding noise mitigation is provided along with noise management through land use planning. Noise management for specific components of the military community, (airfields, base operations, training areas, and housing and recreation areas) are addressed. The nature of noise generated, means of noise abatement at the source, path, and receiver (both physical and organizational/public relations methods), and a case study example are described.

  1. Managing Annual Flood Risk and Reducing Socioeconomic Flood Impacts in Rural Arctic through Science-Community Collaborations

    NASA Astrophysics Data System (ADS)

    Kontar, Y. Y.

    2016-12-01

    Multiple Arctic riverine communities face flood risk every spring. Within hours floodwater and ice debris destroy entire communities, displacing hundreds of people. In FY 2015-2016 an international project entitled Reducing Spring Flood Impacts for Wellbeing of Communities of the North was successfully conducted with the goal to identify best practices in managing the risk and reducing the socioeconomic impacts of floods associated with spring river ice breakup. In this presentation, we will elaborate on socioeconomic impacts of breakup floods, including long-term evacuation of population, loss of means of livelihoods, and ecosystem resource loss. We will also compare and contrast spring flood risk management and reduction strategies and their effectiveness in Alaska and Sakha Republic (Siberia), Russia. The findings are based on surveys completed by the representatives of adverse populations in two flood-prone communities in Alaska and Sakha Republic, as well as a series of roundtable discussions and interviews between social and geoscientists, emergency managers, and community leaders.

  2. Medication Management in Schools: A Systems Approach to Reducing Risk and Strengthening Quality in School Medication Management

    ERIC Educational Resources Information Center

    Center for Health and Health Care in Schools, 2004

    2004-01-01

    This paper and the invitational meeting for which it has been prepared make certain assumptions about the challenge of strengthening the quality of medication management in school. The participants believe that recent research on improving the safety and quality of patient care has relevance for health services in school, particularly the safety…

  3. Reducing CH4 emission from rice paddy fields by altering water management

    NASA Astrophysics Data System (ADS)

    Sudo, S.; Itoh, M.

    2010-12-01

    Percentage of atmospheric methane emitted form rice paddy is estimated at 60Tg/yr (20 - 100Tg/yr) which is near 10% of total global methane emission of 535Tg/yr (410 - 660Tg) (IPCC(1995), and which is near 30% of anthropogenic CH4 emission. Thus, mitigation of CH4 emission is urgently required. CH4 in paddy soil is emanated by the activities of anaerobic bacteria which is called methane producer through reduction of CO2 or decomposition of acetic acid, and it is transported to atmosphere through soil or paddy water surface. It is effective to control methane emission from rice paddy that period is extended on intermittent drainage, composted rice straw is incorporated as fertilizer instead of flesh one, or other. However, empirical approach of these kinds of experiments had not been sufficient because such a kind of experiment required significant times and efforts. In this study, we conducted demonstrative experiments to verify the effects of water management method differences in order to reduce CH4 emission from rice paddy at 9 experimental sites in 8 prefectures. In this, we used new gas analyzer which can measure CH4, CO2 and N2O at once developed by National Institute for Agro-Environmental Sciences (NIAES), Japan. In this report, we show the results in two years of this study. 'Nakaboshi' (mid-season-drainage) is one of cultivation methods in rice paddy that surface water in paddy field is once drained for about 10 days and the field is maintained like upland field to give adequate stress to rice plant for better harvest qualities and yields. Our targeted evaluation was dependencies of Nakaboshi periods lengths and Nakaboshi periods to CH4 emission reduction amounts for total cultivation periods within harvest yield maintained. The longer length of Nakaboshi period was extended, the lesser CH4 emitted even after when Nakaboshi period lasted, as a whole. In some cases, for example in Kagoshima, exceptional phenomena of that significant high emission were

  4. Coping Card Usage can Further Reduce Suicide Reattempt in Suicide Attempter Case Management Within 3-Month Intervention.

    PubMed

    Wang, Ying-Chuan; Hsieh, Ling-Yu; Wang, Ming-Yu; Chou, Cheng-Hsiang; Huang, Min-Wei; Ko, Huei-Chen

    2016-02-01

    This randomized controlled trial was designed to evaluate the effectiveness of using crisis coping cards (n = 32) in the case management of suicide prevention compared with case management without the use of coping cards (n = 32) over a 3-month intervention period. The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk, depression, anxiety, and hopelessness. Results indicated that subsequent suicidal behaviors, severity of suicide risk, depression, anxiety, and hopelessness were reduced more in the coping card intervention group compared to the case management only group. Moreover, for the survival curves of time to suicide reattempt, the coping card group showed a significantly longer time to reattempt than the case management only group at 2-month and 3-month intervention periods.

  5. A system of safety management practices and worker engagement for reducing and preventing accidents: an empirical and theoretical investigation.

    PubMed

    Wachter, Jan K; Yorio, Patrick L

    2014-07-01

    The overall research objective was to theoretically and empirically develop the ideas around a system of safety management practices (ten practices were elaborated), to test their relationship with objective safety statistics (such as accident rates), and to explore how these practices work to achieve positive safety results (accident prevention) through worker engagement. Data were collected using safety manager, supervisor and employee surveys designed to assess and link safety management system practices, employee perceptions resulting from existing practices, and safety performance outcomes. Results indicate the following: there is a significant negative relationship between the presence of ten individual safety management practices, as well as the composite of these practices, with accident rates; there is a significant negative relationship between the level of safety-focused worker emotional and cognitive engagement with accident rates; safety management systems and worker engagement levels can be used individually to predict accident rates; safety management systems can be used to predict worker engagement levels; and worker engagement levels act as mediators between the safety management system and safety performance outcomes (such as accident rates). Even though the presence of safety management system practices is linked with incident reduction and may represent a necessary first-step in accident prevention, safety performance may also depend on mediation by safety-focused cognitive and emotional engagement by workers. Thus, when organizations invest in a safety management system approach to reducing/preventing accidents and improving safety performance, they should also be concerned about winning over the minds and hearts of their workers through human performance-based safety management systems designed to promote and enhance worker engagement. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis.

    PubMed

    Panagioti, Maria; Richardson, Gerry; Small, Nicola; Murray, Elizabeth; Rogers, Anne; Kennedy, Anne; Newman, Stanton; Bower, Peter

    2014-08-27

    There is increasing interest in the role of 'self-management' interventions to support the management of long-term conditions in health service settings. Self-management may include patient education, support for decision-making, self-monitoring and psychological and social support. Self-management support has potential to improve the efficiency of health services by reducing other forms of utilisation (such as primary care or hospital use), but a shift to self-management may lead to negative outcomes, such as patients who feel more anxious about their health, are less able to cope, or who receive worse quality of care, all of which may impact on their health and quality of life. We sought to determine which models of self-management support are associated with significant reductions in health services utilisation without compromising outcomes among patients with long-term conditions. We used systematic review with meta-analysis. We included randomised controlled trials in patients with long-term conditions which included self-management support interventions and reported measures of service utilisation or costs, as well as measures of health outcomes (standardized disease specific quality of life, generic quality of life, or depression/anxiety).We searched multiple databases (CENTRAL, CINAHL, Econlit, EMBASE, HEED, MEDLINE, NHS EED and PsycINFO) and the reference lists of published reviews. We calculated effects sizes for both outcomes and costs, and presented the results in permutation plots, as well as conventional meta-analyses. We included 184 studies. Self-management support was associated with small but significant improvements in health outcomes, with the best evidence of effectiveness in patients with diabetic, respiratory, cardiovascular and mental health conditions. Only a minority of self-management support interventions reported reductions in health care utilisation in association with decrements in health. Evidence for reductions in utilisation

  7. Regional growth management policies: Toward reducing global warming at state and local levels

    SciTech Connect

    Purdie, J.

    1995-09-01

    State and local governments in the United States are accepting mandates to coordinate legislated land use and growth management planning with vigorous environmental protection and resource conservation. These mandates, implemented or planned in states with populations totaling over 100 million, will directly impact growth patterns and ultimately affect the level of atmospheric gases and particulates generated within their borders. This paper addresses the issues of growth management and land use planning at the local, state and regional levels and identifies areas impacting global warming. A review of existing systems will be presented, and recommendations will be made to improve monitoring of growth management mechanisms and organizational structures with the goal of global atmospheric improvement. The issues discussed include urban sprawl, transportation, and growth patterns as managed by policies also designed to protect environments and provide for sustainable growth. Areas for improved coordination between jurisdictions to ease global warming will also be examined.

  8. Case management of chronic ventilator patients. Reduce average length of stay and cost by half.

    PubMed

    Yaksic, J R; DeWoody, S; Campbell, S

    1996-01-01

    The implementation of the case management model and the use of critical pathways has become a major strategy to improve quality of care and cope with measuring and managing costs. Grant Medical Center, a 640-bed Level I Trauma Center, began case managing its chronic ventilator patients in July, 1993. A 30-day critical pathway was developed using a multidisciplinary team approach. In case managing these patients, many problematic issues were identified, such as lack of adequate involvement by staff experienced in specific disciplines and multiple physician decision makers for each case. By increasing multidisciplinary collaboration, care of these patients was systematically changed and streamlined. Over a 2-year period, the average length of stay for chronic ventilator patients decreased from 74.5 days to 41.9 days, and the average cost per case decreased from $189,080 to $107,019.

  9. Sustainable Materials Management (SMM) Web Academy Webinar: Reducing Wasted Food: How Packaging Can Help

    EPA Pesticide Factsheets

    This is a webinar page for the Sustainable Management of Materials (SMM) Web Academy webinar titled Let’s WRAP (Wrap Recycling Action Program): Best Practices to Boost Plastic Film Recycling in Your Community

  10. The Office of Land and Emergency Management is Seeking Feedback on Reducing Regulatory Burden

    EPA Pesticide Factsheets

    This page contains information about the comments the Office of Land and Emergency Management is collecting and the public meeting they are holding in response to Executive Order 13777 Regulatory Reform Review

  11. BestPractices Corporate Energy Management Case Study: Alcoa Teams with DOE to Reduce Energy Consumption

    SciTech Connect

    Not Available

    2004-05-01

    This is the first in a series of DOE Industrial Technologies Program case studies on corporate energy management. The case study highlights Alcoa Aluminum's successful results and activities through its corporate energy management approach and collaboration with DOE. Case studies in this series will be used to encourage other energy-intensive industrial plants to adopt a corporate strategy, and to promote the concept of replicating results with a company or industry.

  12. Medicaid managed care reduces readmissions for youths with type 1 diabetes.

    PubMed

    Healy-Collier, Kathleen; Jones, Walter J; Shmerling, James E; Robertson, Kenneth R; Ferry, Robert J

    2016-04-01

    To determine whether the likelihood of readmission (adjusted for severity on first admission) for pediatric type 1 diabetes (T1D) differs between Medicaid managed care and non-managed care. De-identified patients were retrospectively selected from the Pediatric Health Information Systems database of the Children's Hospital Association (CHA). The cohort of 42 hospitals across 25 states included discharges between 2008 and 2011 for patients who were receiving Medicaid at the time of service and had T1D as their diagnosis. Multiple factors and co-variants for readmission were analyzed by logistic regression, including age, race, gender, severity of illness, and state of admission. Of 14,544 T1D discharges with Medicaid, 4985 were readmitted, including 1792 readmitted for diabetic ketoacidosis (DKA). Despite similar rates of DKA between the managed care and non-managed care cohorts, overall 90-day readmission was 1.12 times more likely for Medicaid patients on non-managed care plans than those on managed care (odds ratio, 1.12; range = 1.04-1.20; both adjusted for severity of illness). Significant contributors were race, age, and gender; the relationship of location (state) and days between readmissions was also significant. The conservative estimate of cost reduction from Medicaid managed care related to lower readmission rate for pediatric T1D across CHA institutions between 2008 and 2011 was $2.6 million. From the largest, national, defined cohort available for contemporary study, youths with T1D on Medicaid managed care plans were less likely to be readmitted within 90 days of discharge.

  13. Implementation of a chest pain management service improves patient care and reduces length of stay.

    PubMed

    Scott, Adam C; O'Dwyer, Kristina M; Cullen, Louise; Brown, Anthony; Denaro, Charles; Parsonage, William

    2014-03-01

    Chest pain is one of the most common complaints in patients presenting to an emergency department. Delays in management due to a lack of readily available objective tests to risk stratify patients with possible acute coronary syndromes can lead to an unnecessarily lengthy admission placing pressure on hospital beds or inappropriate discharge. The need for a co-ordinated system of clinical management based on enhanced communication between departments, timely and appropriate triage, clinical investigation, diagnosis, and treatment was identified. An evidence-based Chest Pain Management Service and clinical pathway were developed and implemented, including the introduction of after-hours exercise stress testing. Between November 2005 and March 2013, 5662 patients were managed according to a Chest Pain Management pathway resulting in a reduction of 5181 admission nights by more timely identification of patients at low risk who could then be discharged. In addition, 1360 days were avoided in high-risk patients who received earlier diagnosis and treatment. The creation of a Chest Pain Management pathway and the extended exercise stress testing service resulted in earlier discharge for low-risk patients; and timely treatment for patients with positive and equivocal exercise stress test results. This service demonstrated a significant saving in overnight admissions.

  14. Sediment Management Methods to Reduce Dredging: Part 2, Sediment Collector Technology

    DTIC Science & Technology

    2017-04-01

    dredging by lowering the downstream grade to reduce flooding and ultimately reduce sediment deposition as far downstream as John Martin Reservoir, a U.S...reservoir storage capacity and related hydroelectric generating capacity and reduce flood risks that would otherwise increase with a loss of storage...Watershed, Flood Control, and Greenway District was created. ERDC TN-DOER-T13 April 2017 6 Costs shown in Table 1 approximate the actual system cost

  15. Efficacy of home-based lymphoedema management in reducing acute attacks in subjects with lymphatic filariasis in Burkina Faso.

    PubMed

    Jullien, Patrick; Somé, Jeanne d'Arc; Brantus, Pierre; Bougma, Roland W; Bamba, Issouf; Kyelem, Dominique

    2011-09-01

    One of the two main goals of the Global Programme to Eliminate Lymphatic Filariasis (LF) is to provide care for those suffering from the devastating clinical manifestations of this filarial infection. Among the 120 million infected people worldwide, up to 16 million have lymphoedema. The WHO strategy for managing lymphoedema is based on rigorous skin hygiene, exercise, antibiotics and antifungals when indicated. The aim is to reduce acute attacks of adenolymphangitis and cellulitis responsible for lymphoedema progression and disability. The objective of our study was to assess the effectiveness of home-based lymphoedema management implemented by the national health system of Burkina Faso. Any patient was eligible to participate in the study if suffering from LF-related lymphoedema of a lower limb at any stage, and receiving care as part of the health education and washing project between April 2005 and December 2007. The primary readout was the occurrence of an acute attack in the month preceding the consultation reported by the patient or observed by the care-giver. In all, 1089 patients were enrolled in the study. Before lymphoedema management intervention, 78.1% (95%CI: 75.5-80.5) of the patients had an acute attack in the month preceding the consultation; after four and half months of lymphoedema management, this was reduced to 39.1% (95%CI: 36.2-42.1). A reduction of acute attacks related to the number of consultations or related to the patients' age and gender was not observed. Our results suggest that the home-based lymphoedema management programme in the primary health care system of Burkina Faso is effective in reducing morbidity due to LF in the short-term (4.5 months). The lymphoedema management requires no additional human resources, but whether its effect can be sustained remains to be seen.

  16. Evaluation and management of patients with recurrent peptic ulcer disease after acid-reducing operations: a systematic review.

    PubMed

    Turnage, Richard H; Sarosi, George; Cryer, Byron; Spechler, Stuart; Peterson, Walter; Feldman, Mark

    2003-01-01

    This systematic review examines the evidence for commonly employed strategies of managing patients with recurrent ulcer disease after acid-reducing operations. Particular attention is given to recent evidence relating Helicobacter pylori (H. pylori ) and nonsteroidal anti-inflammatory drugs (NSAIDs) to ulcer recurrence after operative therapy. MEDLINE word searches of the literature from 1966 to 2001 identified 895 articles that cross-reference the terms "peptic ulcer disease (PUD)," "surgery," and "recurrence." Articles were selected for systematic review of evidence relating incomplete vagotomy, NSAIDs, and H. pylori to postoperative ulcer recurrence and evidence supporting common medical and surgical strategies. The relationship between incomplete vagotomy and recurrent ulcer disease is suggested by randomized controlled trials and well-designed prospective case series. The evidence that NSAID use is an important pathogenic factor in recurrent ulcer disease includes the relationship between NSAIDs and primary PUD, the occurrence of NSAID-induced ulcers in patients taking proton pump inhibitors, and case series demonstrating virulent ulcer disease in patients taking aspirin despite prior acid-reducing operations. The relationship between H. pylori infection and postoperative ulcer recurrence remains uncertain despite multiple controlled trials and well-designed case series that have documented high rates of H. pylori infection in postoperative patients. The initial management of patients with recurrent ulcer disease after acid-reducing operations consists of a protein pump inhibitor or a histamine-2 receptor antagonist and antibiotics directed at H. pylori, if present. Evidence for this regimen includes prospective randomized trials demonstrating the efficacy of cimetidine in healing ulcers after acid-reducing operations and prospective, randomized studies documenting the efficacy of histamine-2 receptor antagonists and protein pump inhibitors in the management

  17. Reducing energy costs at state agencies and institutions in Texas through the Governor's energy management center

    SciTech Connect

    White, J.A.

    1989-01-01

    The one year internship required for partial fulfillment of the Doctor of Engineering Degree was completed at the Governor's Energy Management Center in Austin, Texas. The intern worked for the State Agencies Department of the Energy Management Center. The intern was involved in a variety of projects, but the primary projects requiring the greatest time were the involvement with the design reviews for energy efficiency of new prisons being constructed in Texas, conducting energy management audits at 18 major state universities, and the technical and administrative assistance to the State Cogeneration Council. Other project involvement included managing the preliminary engineering design of the cogeneration facility at Austin State Hospital, responsibility for applying for a $1.4 million dollar crude oil refund on the behalf of all state agencies in Texas, and assisting in the planning and coordination of the $48 million Revolving Loan Program for the state of Texas. The internship taught many things about management and communications. The experience also provided a better understanding of how the state and federal government operate. The greatest contribution of the internship experience was the improvement of the intern's written and oral communication skills.

  18. Optimizing emergency management to reduce morbidity and mortality in pediatric burn patients.

    PubMed

    Haines, Elizabeth; Fairbrother, Hilary

    2015-05-01

    Burns in patients aged < 14 years are consistently among the top causes of injury-induced mortality in pediatric patients. Pediatric burn victims with large body surface area involvement have a multisystem physiologic response that differs from that of adult patients. The spectrum of management is vast and relies heavily on both the classification of the burn and the anatomy involved. Immediate goals for emergency clinicians include resuscitation and stabilization, fluid management, and pain control. Additional goals include decreasing the risk of infection along with improving healing and cosmetic outcomes. Discharge care and appropriate follow-up instructions need to be carefully constructed in order to avoid long-standing complications. This article reviews methods for accurate classification and management of the full range of burns seen in pediatric patients.

  19. Human Milk Management Redesign: Improving Quality and Safety and Reducing Neonatal Intensive Care Unit Nurse Stress.

    PubMed

    Settle, Margaret Doyle; Coakley, Amanda Bulette; Annese, Christine Donahue

    2017-02-01

    Human milk provides superior nutritional value for infants in the neonatal intensive care unit and is the enteral feeding of choice. Our hospital used the system engineering initiative for patient safety model to evaluate the human milk management system in our neonatal intensive care unit. Nurses described the previous process in a negative way, fraught with opportunities for error, increased stress for nurses, and the need to be away from the bedside and their patients. The redesigned process improved the quality and safety of human milk management and created time for the nurses to spend with their patients.

  20. Reducing the distance: providing challenging and engaging online postgraduate education in pain management

    PubMed Central

    Henderson, Sarah E

    2012-01-01

    Summary points 1. Health professionals need access to flexible, high-quality, advanced education in pain management. 2. There are multiple pedagogical distances to be negotiated in the delivery of effective postgraduate education. 3. A critical consideration in the design and delivery of effective online learning for postgraduate education in pain management is how to: actively engage students in the learning process; and encourage students to become lifelong learners. 4. Conceptual frameworks for encouraging student interaction online provide a useful tool in the design of postgraduate online learning activities. PMID:26516472

  1. Toward efficient medication error reduction: error-reducing information management systems.

    PubMed

    Chung, Kyusuk; Choi, Young B; Moon, Sangho

    2003-12-01

    Hospitals and other health-care providers today are being pressed more than ever to use technologies for reducing medical errors. Particularly, medication errors are likely to increase fast as Americans age. This paper intends to provide a starting point for understanding information technologies and database systems supporting such technologies as Computerized Physician Order Entry (CPOE), Automated Dispensing System (ADS), and Bar Coding System designed to reduce medication errors in hospitals. Although vendors provide the necessary communication software and applications, actions involving governments, technology vendors, pharmaceutical companies, and clinical researchers are needed to put to actual use the applications with a massive potential to significantly reduce medication-related errors.

  2. Farm-economic analysis of reducing antimicrobial use whilst adopting improved management strategies on farrow-to-finish pig farms.

    PubMed

    Rojo-Gimeno, Cristina; Postma, Merel; Dewulf, Jeroen; Hogeveen, Henk; Lauwers, Ludwig; Wauters, Erwin

    2016-07-01

    Due to increasing public health concerns that food animals could be reservoirs for antibiotic resistant organisms, calls for reduced current antibiotic use on farms are growing. Nevertheless, it is challenging for farmers to perform this reduction without negatively affecting technical and economic performance. As an alternative, improved management practices based on biosecurity and vaccinations have been proven useful to reduce antimicrobial use without lowering productivity, but issues with insufficient experimental design possibilities have hindered economic analysis. In the present study a quasi-experimental approach was used for assessing the economic impact of reduction of antimicrobial use coupled with improved management strategies, particularly biosecurity strategies. The research was performed on farrow-to-finish pig farms in Flanders (northern region of Belgium). First, to account for technological progress and to avoid selection bias, propensity score analysis was used to compare data on technical parameters. The treatment group (n=48) participated in an intervention study whose aim was to improve management practices to reduce the need for use of antimicrobials. Before and after the change in management, data were collected on the technical parameters, biosecurity status, antimicrobial use, and vaccinations. Treated farms were matched without replacement with control farms (n=69), obtained from the Farm Accountancy Data Network, to estimate the difference in differences (DID) of the technical parameters. Second, the technical parameters' DID, together with the estimated costs of the management intervention and the price volatility of the feed, meat of the finisher pigs, and piglets served as a basis for modelling the profit of 11 virtual farrow-to-finish pig farms representative of the Flemish sector. Costs incurred by new biosecurity measures (median +€3.96/sow/year), and new vaccinations (median €0.00/sow/year) did not exceed the cost reduction

  3. Debriefing Can Reduce Misperceptions of Feedback: The Case of Renewable Resource Management

    ERIC Educational Resources Information Center

    Qudrat-Ullah, Hassan

    2007-01-01

    According to the hypothesis of misperception of feedback, people's poor performance in renewable resource management tasks can be attributed to their general tendency to systematically misperceive the dynamics of bioeconomic systems. The thesis of this article is that dynamic decision performance can be improved by helping individuals develop more…

  4. Working to Reduce the Effects of Discrimination: Identity Management Strategies in Organizations

    ERIC Educational Resources Information Center

    Shih, Margaret; Young, Maia J.; Bucher, Amy

    2013-01-01

    Despite efforts to dispel discrimination, workplace discrimination still occurs. We introduce two classes of identity management strategies individuals use to mitigate the negative consequences of discrimination: identity switching (i.e., deemphasizing target identities and recategorizing to a more positively valued identity) and identity…

  5. Reducing CO2 emissions by managing for sudden oak death...is it possible?

    Treesearch

    Brendan Twieg; Yana Valachovic; Richard Cobb; Dan Stark

    2017-01-01

    Forest CO2 emissions, which have recently become a more regular concern in forest management, can radically increase following pest and disease outbreaks. We inventoried trees in a stand adjacent to an infested area in northern Humboldt County, California, and used a stand-level dynamic disease model to forecast Phythophthora ramorum...

  6. Prefire (preemptive) management to decrease fire-induced bunchgrass mortality and reduce reliance on postfire seeding

    USDA-ARS?s Scientific Manuscript database

    Western rangelands are currently under severe threat from exotic annual grasses. To successfully manage rangelands that are either infested with or susceptible to exotic annual grasses, we must focus on increasing resilience to disturbance and resistance to exotic annual grass invasion. Here, we p...

  7. Understanding and Reducing the Impact of Defensiveness on Management Learning: Some Lessons from Neuroscience

    ERIC Educational Resources Information Center

    Holmer, Leanna L.

    2014-01-01

    The neurosciences have expanded our understanding of the role of the "old" brain in generating defensive reactions to threat. Because the learning and practice of management skills pose various forms of threat to would-be practitioners, the question of how individuals respond to threat and how this affects their ability to learn has also…

  8. Sustainable forest management of tropical forests can reduce carbon emissions and stabilize timber production

    Treesearch

    N. Sasaki; G.P. Asner; Yude Pan; W. Knorr; P.B. Durst; H.O. Ma; I. Abe; A.J. Lowe; L.P. Koh

    2016-01-01

    The REDD+ scheme of the United Nations Framework Conventionon Climate Change has provided opportunities to manage tropical forests for timber production and carbon emission reductions. To determine the appropriate loggingtechniques, we analyzed potential timber production and carbon emission reductions under two logging techniques over a 40-year period of selective...

  9. Working to Reduce the Effects of Discrimination: Identity Management Strategies in Organizations

    ERIC Educational Resources Information Center

    Shih, Margaret; Young, Maia J.; Bucher, Amy

    2013-01-01

    Despite efforts to dispel discrimination, workplace discrimination still occurs. We introduce two classes of identity management strategies individuals use to mitigate the negative consequences of discrimination: identity switching (i.e., deemphasizing target identities and recategorizing to a more positively valued identity) and identity…

  10. Understanding and Reducing the Impact of Defensiveness on Management Learning: Some Lessons from Neuroscience

    ERIC Educational Resources Information Center

    Holmer, Leanna L.

    2014-01-01

    The neurosciences have expanded our understanding of the role of the "old" brain in generating defensive reactions to threat. Because the learning and practice of management skills pose various forms of threat to would-be practitioners, the question of how individuals respond to threat and how this affects their ability to learn has also…

  11. Debriefing Can Reduce Misperceptions of Feedback: The Case of Renewable Resource Management

    ERIC Educational Resources Information Center

    Qudrat-Ullah, Hassan

    2007-01-01

    According to the hypothesis of misperception of feedback, people's poor performance in renewable resource management tasks can be attributed to their general tendency to systematically misperceive the dynamics of bioeconomic systems. The thesis of this article is that dynamic decision performance can be improved by helping individuals develop more…

  12. Topographic placement of management practices to reduce water quality impacts from pastures

    USDA-ARS?s Scientific Manuscript database

    Best management practices (BMPs) such as streambank fencing and vegetative buffers lessen environmental impacts on streams from pasture-based agriculture by limiting livestock time in streams and intercepting sediment and nutrients in overland flow. Placing streamside BMPs at the closest point to th...

  13. Nontraumatic subarachnoid hemorrhage management: evaluation with reduced iodine volume at CT angiography.

    PubMed

    Millon, Domitille; Derelle, Anne Laure; Omoumi, Patrick; Tisserand, Marie; Schmitt, Emmanuelle; Foscolo, Sylvain; Anxionnat, René; Bracard, Serge

    2012-07-01

    To evaluate the technical quality and the diagnostic performance of a protocol with use of low volumes of contrast medium (25 mL) at 64-detector spiral computed tomography (CT) in the diagnosis and management of adult, nontraumatic subarachnoid hemorrhage (SAH). This study was performed outside the United States and was approved by the institutional review board. Intracranial CT angiography was performed in 73 consecutive patients with nontraumatic SAH diagnosed at nonenhanced CT. Image quality was evaluated by two observers using two criteria: degree of arterial enhancement and venous contamination. The two independent readers evaluated diagnostic performance (lesion detection and correct therapeutic decision-making process) by using rotational angiographic findings as the standard of reference. Sensitivity, specificity, and positive and negative predictive values were calculated for patients who underwent CT angiography and three-dimensional rotational angiography. The intraclass correlation coefficient was calculated to assess interobserver concordance concerning aneurysm measurements and therapeutic management. All aneurysms were detected, either ruptured or unruptured. Arterial opacification was excellent in 62 cases (85%), and venous contamination was absent or minor in 61 cases (84%). In 95% of cases, CT angiographic findings allowed optimal therapeutic management. The intraclass correlation coefficient ranged between 0.93 and 0.95, indicating excellent interobserver agreement. With only 25 mL of iodinated contrast medium focused on the arterial phase, 64-detector CT angiography allowed satisfactory diagnostic and therapeutic management of nontraumatic SAH. © RSNA, 2012.

  14. Strategic Management of ELT in Public Educational Systems: Trying to Reduce Failure, Increase Success

    ERIC Educational Resources Information Center

    Davies, Paul

    2009-01-01

    English as a foreign/second language teaching (ELT) is notably successful in some national public educational systems and unsuccessful in others. Holland, Singapore and Sweden are outstanding examples of great success in the strategic management of ELT in their public educational systems. General failures abound, particularly in countries that…

  15. Management practices to reduce lupine-induced Crooked Calf Syndrome in the Northwest

    USDA-ARS?s Scientific Manuscript database

    Many factors contribute to the incidence of lupine-induced “Crooked Calf Syndrome” (CCS) in the northwestern U.S. A 1-5% incidence of CCS is common on many ranches and higher incidences occur when environmental conditions are conducive to lupine population increases. Multiple management strategies s...

  16. This New Management Demeanor Reduces Post-Strike Rancor in Schools.

    ERIC Educational Resources Information Center

    Schwerdtfeger, Robert D.

    1984-01-01

    Following examples of strike management in Tacoma and West Valley, Washington, advice is offered to school boards for minimizing damage during teachers' strikes. Topics discussed are substitute teachers, teacher contact, public relations, telephone strategies, consultants, picket lines, and maintaining patience and communication with school and…

  17. Reducing the risks of herbicide resistance: best management practices and recommendations

    USDA-ARS?s Scientific Manuscript database

    Herbicides are the foundation of weed control in commercial crop production. However, herbicide-resistant weed populations are developing rapidly in response to selection pressure. Critical practices include reducing selection through diversification of weed control techniques, minimizing spread of ...

  18. Lack of Cross-Scale Linkages Reduces Robustness of Community-Based Fisheries Management

    PubMed Central

    Cudney-Bueno, Richard; Basurto, Xavier

    2009-01-01

    Community-based management and the establishment of marine reserves have been advocated worldwide as means to overcome overexploitation of fisheries. Yet, researchers and managers are divided regarding the effectiveness of these measures. The “tragedy of the commons” model is often accepted as a universal paradigm, which assumes that unless managed by the State or privatized, common-pool resources are inevitably overexploited due to conflicts between the self-interest of individuals and the goals of a group as a whole. Under this paradigm, the emergence and maintenance of effective community-based efforts that include cooperative risky decisions as the establishment of marine reserves could not occur. In this paper, we question these assumptions and show that outcomes of commons dilemmas can be complex and scale-dependent. We studied the evolution and effectiveness of a community-based management effort to establish, monitor, and enforce a marine reserve network in the Gulf of California, Mexico. Our findings build on social and ecological research before (1997–2001), during (2002) and after (2003–2004) the establishment of marine reserves, which included participant observation in >100 fishing trips and meetings, interviews, as well as fishery dependent and independent monitoring. We found that locally crafted and enforced harvesting rules led to a rapid increase in resource abundance. Nevertheless, news about this increase spread quickly at a regional scale, resulting in poaching from outsiders and a subsequent rapid cascading effect on fishing resources and locally-designed rule compliance. We show that cooperation for management of common-pool fisheries, in which marine reserves form a core component of the system, can emerge, evolve rapidly, and be effective at a local scale even in recently organized fisheries. Stakeholder participation in monitoring, where there is a rapid feedback of the systems response, can play a key role in reinforcing

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

    USDA-ARS?s Scientific Manuscript database

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

  20. Integrated Pest Management Practices Reduce Insecticide Applications, Preserve Beneficial Insects, and Decrease Pesticide Residues in Flue-Cured Tobacco Production.

    PubMed

    Slone, Jeremy D; Burrack, Hannah J

    2016-09-22

    Integrated pest management (IPM) recommendations, including scouting and economic thresholds (ETs), are available for North Carolina flue-cured tobacco growers, although ETs for key pests have not been updated in several decades. Moreover, reported IPM adoption rates by flue-cured tobacco growers remain low, at < 40%, according to NC cooperative extension surveys conducted during the last four years. Previous research has suggested that timing insecticide treatments using currently available ETs can reduce the average number of applications to two or fewer per season. We conducted field-scale trials at nine commercial tobacco farms, three in 2104 and six in 2015, to quantify inputs associated with current scouting recommendations, to determine if current ETs were able to reduce insecticide applications as compared to grower standard practices, and to assess the impacts of reduced insecticide applications on end of season yield and pesticide residues. Two fields were identified at each farm and were scouted weekly for insects. One field was only treated with insecticides if pests reached ET (IPM), while the other field was managed per grower discretion (Grower Standard). IPM fields received an average of two fewer insecticide applications without compromising yield. More insecticide applications resulted in higher pesticide residues in cured leaf samples from Grower Standard fields than those from IPM fields. Reductions in insecticides and management intensity also resulted in larger beneficial insect populations in IPM fields.

  1. Package of care for active management in labour for reducing caesarean section rates in low-risk women

    PubMed Central

    Brown, Heather C; Paranjothy, Shantini; Dowswell, Therese; Thomas, Jane

    2014-01-01

    Background Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one to one support in labour. Objectives To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (February 2008), MEDLINE (1966 to December 2007), EMBASE (1980 to 2007), MIDIRS (1985 to 2007) and CINAHL (1982 to 2007). Selection criteria Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where slow progress had been diagnosed before entry into the trial were excluded. Data collection and analysis At least two review authors extracted data. We assessed included studies for risk of bias. Main results We included seven trials, with a total of 5390 women. The quality of studies was mixed. The CS rate was slightly lower in the active management group compared to the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01). However, in one study there was a large number of post-randomisation exclusions. On excluding this study, CS rates in the active management group were statistically significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94). More women in the active management group had labours lasting less than twelve hours, but there was wide variation in length of labour within and between trials. There were no differences

  2. Damage Characterization Method for Structural Health Management Using Reduced Number of Sensor Inputs

    NASA Technical Reports Server (NTRS)

    Krishnamurthy, T.; Hochhalter, Jacob D.; Gallegos, Adam M.

    2012-01-01

    The development of validated multidisciplinary Integrated Vehicle Health Management (IVHM) tools, technologies, and techniques to enable detection, diagnosis, prognosis, and mitigation in the presence of adverse conditions during flight will provide effective solutions to deal with safety related challenges facing next generation aircraft. The adverse conditions include loss of control caused by environmental factors, actuator and sensor faults or failures, and damage conditions. A major concern in these structures is the growth of undetected damage (cracks) due to fatigue and low velocity foreign impacts that can reach a critical size during flight, resulting in loss of control of the aircraft. Hence, development of efficient methodologies to determine the presence, location, and severity of damage in critical structural components is highly important in developing efficient structural health management systems.

  3. Reducing visitor noise levels at Muir Woods National Monument using experimental management.

    PubMed

    Stack, David W; Peter, Newman; Manning, Robert E; Fristrup, Kurt M

    2011-03-01

    Noise impacts resources and visitor experience in many protected natural areas, and visitors can be the dominant source of noise. This experimental study tested the efficacy and acceptability of signs asking visitors to be quiet at Muir Woods National Monument, California. Signs declaring a "quiet zone" (at the park's Cathedral Grove) or a "quiet day" (throughout the park) were posted on a randomized schedule that included control days (no signs). Visitor surveys were conducted to measure the cognitive and behavioral responses of visitors to the signs and test the acceptability of these management practices to visitors. Visitors were highly supportive of these management practices and reported that they consciously limited the amount of noise they produced. Sound level measurements showed substantial decreases on days when signs were posted.

  4. Telehealth interventions to reduce management complications in type 1 diabetes: A review.

    PubMed

    Balkhi, Amanda M; Reid, Adam M; Westen, Sarah C; Olsen, Brian; Janicke, David M; Geffken, Gary R

    2015-04-15

    Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided.

  5. Telehealth interventions to reduce management complications in type 1 diabetes: A review

    PubMed Central

    Balkhi, Amanda M; Reid, Adam M; Westen, Sarah C; Olsen, Brian; Janicke, David M; Geffken, Gary R

    2015-01-01

    Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided. PMID:25897348

  6. Changes in the management of liver trauma leading to reduced mortality: 15-year experience in a major trauma centre.

    PubMed

    Suen, Kary; Skandarajah, Anita R; Knowles, Brett; Judson, Rodney; Thomson, Benjamin N

    2016-11-01

    Worldwide, the evolution of management of liver injury has resulted in improved outcomes. The aim of this study was to examine the trend in the management and outcomes of patients with liver injury. Primary outcomes were defined as mortality and hospital length of stay. The secondary aim was to identify independent predictors of mortality. This study utilized hospital trauma registry data of all trauma patients with liver injuries admitted from 1999 to 2013. Patients in this 15-year period were divided into three periods of 5 years each and compared in terms of demographics, management and outcomes. A total of 725 patients with hepatic trauma were included. Patient demographics were similar, except for an increase in patient transfers from rural locations. Non-operative management increased significantly. There was a significant increase in the use of damage control surgery with perihepatic packing in high-grade liver injuries managed operatively. Hepatic angioembolization commenced midway through the study period. The overall mortality decreased by approximately threefold (P < 0.001) and mortality within 24 h of arrival to hospital by approximately fivefold (P < 0.001). Controlling for independent predictive factors of mortality, the mortality within 24 h reduced from 18.8% in period 1 to 3.6% in period 3 (P = 0.001). At this institution, an integrated trauma service has led to an evolution in the management of hepatic trauma, favouring non-operative management, damage control surgery and the use of hepatic angioembolization. We experienced a significantly improved mortality within 24 h of arrival to hospital in patients with liver trauma. © 2015 Royal Australasian College of Surgeons.

  7. Cover crop use for weed management in Southern reduced-tillage vegetable cropping systems

    USDA-ARS?s Scientific Manuscript database

    With growing agricultural demands from both conventional and organic systems comes the need for sustainable practices to ensure long-term productivity. Implementation of reduced- or no-till practices offers a number of environmental benefits for agricultural land and maintains adequate yield for cu...

  8. Corn and soybean rotation under reduced tillage management: impacts on soil properties, yield, and net return

    USDA-ARS?s Scientific Manuscript database

    A 4-yr field study was conducted from 2007 to 2010 at Stoneville, MS to examine the effects of rotating corn and soybean under reduced tillage conditions on soil properties, yields, and net return. The six rotation systems were continuous corn (CCCC), continuous soybean (SSSS), corn-soybean (CSCS),...

  9. Improvements in Care and Reduced Self-Management Barriers Among Rural Patients With Diabetes

    ERIC Educational Resources Information Center

    Dettori, Nancy; Flook, Benjamin N.; Pessl, Erich; Quesenberry, Kim; Loh, Johnson; Harris, Colleen; McDowall, Janet M.; Butcher, Marcene K.; Helgerson, Steven D.; Gohdes, Dorothy; Harwell, Todd S.

    2005-01-01

    Improved preventive care and clinical outcomes among patients with diabetes can reduce complications and costs; however, diabetes care continues to be suboptimal. Few studies have described effective strategies for improving care among rural populations with diabetes. In 2000, the Park County Diabetes Project and the Montana Diabetes Control…

  10. Fuels Management Reduces Tree Mortality from Wildfires In Southeastern United States

    Treesearch

    Kenneth W. Outcalt; Dale D. Wade

    2004-01-01

    The objective was to determine the effectiveness of a regular prescribed burning program for reducing tree mortality in southern pine forests burned by wildfire. This study was conducted on public and industry lands in northeast Florida. On the Osceola National Forest, mean mortality was 3.5% in natural stands and 43% in plantations two growing seasons after a June...

  11. Best Nitrogen Management Practices Can Reduce the Potential Flux of Nitrogen Out of the Arkansas Delta

    USDA-ARS?s Scientific Manuscript database

    It has been reported that nitrogen losses in the Arkansas Delta can contribute to the flux of nitrogen into the Mississippi River Basin, which can in turn contribute to the nitrate load that the hypoxia problem in the Gulf of Mexico has been attributed to. Developing effective methods of reducing th...

  12. Improvements in Care and Reduced Self-Management Barriers Among Rural Patients With Diabetes

    ERIC Educational Resources Information Center

    Dettori, Nancy; Flook, Benjamin N.; Pessl, Erich; Quesenberry, Kim; Loh, Johnson; Harris, Colleen; McDowall, Janet M.; Butcher, Marcene K.; Helgerson, Steven D.; Gohdes, Dorothy; Harwell, Todd S.

    2005-01-01

    Improved preventive care and clinical outcomes among patients with diabetes can reduce complications and costs; however, diabetes care continues to be suboptimal. Few studies have described effective strategies for improving care among rural populations with diabetes. In 2000, the Park County Diabetes Project and the Montana Diabetes Control…

  13. Managing Medical Costs by Reducing Demand for Services: The Missing Element in Health Care Reform.

    ERIC Educational Resources Information Center

    Kelly, Edward K.; And Others

    1994-01-01

    It is argued that higher education institutions can play a major role in health care reform by providing campus cultures that foster healthy lifestyle choices and in turn reduce medical costs. Specific issues discussed include elimination of unnecessary tests, focus on special high-risk populations, and use of advance directives. (MSE)

  14. Reducing Fear in the Schools: Managing Conflict through Student Problem Solving.

    ERIC Educational Resources Information Center

    Kenney, Dennis Jay; Watson, T. Steuart

    1996-01-01

    Describes a component of one North Carolina school district's plan for improving the high school environment by integrating community-policing strategies and problem-solving techniques for reducing school crime, delinquency, and disorder. By using teacher/student working groups, the school reports declines in the incidence of school crime and…

  15. Reducing Fear in the Schools: Managing Conflict through Student Problem Solving.

    ERIC Educational Resources Information Center

    Kenney, Dennis Jay; Watson, T. Steuart

    1996-01-01

    Describes a component of one North Carolina school district's plan for improving the high school environment by integrating community-policing strategies and problem-solving techniques for reducing school crime, delinquency, and disorder. By using teacher/student working groups, the school reports declines in the incidence of school crime and…

  16. Synthetic pheromones as a management technique - dispensers reduce Linepithema humile activity in a commercial vineyard.

    PubMed

    Westermann, Fabian L; Bell, Vaughn A; Suckling, David M; Lester, Philip J

    2016-04-01

    Invasive ants, such as the Argentine ant, have often been reported to facilitate honeydew-producing hemipteran pests such as mealybugs, which can be vectors of plant pathogens. Synthetic pheromones may offer a target-specific method to control such ants and consequently lower the abundance of honeydew-producing pests. Here we report the results of a trial to suppress Argentine ants in grapevines using ant pheromone dispensers. Compared with untreated controls, we observed a significant drop in Argentine ant activity on the ground, irrespective of whether pheromone dispensers were placed at ground level, within the canopy or in both locations. Ant counts in the canopy confirmed that Argentine ant abundance was reduced under the influence of the pheromone dispenser placed at ground level compared with untreated controls. However, placing dispensers only in the canopy did not reduce the numbers of ants within the canopy compared with untreated controls. Our results showed that pheromone dispensers can significantly reduce Argentine ant foraging in grapevines if they are positioned appropriately. This technique could potentially reduce the abundance of associated mealybugs and potentially attendant virus vectoring areawide. © 2015 Society of Chemical Industry.

  17. Reducing stock-outs of essential tuberculosis medicines: a system dynamics modelling approach to supply chain management.

    PubMed

    Bam, L; McLaren, Z M; Coetzee, E; von Leipzig, K H

    2017-10-01

    The under-performance of supply chains presents a significant hindrance to disease control in developing countries. Stock-outs of essential medicines lead to treatment interruption which can force changes in patient drug regimens, drive drug resistance and increase mortality. This study is one of few to quantitatively evaluate the effectiveness of supply chain policies in reducing shortages and costs. This study develops a systems dynamics simulation model of the downstream supply chain for amikacin, a second-line tuberculosis drug using 10 years of South African data. We evaluate current supply chain performance in terms of reliability, responsiveness and agility, following the widely-used Supply Chain Operation Reference framework. We simulate 141 scenarios that represent different combinations of supplier characteristics, inventory management strategies and demand forecasting methods to identify the Pareto optimal set of management policies that jointly minimize the number of shortages and total cost. Despite long supplier lead times and unpredictable demand, the amikacin supply chain is 98% reliable and agile enough to accommodate a 20% increase in demand without a shortage. However, this is accomplished by overstocking amikacin by 167%, which incurs high holding costs. The responsiveness of suppliers is low: only 57% of orders are delivered to the central provincial drug depot within one month. We identify three Pareto optimal safety stock management policies. Short supplier lead time can produce Pareto optimal outcomes even in the absence of other optimal policies. This study produces concrete, actionable guidelines to cost-effectively reduce stock-outs by implementing optimal supply chain policies. Preferentially selecting drug suppliers with short lead times accommodates unexpected changes in demand. Optimal supply chain management should be an essential component of national policy to reduce the mortality rate. © The Author 2017. Published by Oxford

  18. Collaborative care management reduces disparities in dementia care quality for caregivers with less education.

    PubMed

    Brown, Arleen F; Vassar, Stefanie D; Connor, Karen I; Vickrey, Barbara G

    2013-02-01

    To examine educational gradients in dementia care and whether the effect of a dementia collaborative care management intervention varied according to the educational attainment of the informal caregiver. Analysis of data from a cluster-randomized controlled trial. Eighteen clinics in three healthcare organizations in southern California. Dyads of Medicare recipients aged 65 and older with a diagnosis of dementia and an eligible caregiver. Collaborative care management for dementia. Caregiver educational attainment, adherence to four dimensions of guideline-recommended processes of dementia care (assessment, treatment, education and support, and safety) before and after the intervention, and the adjusted intervention effect (IE) for each dimension stratified according to caregiver education. Each IE was estimated by subtracting the difference between pre- and postintervention scores for the usual care participants from the difference between pre- and postintervention scores in the intervention participants. At baseline, caregivers with lower educational attainment provided poorer quality of dementia care for the Treatment and Education dimensions than those with more education, but less-educated caregivers had significantly more improvement after the intervention on the assessment, treatment, and safety dimensions. The IEs for those who had not graduated from high school were 44.4 for the assessment dimension, 36.9 for the treatment dimension, and 52.7 for the safety dimension, versus 29.5, 15.7, and 40.9 respectively, for college graduates (P < .001 for all three). Collaborative care management was associated with smaller disparities in dementia care quality between caregivers with lower educational attainment and those with more education. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  19. Reducing pump power consumption by 40% (1000 kw) through improved pump management in a central plant

    SciTech Connect

    Deng, S.; Liu, M.; Turner, D.

    1998-07-01

    Chilled water system data collection and field measurements performed at the Central Utility Plant of Texas A and M University (TAMU) in College Station, Texas revealed that 30--50 % of the primary pump head is consumed by manual and automatic valves being operated in a partially-opened condition. A comprehensive analysis was performed to develop an improved pump management schedule. The results show potential savings of up to 40% of the pump power consumption without any capital investment. The optimized schedule is being implemented. This paper describes the method and presents results of the analysis and implementation.

  20. Soil pH management without lime, a strategy to reduce greenhouse gas emissions from cultivated soils

    NASA Astrophysics Data System (ADS)

    Nadeem, Shahid; Bakken, Lars; Reent Köster, Jan; Tore Mørkved, Pål; Simon, Nina; Dörsch, Peter

    2015-04-01

    For decades, agricultural scientists have searched for methods to reduce the climate forcing of food production by increasing carbon sequestration in the soil and reducing the emissions of nitrous oxide (N2O). The outcome of this research is depressingly meagre and the two targets appear incompatible: efforts to increase carbon sequestration appear to enhance the emissions of N2O. Currently there is a need to find alternative management strategies which may effectively reduce both the CO2 and N2O footprints of food production. Soil pH is a master variable in soil productivity and plays an important role in controlling the chemical and biological activity in soil. Recent investigations of the physiology of denitrification have provided compelling evidence that the emission of N2O declines with increasing pH within the range 5-7. Thus, by managing the soil pH at a near neutral level appears to be a feasible way to reduce N2O emissions. Such pH management has been a target in conventional agriculture for a long time, since a near-neutral pH is optimal for a majority of cultivated plants. The traditional way to counteract acidification of agricultural soils is to apply lime, which inevitably leads to emission of CO2. An alternative way to increase the soil pH is the use of mafic rock powders, which have been shown to counteract soil acidification, albeit with a slower reaction than lime. Here we report a newly established field trail in Norway, in which we compare the effects of lime and different mafic mineral and rock powders (olivine, different types of plagioclase) on CO2 and N2O emissions under natural agricultural conditions. Soil pH is measured on a monthly basis from all treatment plots. Greenhouse gas (GHG) emission measurements are carried out on a weekly basis using static chambers and an autonomous robot using fast box technique. Field results from the first winter (fallow) show immediate effect of lime on soil pH, and slower effects of the mafic rocks. The

  1. Reducing domestic heating demand: Managing the impact of behavior-changing feedback devices via marketing.

    PubMed

    Jensen, Thorben; Chappin, Émile J L

    2017-07-15

    Feedback devices can be used to inform households about their energy-consumption behavior. This may persuade them to practice energy conservation. The use of feedback devices can also-via word of mouth-spread among households and thereby support the spread of the incentivized behavior, e.g. energy-efficient heating behavior. This study investigates how to manage the impact of these environmental innovations via marketing. Marketing activities can support the diffusion of devices. This study aims to identify the most effective strategies of marketing feedback devices. We did this by adapting an agent-based model to simulate the roll-out of a novel feedback technology and heating behavior within households in a virtual city. The most promising marketing strategies were simulated and their impacts were analyzed. We found it particularly effective to lend out feedback devices to consumers, followed by leveraging the social influence of well-connected individuals, and giving away the first few feedback devices for free. Making households aware of the possibility of purchasing feedback devices was found to be least effective. However, making households aware proved to be most cost-efficient. This study shows that actively managing the roll-out of feedback devices can increase their impacts on energy-conservation both effectively and cost-efficiently. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Reducing errors through a web-based self-management support system.

    PubMed

    Ekstedt, Mirjam; Børøsund, Elin; Svenningsen, Ina K; Ruland, Cornelia M

    2014-01-01

    Web-based self-management support systems SMSS, can successfully assist a wide range of patients with information and self-management support. O or as a stand-alone service, are e-messages. This study describes how one component of a multi component SMSS, an e-message service, in which patients with breast cancer could direct questions to nurses, physicians or social workers at the hospital where they were being treated, had an influence on safety and continuity of care. Ninety-one dialogues consisting of 284 messages were analysed. The communications between patients and the healthcare team revealed that the e-messages service served as a means for quality assurance of information, for double-checking and for coordination of care. We give examples of how an e-mail service may improve patients' knowledge in a process of taking control over their own care - increasingly important in a time of growing complexity and specialization in healthcare. It remains to be tested whether an e-message service can improve continuity of care and prevent or mitigate medical mishaps.

  3. Burnout/stress management: how to reduce burnout and stress in the workplace.

    PubMed

    Matula, Brian

    2013-01-01

    We all encounter various forms of stress every single day. Stress can be caused by family issues, relationships, children and especially work. With the ever-growing demands that are placed on Healthcare Security professionals today, career burnout associated with stress is becoming more and more common. In this article, the author discusses some signs and symptoms, as well as giving some stress reduction exercises that may be able to help your officers reduce their stress.

  4. Through Life Management of Naval Gas Turbines for Extended Service Lives and Reduced Lifetime Costs

    DTIC Science & Technology

    2003-02-01

    Symposium Partie A - Developpements dans le domaine de l’aeroacoustique et I’hydroacoustique numeriques ] [Symposium Partie B ... To order the complete...and Belgian Reduction Strategies developed by the UK Ministry of Defence in Navies, the Olympus operates in combination with direct acting support of... STRATEGIES IN REDUCING THROUGH LIFE COSTSTuRn! TIE DELIVERY PRI GRAMME SIMULATION INCLUDES Current strate2v: TAKE 91 ATES AND RANDOM FAILURES SERVICEABLE

  5. Early density management of longleaf pine reduces susceptibility to ice storm damage

    Treesearch

    Timothy B. Harrington; Thaddeus A. Harrington

    2016-01-01

    The Pax winter storm of February 2014 caused widespread damage to forest stands throughout the southeastern U.S. In a long-term study of savanna plant community restoration at the Savannah River Site, Aiken, SC, precommercial thinning (PCT) of 8- to 11-year-old plantations of longleaf pine (Pinus palustris) in 1994 reduced...

  6. Inventory management strategies that reduce the age of red blood cell components at the time of transfusion.

    PubMed

    Poisson, Jessica L; Tuma, Christopher W; Shulman, Ira A

    2016-07-01

    There has been interest concerning patient outcomes when older red blood cell (RBC) components are utilized. Inventory management is key to maintaining a stock of fresher RBCs for general transfusion needs. We have altered our practice for RBC management to reduce RBC age at the time of transfusion. Retrospective review of RBC age at time of transfusion at a tertiary care hospital with active trauma service was performed. The baseline nonirradiated RBC inventory was decreased from 12 to 15 days of stock to 7 to 10 days of stock, with request made to the blood supplier for fresher RBCs, specified at 75% of RBCs less than 14 days old. The age of RBCs at time of receipt and at time of transfusion was tracked on a monthly basis for the next 12 months. The mean age of RBCs at transfusion was decreased by 9 days on average for the year. Significant decreases in the mean age of RBCs at transfusion were seen in the second half of the year, with 4 of 6 months seeing a mean age of less than 20 days. There were no documented incidences of hospital blood shortages after the reduction in inventory; no surgery was canceled or delayed because of inventory. Inventory age depends on active management, combined with vendor cooperation to receive fresher components. Reducing the age of RBC components transfused is possible without experiencing blood component shortages. Longer periods of observation may allow for further adjustment of stocking levels on a seasonal basis. © 2016 AABB.

  7. A management strategy to reduce bacterial pollution in shellfish areas: A case study

    NASA Astrophysics Data System (ADS)

    Crane, Stuart R.; Moore, James A.

    1986-01-01

    The problem of bacterial pollution in shellfishing areas is not uncommon in the coastal regions of the United States. Bacterial contamination from man's activities can effectively reduce our natural shellfish resource areas by forcing their closure because of high potential risk of diseases being spread by shellfish harvested in these areas. Tillamook Bay, a relatively small, enclosed drainage basin of nonurban character, presents an excellent study area for observing this problem. The high population density of animals, raised on a relatively small floodplain area, represents one of the major sources of pollution in the bay. This paper summarizes the history of the agencies involved with the problem and presents the current approach to alleviate bacterial pollution in the bay without unduly penalizing other industries in the Tillamook basin. The paper also presents some of the legal aspects of reducing water pollution in shellfish harvesting areas and the jurisdiction of federal agencies in these matters. Finally, recommendations are given to reduce bacterial output by the major source categories in the basin, and criteria for bay closure to shellfish harvest are developed to protect the public from bacterially contaminated shellfish.

  8. Reduced NOx and PM10 emissions on urban motorways in The Netherlands by 80 km/h speed management.

    PubMed

    Keuken, M P; Jonkers, S; Wilmink, I R; Wesseling, J

    2010-05-15

    A speed limit of 80 km/h with "strict enforcement" has been introduced in 2005 on zones of urban motorways in The Netherlands with the aim to improve air quality of NO(2) and PM(10) along these motorways. Strict enforcement means speed control by camera surveillance over the whole trajectory of 2-4 km combined with licence plate recognition and automatic fining in case of exceeding the speed limit. Traffic data measured in Rotterdam and Amsterdam at the zones without and with speed management showed that traffic dynamics have been significantly reduced as a result of speed management with strict enforcement. Reduction of traffic dynamics results in more free-flowing traffic with relatively less NO(x) and exhaust PM(10) emissions compared to congested traffic, i.e., stop-and-go traffic. The actual effect on NO(x) and PM(10) emissions at these speed management zones was studied in the cities Rotterdam and Amsterdam. The study was performed in two different ways: firstly by measurements and by modelling the contribution to NO(x) and PM(10) concentrations on both sides of the motorways, and secondly by estimating the change in traffic dynamics and the effect on emissions. From the results of both approaches in this study, it was concluded that in our case study in the Netherlands emission reduction by speed management is in the range of 5-30% for NO(x) and 5-25% for PM(10). Actual emission reductions by speed management at a specific motorway mainly depend on the ratio of congested traffic prior and after implementation of speed management. The larger this ratio, the larger is the relative emission reduction. The impact on air quality of 80 km/h for NO(x) and PM(10) is largest on motorways with a high fraction of heavy-duty vehicles. Copyright 2010 Elsevier B.V. All rights reserved.

  9. Designing management options to reduce surface runoff and sediment yield with farmers: an experiment in south-western France.

    PubMed

    Furlan, Adriana; Poussin, Jean-Christophe; Mailhol, Jean-Claude; Le Bissonnais, Yves; Gumiere, Silvio J

    2012-04-15

    To preserve the quality of surface water, official French regulations require farmers to keep a minimum acreage of grassland, especially bordering rivers. These agro-environmental measures do not account for the circulation of water within the catchment. This paper examines whether it is possible to design with the farmers agri-environmental measures at field and catchment scale to prevent soil erosion and surface water pollution. To support this participatory approach, the hydrology and erosion model STREAM was used for assessing the impact of a spring stormy event on surface runoff and sediment yield with various management scenarios. The study was carried out in collaboration with an agricultural committee in an area of south-western France where erosive runoff has a major impact on the quality of surface water. Two sites (A and B) were chosen with farmers to discuss ways of reducing total surface runoff and sediment yield at each site. The STREAM model was used to assess surface runoff and sediment yield under current cropping pattern at each site and to evaluate management scenarios including grass strips implementation or changes in cropping patterns within the catchment. The results of STREAM simulations were analysed jointly by farmers and researchers. Moreover, the farmers discussed each scenario in terms of its technical and economical feasibility. STREAM simulations showed that a 40 mm spring rainfall with current cropping patterns led to 3116 m3 total water runoff and 335 metric tons of sediment yield at site A, and 3249 m3 and 241 metric tons at site B. Grass strips implementation could reduce runoff for about 40% and sediment yield for about 50% at site A. At site B, grass strips could reduce runoff and sediment yield for more than 50%, but changes in cropping pattern could reduce it almost totally. The simulations led to three main results: (i) grass strips along rivers and ditches prevented soil sediments from entering the surface water but did not

  10. Many-Objective Reservoir Policy Identification and Refinement to Reduce Institutional Myopia in Water Management

    NASA Astrophysics Data System (ADS)

    Giuliani, M.; Herman, J. D.; Castelletti, A.; Reed, P. M.

    2013-12-01

    Institutional inertia strongly limits our ability to adapt water reservoir operations to better manage growing water demands as well as their associated uncertainties in a changing climate. Although it has long been recognized that these systems are generally framed in heterogeneous socio-economic contexts involving a myriad of conflicting, non-commensurable operating objectives, our broader understanding of the multiobjective consequences of current operating rules as well as their vulnerability to hydroclimatic uncertainties is severely limited. This study proposes a decision analytic framework to overcome policy inertia and myopia in complex river basin management contexts. The framework combines reservoir policy identification and many-objective optimization under uncertainty to characterize current operations and discover key tradeoffs between alternative policies for balancing evolving demands and system uncertainties. The approach is demonstrated on the Conowingo Dam, located within the Lower Susquehanna River, USA. The Lower Susquehanna River is an interstate water body that has been subject to intensive water management efforts due to the system's competing demands from urban water supply, atomic power plant cooling, hydropower production, and federally regulated environmental flows. Initially our proposed framework uses available streamflow observations to implicitly identify the Conowingo Dam's current but unknown operating policy. This baseline policy is identified by fitting radial basis functions to existing system dynamics. Our assumption in the baseline policy is that the dam operator is represented as a rational agent seeking to maximize primary operational objectives (i.e., guaranteeing the public water supply and maximizing the hydropower revenue). The quality of the identified baseline policy is evaluated by its ability to replicate historical release dynamics. Once identified, the historical baseline policy then provides a means of representing

  11. Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples’ experiences

    PubMed Central

    2014-01-01

    Background Coronary heart disease is an incurable condition. The only approach known to slow its progression is healthy lifestyle change and concordance with cardio-protective medicines. Few people fully succeed in these daily activities so potential health improvements are not fully realised. Little is known about peoples’ experiences of managing lifestyle change. The aim of this study was to synthesise qualitative research to explain how participants make lifestyle change after a cardiac event and explore this within the wider illness experience. Methods A qualitative synthesis was conducted drawing upon the principles of meta-ethnography. Qualitative studies were identified through a systematic search of 7 databases using explicit criteria. Key concepts were identified and translated across studies. Findings were discussed and diagrammed during a series of audiotaped meetings. Results The final synthesis is grounded in findings from 27 studies, with over 500 participants (56% male) across 8 countries. All participants experienced a change in their self-identity from what was ‘familiar’ to ‘unfamiliar’. The transition process involved ‘finding new limits and a life worth living’ , ‘finding support for self’ and ‘finding a new normal’. Analyses of these concepts led to the generation of a third order construct, namely an ongoing process of ‘reassessing past, present and future lives’ as participants considered their changed identity. Participants experienced a strong urge to get back to ‘normal’. Support from family and friends could enable or constrain life change and lifestyle changes. Lifestyle change was but one small part of a wider ‘life’ change that occurred. Conclusions The final synthesis presents an interpretation, not evident in the primary studies, of a person-centred model to explain how lifestyle change is situated within ‘wider’ life changes. The magnitude of individual responses to a changed health status

  12. Many-objective reservoir policy identification and refinement to reduce institutional myopia in water management

    NASA Astrophysics Data System (ADS)

    Giuliani, Matteo; Herman, Jonathan D.; Castelletti, Andrea; Reed, Patrick M.

    2014-05-01

    Current water reservoir operating policies are facing growing water demands as well as increasing uncertainties associated with a changing climate. However, policy inertia and myopia strongly limit the possibility of adapting current water reservoir operations to the undergoing change. Historical agreements and regulatory constraints limit the rate that reservoir operations are innovated and creates policy inertia, where water institutions are unlikely to change their current practices in absence of dramatic failures. Yet, no guarantee exists that historical management policies will not fail in coming years. In reference to policy myopia, although it has long been recognized that water reservoir systems are generally framed in heterogeneous socio-economic contexts involving a myriad of conflicting, non-commensurable operating objectives, the broader understanding of the multi-objective consequences of current operating rules as well as their vulnerability to hydroclimatic uncertainties is severely limited. This study proposes a decision analytic framework to overcome both policy inertia and myopia in complex river basin management contexts. The framework combines reservoir policy identification, many-objective optimization under uncertainty, and visual analytics to characterize current operations and discover key tradeoffs between alternative policies for balancing evolving demands and system uncertainties. The approach is demonstrated on the Conowingo Dam, located within the Lower Susquehanna River, USA. The Lower Susquehanna River is an interstate water body that has been subject to intensive water management efforts due to the system's competing demands from urban water supply, atomic power plant cooling, hydropower production, and federally regulated environmental flows. The proposed framework initially uses available streamflow observations to implicitly identify the current but unknown operating policy of Conowingo Dam. The quality of the identified baseline

  13. Integrated mosquito larval source management reduces larval numbers in two highland villages in western Kenya

    PubMed Central

    2012-01-01

    Background In western Kenya, malaria remains one of the major health problems and its control remains an important public health measure. Malaria control is by either use of drugs to treat patients infected with malaria parasites or by controlling the vectors. Vector control may target the free living adult or aquatic (larval) stages of mosquito. The most commonly applied control strategies target indoor resting mosquitoes. However, because mosquitoes spend a considerable time in water, targeting the aquatic stages can complement well with existing adult control measures. Methods Larval source management (LSM) of malaria vectors was examined in two villages i.e. Fort Ternan and Lunyerere, with the aim of testing strategies that can easily be accessed by the affected communities. Intervention strategies applied include environmental management through source reduction (drainage of canals, land levelling or by filling ditches with soil), habitat manipulation (by provision of shading from arrow root plant), application of Bacillus thuringiensis var israelensis (Bti) and the use of predatory fish, Gambusia affinis. The abundance of immature stages of Anopheles and Culex within intervention habitats was compared to that within non-intervention habitats. Results The findings show that in Fort Ternan no significant differences were observed in the abundance of Anopheles early and late instars between intervention and non-intervention habitats. In Lunyerere, the abundance of Anopheles early instars was fifty five times more likely to be present within non-intervention habitats than in habitats under drainage. No differences in early instars abundance were observed between non-intervention and habitats applied with Bti. However, late instars had 89 % and 91 % chance of being sampled from non-intervention rather than habitats under drainage and those applied with Bti respectively. Conclusion Most of these interventions were applied in habitats that arose due to human

  14. Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples' experiences.

    PubMed

    Astin, Felicity; Horrocks, Judith; Closs, S Jose

    2014-08-05

    Coronary heart disease is an incurable condition. The only approach known to slow its progression is healthy lifestyle change and concordance with cardio-protective medicines. Few people fully succeed in these daily activities so potential health improvements are not fully realised. Little is known about peoples' experiences of managing lifestyle change. The aim of this study was to synthesise qualitative research to explain how participants make lifestyle change after a cardiac event and explore this within the wider illness experience. A qualitative synthesis was conducted drawing upon the principles of meta-ethnography. Qualitative studies were identified through a systematic search of 7 databases using explicit criteria. Key concepts were identified and translated across studies. Findings were discussed and diagrammed during a series of audiotaped meetings. The final synthesis is grounded in findings from 27 studies, with over 500 participants (56% male) across 8 countries. All participants experienced a change in their self-identity from what was 'familiar' to 'unfamiliar'. The transition process involved 'finding new limits and a life worth living' , 'finding support for self' and 'finding a new normal'. Analyses of these concepts led to the generation of a third order construct, namely an ongoing process of 'reassessing past, present and future lives' as participants considered their changed identity. Participants experienced a strong urge to get back to 'normal'. Support from family and friends could enable or constrain life change and lifestyle changes. Lifestyle change was but one small part of a wider 'life' change that occurred. The final synthesis presents an interpretation, not evident in the primary studies, of a person-centred model to explain how lifestyle change is situated within 'wider' life changes. The magnitude of individual responses to a changed health status varied. Participants experienced distress as their notion of self identity

  15. Selection and placement of best management practices used to reduce water quality degradation in Lincoln Lake watershed

    NASA Astrophysics Data System (ADS)

    Rodriguez, Hector German; Popp, Jennie; Maringanti, Chetan; Chaubey, Indrajeet

    2011-01-01

    An increased loss of agricultural nutrients is a growing concern for water quality in Arkansas. Several studies have shown that best management practices (BMPs) are effective in controlling water pollution. However, those affected with water quality issues need water management plans that take into consideration BMPs selection, placement, and affordability. This study used a nondominated sorting genetic algorithm (NSGA-II). This multiobjective algorithm selects and locates BMPs that minimize nutrients pollution cost-effectively by providing trade-off curves (optimal fronts) between pollutant reduction and total net cost increase. The usefulness of this optimization framework was evaluated in the Lincoln Lake watershed. The final NSGA-II optimization model generated a number of near-optimal solutions by selecting from 35 BMPs (combinations of pasture management, buffer zones, and poultry litter application practices). Selection and placement of BMPs were analyzed under various cost solutions. The NSGA-II provides multiple solutions that could fit the water management plan for the watershed. For instance, by implementing all the BMP combinations recommended in the lowest-cost solution, total phosphorous (TP) could be reduced by at least 76% while increasing cost by less than 2% in the entire watershed. This value represents an increase in cost of 5.49 ha-1 when compared to the baseline. Implementing all the BMP combinations proposed with the medium- and the highest-cost solutions could decrease TP drastically but will increase cost by 24,282 (7%) and $82,306 (25%), respectively.

  16. Effectiveness of a Comprehensive Stress Management Program to Reduce Work-Related Stress in a Medium-Sized Enterprise

    PubMed Central

    2014-01-01

    Objectives To assess the effectiveness of a comprehensive workplace stress management program consisting of participatory action-oriented training (PAOT) and individual management. Methods A comprehensive workplace stress management program was conducted in a medium-sized enterprise. The baseline survey was conducted in September 2011, using the Korean Occupational Stress Scale (KOSS) and Worker’s Stress Response Inventory (WSRI). After implementing both organizational and individual level interventions, the follow up evaluation was conducted in November 2011. Results Most of the workers participated in the organizational level PAOT and made Team-based improvement plans. Based on the stress survey, 24 workers were interviewed by a researcher. After the organizational and individual level interventions, there was a reduction of several adverse psychosocial factors and stress responses. In the case of blue-collar workers, psychosocial factors such as the physical environment, job demands, organizational system, lack of rewards, and occupational climate were significantly improved; in the case of white-collar workers, the occupational climate was improved. Conclusions In light of these results, we concluded that the comprehensive stress management program was effective in reducing work-related stress in a short-term period. A persistent long-term follow up is necessary to determine whether the observed effects are maintained over time. Both team-based improvement activities and individual interviews have to be sustainable and complementary to each other under the long-term plan. PMID:24524591

  17. An integrated speed management plan to reduce vehicle speeds in residential areas: implementation and evaluation of the Silverberry Action Plan.

    PubMed

    Islam, Md Tazul; El-Basyouny, Karim

    2013-06-01

    Speeding in residential areas is one aspect of a larger set of problems related to speeding and traffic safety. The problem affects the safety of vulnerable road users (pedestrians and cyclists), specifically young children, and creates a sense of insecurity due to the risk of being involved in a vehicle crash and the seriousness of ensuing injuries. This paper describes the implementation and evaluation of an integrated speed management plan to reduce vehicle speeds on residential roads. A before-after experimental design with comparison group was employed for the evaluation. To address the fact that the effectiveness of treatment might diminish with time, two sets of speed data were collected with one immediately after the treatment and another after four months. Statistical analysis reveals that the proposed plan can effectively reduce vehicle speeds and speed variances for both the short and long term. The effectiveness was found to vary with time of day and day of week. Overall, reductions of mean speed were estimated at 2.94 km/h (5.8%) and 2.26 km/h (4.5%) for the short term and long term, respectively. The study shows that an integrated speed management strategy, which combines education and enforcement activities with a low cost engineering treatment, can effectively reduce vehicle speeds on residential roads with a potential to improving road safety. Copyright © 2013 National Safety Council and Elsevier Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Reducing input data via image categorization to improve the speed of copyright content management systems

    NASA Astrophysics Data System (ADS)

    Ikeda, Kanami; Watanabe, Eriko

    2015-02-01

    An optical correlator has the advantage of high data transfer speed and parallel operation. However, in copyright content management systems (CCMSs), the numerous video files that need to be downloaded from the Internet and input to the optical correlator constitute a bottleneck. This paper proposes an image categorization method for CCMSs that uses the difference in the color features between animation and live-action images to remove this bottleneck and increase the speed of CCMSs. The results of experiments conducted indicate that the proposed method achieves a live-action video true rejection rate of 86.7 % and an animation video false rejection rate of 13.3 %. This indicates that the proposed method can improve the overall speed of a CCMS more than twice the original speed.

  19. Reduced accommodative function in dyskinetic cerebral palsy: a novel management strategy.

    PubMed

    Ross, L M; Heron, G; Mackie, R; McWilliam, R; Dutton, G N

    2000-10-01

    A 9-year-old boy with dyskinetic cerebral palsy secondary to neonatal encephalopathy is described. He presented with blurring of near vision which had begun to impact on his school work. Objective assessment of accommodation showed that very little was present, although convergence was almost normal. The near-vision symptoms were completely removed and reading dramatically improved with the provision of varifocal spectacles. Varifocal lenses provide an optimal correction for far, intermediate (i.e. for computer screens), and near distances (i.e. for reading). Managing this type of patient with varifocal spectacles has not been previously reported. It is clearly very important to prescribe an optimal spectacle correction to provide clear vision to optimize learning.

  20. Reducing Gridlock on the Grid: Utility Trends in Managing Peak Electric Load through Residential Demand Response

    NASA Astrophysics Data System (ADS)

    McDonald, Betsy

    Utilities across the United States are piloting residential demand response programs to help manage peak electric demand. Using publicly available program evaluations, this thesis analyzes nine such programs to uncover and synthesize the range of program offerings, goals, enrollment strategies, and customer experiences. This review reveals that program participation, components, and results differ based on a variety of factors, including geographic characteristics, program goals, and implementation strategies. The diversity of program designs and evaluation findings suggests an underlying tension between the need to generate cost-effective program impacts and the desire to increase accessibility so that program benefits are not exclusive to certain segments of the population. For more significant and impactful engagement, program goals may need to shift. State level policy support could help shift program goals toward increasing program accessibility. Future research should explore creative strategies that target existing barriers and allow for more inclusive deployment.

  1. Freedom from restraint: consequences of reducing physical restraints in the management of the elderly.

    PubMed Central

    Powell, C; Mitchell-Pedersen, L; Fingerote, E; Edmund, L

    1989-01-01

    Physical restraint is commonly used in the management of elderly people in North American hospitals and nursing homes. Between December 1981 and March 1982 the Department of Geriatric Medicine, St. Boniface General Hospital, Winnipeg, changed its practice regarding the use of such restraints. In the fiscal year 1980-81 the rate of application of physical restraints was 52 per 1000 patient-days and the frequency of falls 7 per 1000 patient-days. By 1986-87 the figures were 0.3 and 8.7 per 1000 patient-days respectively; the increase in falls was not clinically significant. During the study period there was a 40% reduction in the use of chemical restraints (psychotropic drugs other than hypnotic and antidepressant agents). Here we record how this change in practice occurred and persisted. PMID:2776096

  2. Failures of foreseeability: Risk management considerations in reducing allegations of sexual violence in psychiatric units.

    PubMed

    Banja, John D

    2017-01-01

    This article begins with a brief discussion of findings on causal factors leading to allegations of sexual violence in health care facilities and then offers the author's account of 4 such cases that he reviewed, 3 of which occurred in psychiatric units. These cases show remarkably similar variables, especially involving decisions to allow male and female patients to commingle, the inadequate physical layout of the units, poor or absent video surveillance, and staff unacquainted with institutional policies on patient safety or refusing to enforce relevant rules. These variables arguably amount to "failures of foreseeability" that reasonably cautious health care personnel should recognize as facilitating or enabling sexual violence. As such, the proactive message of this article for health care risk management urges critical and robust attention paid to a unit's environmental/physical design as well as to performance factors among personnel so as to prevent sexual attacks and diminish the probability of malpractice actions.

  3. [Modern coagulation management reduces the transfusion rate of allogenic blood products].

    PubMed

    Weber, Christian Friedrich

    2012-06-01

    Evaluating the patient's individual bleeding history with a standardized questionnaire, using "point-of-care" - methods for coagulation analyses and providing autologous transfusion techniques are preconditions of a modern coagulation management. Therapy of coagulopathic patients should be based on structured hemotherapy algorithms. Surgical haemostasis and the maintenance of the basic conditions for haemostasis are elementary requirements for an effective therapy. In cases of diffuse bleeding, early antifibrinolytic therapy should be considered. Coagulation factor deficiencies should be corrected "goal-directed" using coagulation factor concentrates. Transfusion of fresh frozen plasma is only indicated in the clinical setting of massive transfusions. DDAVP and transfusion of platelet concentrates are options to optimize primary haemostasis. In cases of on-going bleeding, recombinant activated coagulation factor VII represents an option for "ultima-ratio" therapy. © Georg Thieme Verlag Stuttgart · New York.

  4. Managing tile drainage, subirrigation, and nitrogen fertilization to enhance crop yields and reduce nitrate loss.

    PubMed

    Drury, C F; Tan, C S; Reynolds, W D; Welacky, T W; Oloya, T O; Gaynor, J D

    2009-01-01

    Improving field-crop use of fertilizer nitrogen is essential for protecting water quality and increasing crop yields. The objective of this study was to determine the effectiveness of controlled tile drainage (CD) and controlled tile drainage with subsurface irrigation (CDS) for mitigating off-field nitrate losses and enhancing crop yields. The CD and CDS systems were compared on a clay loam soil to traditional unrestricted tile drainage (UTD) under a corn (Zea Mays L.)-soybean (Glycine Max. (L.) Merr.) rotation at two nitrogen (N) fertilization rates (N1: 150 kg N ha(-1) applied to corn, no N applied to soybean; N2: 200 kg N ha(-1) applied to corn, 50 kg N ha(-1) applied to soybean). The N concentrations in tile flow events with the UTD treatment exceeded the provisional long-term aquatic life limit (LT-ALL) for freshwater (4.7 mg N L(-1)) 72% of the time at the N1 rate and 78% at the N2 rate, whereas only 24% of tile flow events at N1 and 40% at N2 exceeded the LT-ALL for the CDS treatment. Exceedances in N concentration for surface runoff and tile drainage were greater during the growing season than the non-growing season. At the N1 rate, CD and CDS reduced average annual N losses via tile drainage by 44 and 66%, respectively, relative to UTD. At the N2 rate, the average annual decreases in N loss were 31 and 68%, respectively. Crop yields from CDS were increased by an average of 2.8% relative to UTD at the N2 rate but were reduced by an average of 6.5% at the N1 rate. Hence, CD and CDS were effective for reducing average nitrate losses in tile drainage, but CDS increased average crop yields only when additional N fertilizer was applied.

  5. Tail biting in pigs--causes and management intervention strategies to reduce the behavioural disorder. A review.

    PubMed

    Sonoda, Lilia Thays; Fels, Michaela; Oczak, Maciej; Vranken, Erik; Ismayilova, Gunel; Guarino, Marcella; Viazzi, Stefano; Bahr, Claudia; Berckmans, Daniel; Hartung, Jörg

    2013-01-01

    One of the largest animal welfare problems in modern pig production is tail biting. This abnormal behaviour compromises the well-being of the animals, can seriously impair animal health and can cause considerable economic losses. Tail biting has a multifactorial origin and occurs mainly in fattening pigs. High stocking densities, poor environment and bad air quality are seen as important factors. However, it is presumed that a plurality of internal and external motivators in intensive pig production can trigger this behaviour which is not reported in sounders of wild boars. The aim of this review is to summarize the causes and the effects of tail biting in pigs and present management strategies that are likely to reduce its incidence. In particular, management strategies by applying Precision Livestock Farming (PLF) technologies to monitor and control the behaviour of the pigs may be suitable to detect the outbreaks of tail biting at an early stage so that counter measures can be taken in time.

  6. Use of a total quality management model to reduce pressure ulcer prevalence in the acute care setting.

    PubMed

    Sacharok, C; Drew, J

    1998-03-01

    As the population ages and becomes more frail, pressure ulcer prevalence and incidence within specific care settings are being evaluated through outcomes review. This article summarizes the process and outcomes of an ongoing prevalence study at a 300-bed acute care community hospital. All patients on the adult medical, surgical, and critical care units were examined regularly by the "Rear Admirals," a team comprising a skin care resource person and a nursing unit representative. The Total Quality Management model, characterized by the phrase "Plan-Do-Check-Act," was used to address barriers to quality care. Findings during that time prompted changes in policies, products, protocols, work assignments, and documentation tools. The outcomes achieved demonstrated the effectiveness of those strategies. After implementation of the Total Quality Management model at our Institution, the prevalence of patients with nosocomial pressure ulcers was reduced by 83%.

  7. Modelling the benefits of flood emergency management measures in reducing damages: a case study on Sondrio, Italy

    NASA Astrophysics Data System (ADS)

    Molinari, D.; Ballio, F.; Menoni, S.

    2013-08-01

    The European "Floods Directive" 2007/60/EU has produced an important shift from a traditional approach to flood risk management centred only on hazard analysis and forecast to a newer one which encompasses other aspects relevant to decision-making and which reflect recent research advances in both hydraulic engineering and social studies on disaster risk. This paper accordingly proposes a way of modelling the benefits of flood emergency management interventions calculating the possible damages by taking into account exposure, vulnerability, and expected damage reduction. The results of this model can be used to inform decisions and choices for the implementation of flood emergency management measures. A central role is played by expected damages, which are the direct and indirect consequence of the occurrence of floods in exposed and vulnerable urban systems. How damages should be defined and measured is a key question that this paper tries to address. The Floods Directive suggests that mitigation measures taken to reduce flood impact need to be evaluated also by means of a cost-benefit analysis. The paper presents a methodology for assessing the effectiveness of early warning for flash floods, considering its potential impact in reducing direct physical damage, and it assesses the general benefit in regard to other types of damages and losses compared with the emergency management costs. The methodology is applied to the case study area of the city of Sondrio in the northern Alpine region of Italy. A critical discussion follows the application. Its purpose is to highlight the strengths and weaknesses of available models for quantifying direct physical damage and of the general model proposed, given the current state of the art in damage and loss assessment.

  8. Assessing the potential of reservoir outflow management to reduce sedimentation using continuous turbidity monitoring and reservoir modelling

    USGS Publications Warehouse

    Lee, Casey; Foster, Guy

    2013-01-01

    In-stream sensors are increasingly deployed as part of ambient water quality-monitoring networks. Temporally dense data from these networks can be used to better understand the transport of constituents through streams, lakes or reservoirs. Data from existing, continuously recording in-stream flow and water quality monitoring stations were coupled with the two-dimensional hydrodynamic CE-QUAL-W2 model to assess the potential of altered reservoir outflow management to reduce sediment trapping in John Redmond Reservoir, located in east-central Kansas. Monitoring stations upstream and downstream from the reservoir were used to estimate 5.6 million metric tons of sediment transported to John Redmond Reservoir from 2007 through 2010, 88% of which was trapped within the reservoir. The two-dimensional model was used to estimate the residence time of 55 equal-volume releases from the reservoir; sediment trapping for these releases varied from 48% to 97%. Smaller trapping efficiencies were observed when the reservoir was maintained near the normal operating capacity (relative to higher flood pool levels) and when average residence times were relatively short. An idealized, alternative outflow management scenario was constructed, which minimized reservoir elevations and the length of time water was in the reservoir, while continuing to meet downstream flood control end points identified in the reservoir water control manual. The alternative scenario is projected to reduce sediment trapping in the reservoir by approximately 3%, preventing approximately 45 000 metric tons of sediment from being deposited within the reservoir annually. This article presents an approach to quantify the potential of reservoir management using existing in-stream data; actual management decisions need to consider the effects on other reservoir benefits, such as downstream flood control and aquatic life.

  9. Reducing the economic burden in management of Guillain–Barre syndrome using modified plasmapheresis

    PubMed Central

    Iyer, Rekha Ramaswamy; Shah, Pragnesh Hasmukhlal; Roy, Sher Sankar K.; Suri, Sushil Kumar Kundanlal

    2016-01-01

    Background: Guillain–Barre syndrome (GBS) is an autoimmune acute inflammatory demyelinating polyneuropathy affecting the peripheral nervous system treated with high-dose immunoglobulin, physical therapy, or plasmapheresis. Immunoglobulins are expensive and even plasmapheresis might not be affordable to patients visiting government set-ups. Aims: This study was undertaken to emphasize the efficacy of plasmapheresis in treatment of adult GBS patients and to narrate methods of reducing the economic burden in the treatment of these patients using modified plasmapheresis. Methods: A study was conducted on 12 adult GBS patients at Sir Takhtasinhji General Hospital, Bhavnagar from July 2012 to July 2014. Patients were assessed on a 6-point disability scale. They were treated with plasmapheresis over 10 days with REF627 kit from Haemonetics Corporation Limited on MCS+ machine. Improvement was noted by the change in the disability scale score and expenses of various modes of treatment were also considered. Results: Seventy-five percent showed improvement at the end of the treatment. The cost of modified plasmapheresis was Rs. 8000/cycle, i.e., Rs. 40,000/patient. Conclusion: Plasmapheresis along with proper supportive measures is a more cost-effective efficacious mode of therapy in adult patients of GBS. Further, modified plasmapheresis using REF627 kit and 6% hexastarch as replacement fluid on MCS+ apheresis machine reduces the cost of therapy for poor patients visiting government set-ups. PMID:27605847

  10. Simulating land management options to reduce nitrate pollution in an agricultural watershed dominated by an alluvial aquifer.

    PubMed

    Cerro, Itsasne; Antigüedad, Iñaki; Srinavasan, Raghavan; Sauvage, Sabine; Volk, Martin; Sanchez-Perez, José Miguel

    2014-01-01

    The study area (Alegria watershed, Basque Country, Northern Spain) considered here is influenced by an important alluvial aquifer that plays a significant role in nitrate pollution from agricultural land use and management practices. Nitrates are transported primarily from the soil to the river through the alluvial aquifer. The agricultural activity covers 75% of the watershed and is located in a nitrate-vulnerable zone. The main objective of the study was to find land management options for water pollution abatement by using model systems. In a first step, the SWAT model was applied to simulate discharge and nitrate load in stream flow at the outlet of the catchment for the period between October 2009 and June 2011. The LOADEST program was used to estimate the daily nitrate load from measured nitrate concentration. We achieved satisfactory simulation results for discharge and nitrate loads at monthly and daily time steps. The results revealed clear variations in the seasons: higher nitrate loads were achieved for winter (20,000 kg mo NO-N), and lower nitrate loads were simulated for the summer (<1000 kg mo NO-N) period. In a second step, the calibrated model was used to evaluate the long-term effects of best management practices (BMPs) for a 50-yr period by maintaining actual agricultural practices, reducing fertilizer application by 20%, splitting applications (same total N but applied over the growing period), and reducing 20% of the applied fertilizer amount and splitting the fertilizer doses. The BMPs were evaluated on the basis of local experience and farmer interaction. Results showed that reducing fertilizer amounts by 20% could lead to a reduction of 50% of the number of days exceeding the nitrate concentration limit value (50 mg L) set by the European Water Framework Directive. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  11. Forest management under climatic and social uncertainty: trade-offs between reducing climate change impacts and fostering adaptive capacity.

    PubMed

    Seidl, Rupert; Lexer, Manfred J

    2013-01-15

    The unabated continuation of anthropogenic greenhouse gas emissions and the lack of an international consensus on a stringent climate change mitigation policy underscore the importance of adaptation for coping with the all but inevitable changes in the climate system. Adaptation measures in forestry have particularly long lead times. A timely implementation is thus crucial for reducing the considerable climate vulnerability of forest ecosystems. However, since future environmental conditions as well as future societal demands on forests are inherently uncertain, a core requirement for adaptation is robustness to a wide variety of possible futures. Here we explicitly address the roles of climatic and social uncertainty in forest management, and tackle the question of robustness of adaptation measures in the context of multi-objective sustainable forest management (SFM). We used the Austrian Federal Forests (AFF) as a case study, and employed a comprehensive vulnerability assessment framework based on ecosystem modeling, multi-criteria decision analysis, and practitioner participation. We explicitly considered climate uncertainty by means of three climate change scenarios, and accounted for uncertainty in future social demands by means of three societal preference scenarios regarding SFM indicators. We found that the effects of climatic and social uncertainty on the projected performance of management were in the same order of magnitude, underlining the notion that climate change adaptation requires an integrated social-ecological perspective. Furthermore, our analysis of adaptation measures revealed considerable trade-offs between reducing adverse impacts of climate change and facilitating adaptive capacity. This finding implies that prioritization between these two general aims of adaptation is necessary in management planning, which we suggest can draw on uncertainty analysis: Where the variation induced by social-ecological uncertainty renders measures aiming to

  12. Exploiting Co-Benefits of Increased Rice Production and Reduced Greenhouse Gas Emission through Optimized Crop and Soil Management.

    PubMed

    An, Ning; Fan, Mingsheng; Zhang, Fusuo; Christie, Peter; Yang, Jianchang; Huang, Jianliang; Guo, Shiwei; Shi, Xiaojun; Tang, Qiyuan; Peng, Jianwei; Zhong, Xuhua; Sun, Yixiang; Lv, Shihua; Jiang, Rongfeng; Dobermann, Achim

    2015-01-01

    Meeting the future food security challenge without further sacrificing environmental integrity requires transformative changes in managing the key biophysical determinants of increasing agronomic productivity and reducing the environmental footprint. Here, we focus on Chinese rice production and quantitatively address this concern by conducting 403 on-farm trials across diverse rice farming systems. Inherent soil productivity, management practices and rice farming type resulted in confounded and interactive effects on yield, yield gaps and greenhouse gas (GHG) emissions (N2O, CH4 and CO2-equivalent) with both trade-offs and compensating effects. Advances in nitrogen, water and crop management (Best Management Practices-BMPs) helped closing existing yield gaps and resulted in a substantial reduction in CO2-equivalent emission of rice farming despite a tradeoff of increase N2O emission. However, inherent soil properties limited rice yields to a larger extent than previously known. Cultivating inherently better soil also led to lower GHG intensity (GHG emissions per unit yield). Neither adopting BMPs only nor improving soils with low or moderate productivity alone can adequately address the challenge of substantially increasing rice production while reducing the environmental footprint. A combination of both represents the most efficient strategy to harness the combined-benefits of enhanced production and mitigating climate change. Extrapolating from our farm data, this strategy could increase rice production in China by 18%, which would meet the demand for direct human consumption of rice by 2030. It would also reduce fertilizer nitrogen consumption by 22% and decrease CO2-equivalent emissions during the rice growing period by 7% compared with current farming practice continues. Benefits vary by rice-based cropping systems. Single rice systems have the largest food provision benefits due to its wider yield gap and total cultivated area, whereas double-rice system

  13. Intussusception. Part 3: Diagnosis and management of those with an identifiable or predisposing cause and those that reduce spontaneously.

    PubMed

    Navarro, Oscar; Daneman, Alan

    2004-04-01

    In the previous two parts of this review on intussusception, the diagnosis and management of symptomatic, "idiopathic" ileocolic and ileoileocolic intussusceptions, which are considered to result from hyperplasia of lymphoid tissue in the distal ileum, were discussed. In this third part, those intussusceptions with an identifiable cause including pathologic lead point, those due to gastrojejunostomy or other feeding tubes, and those that are seen in the postoperative period as well as those that may be asymptomatic or may reduce spontaneously (usually limited to the small bowel) are discussed.

  14. Exploiting Co-Benefits of Increased Rice Production and Reduced Greenhouse Gas Emission through Optimized Crop and Soil Management

    PubMed Central

    An, Ning; Fan, Mingsheng; Zhang, Fusuo; Christie, Peter; Yang, Jianchang; Huang, Jianliang; Guo, Shiwei; Shi, Xiaojun; Tang, Qiyuan; Peng, Jianwei; Zhong, Xuhua; Sun, Yixiang; Lv, Shihua; Jiang, Rongfeng; Dobermann, Achim

    2015-01-01

    Meeting the future food security challenge without further sacrificing environmental integrity requires transformative changes in managing the key biophysical determinants of increasing agronomic productivity and reducing the environmental footprint. Here, we focus on Chinese rice production and quantitatively address this concern by conducting 403 on-farm trials across diverse rice farming systems. Inherent soil productivity, management practices and rice farming type resulted in confounded and interactive effects on yield, yield gaps and greenhouse gas (GHG) emissions (N2O, CH4 and CO2-equivalent) with both trade-offs and compensating effects. Advances in nitrogen, water and crop management (Best Management Practices—BMPs) helped closing existing yield gaps and resulted in a substantial reduction in CO2-equivalent emission of rice farming despite a tradeoff of increase N2O emission. However, inherent soil properties limited rice yields to a larger extent than previously known. Cultivating inherently better soil also led to lower GHG intensity (GHG emissions per unit yield). Neither adopting BMPs only nor improving soils with low or moderate productivity alone can adequately address the challenge of substantially increasing rice production while reducing the environmental footprint. A combination of both represents the most efficient strategy to harness the combined-benefits of enhanced production and mitigating climate change. Extrapolating from our farm data, this strategy could increase rice production in China by 18%, which would meet the demand for direct human consumption of rice by 2030. It would also reduce fertilizer nitrogen consumption by 22% and decrease CO2-equivalent emissions during the rice growing period by 7% compared with current farming practice continues. Benefits vary by rice-based cropping systems. Single rice systems have the largest food provision benefits due to its wider yield gap and total cultivated area, whereas double-rice system

  15. Terror management theory and self-esteem: evidence that increased self-esteem reduces mortality salience effects.

    PubMed

    Harmon-Jones, E; Simon, L; Greenberg, J; Pyszczynski, T; Solomon, S; McGregor, H

    1997-01-01

    On the basis of the terror management theory proposition that self-esteem provides protection against concerns about mortality, it was hypothesized that self-esteem would reduce the worldview defense produced by mortality salience (MS). The results of Experiments 1 and 2 confirmed this hypothesis by showing that individuals with high self-esteem (manipulated in Experiment 1; dispositional in Experiment 2) did not respond to MS with increased worldview defense, whereas individuals with moderate self-esteem did. The results of Experiment 3 suggested that the effects of the first 2 experiments may have occurred because high self-esteem facilitates the suppression of death constructs following MS.

  16. Interventions to reduce Staphylococcus aureus in the management of atopic eczema.

    PubMed

    Birnie, Andrew J; Bath-Hextall, Fiona J; Ravenscroft, Jane Catherine; Williams, Hywel C

    2008-07-16

    Staphylococcus aureus can cause secondary infection in atopic eczema, and it may promote inflammation in eczema that does not look infected. Many antimicrobial products exist for eczema, but it is unclear if they work or if they promote bacterial resistance. To assess the effects of interventions to reduce Staphylococcus aureus for treating infected or uninfected atopic eczema. We searched the Cochrane Skin Group Specialised Register (March 2008), the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 1, 2008), MEDLINE (OVID) (from 2002 to March 2008), EMBASE (OVID) (from 2002 to March 2008), Ongoing trials registers (March 2008). References from trials and reviews were searched, pharmaceutical companies were contacted for unpublished trials. There were no language restrictions. Randomised controlled trials (RCTs) of people with atopic eczema who have been treated with a product intended to reduce S. aureus on the skin. Two people independently performed the study selection, data abstraction and quality assessment. We included 21 studies (1018 participants) covering 7 treatment categories. Most studies were poorly reported and study differences limited pooling of results. Adverse effects were especially poorly reported, and only one study reported the emergence of resistant bacterial strains following oral antibiotics. Oral antibiotics were not associated with benefit in non-infected (2 trials, 66 participants) or infected eczema (1 trial, 33 participants). We did not find any benefit for antibacterial soaps (1 trial, 50 participants), or antibacterial bath additives (2 trials, 41 participants), or topical antibiotics/antiseptics (4 studies, 95 participants). Adding antibiotics to topical corticosteroids reduced numbers of Staphylococcus aureus in 4 trials (302 participants), but there was no evidence of any clinical benefit in 9 trials involving 677 participants: betamethasone plus neomycin vs clobetasol (MD 1.2; 95% CI 0.25, 2

  17. Managing aquatic parasites for reduced drug resistance: lessons from the land.

    PubMed

    McEwan, Gregor F; Groner, Maya L; Burnett, Danielle L; Fast, Mark D; Revie, Crawford W

    2016-12-01

    Atlantic salmon farming is one of the largest aquaculture industries in the world. A major problem in salmon farms is the sea louse ectoparasite Lepeophtheirus salmonis, which can cause stress, secondary infection and sometimes mortality in the salmon host. Sea lice have substantial impacts on farm economics and potentially nearby wild salmonid populations. The most common method of controlling sea louse infestations is application of chemicals. However, most farming regions worldwide have observed resistance to the small set of treatment chemicals that are available. Despite this, there has been little investigation of treatment strategies for managing resistance in aquaculture. In this article, we compare four archetypical treatment strategies inspired by agriculture, where the topic has a rich history of study, and add a fifth strategy common in aquaculture. We use an agent-based model (ABM) to simulate these strategies and their varying applications of chemicals over time and space. We analyse the ABM output to compare how the strategies perform in controlling louse abundance, number of treatments required and levels of resistance in the sea louse population. Our results indicated that among the approaches considered applying chemicals in combination was the most effective over the long term. © 2016 The Author(s).

  18. Potential for reduced methane and carbon dioxide emissions from livestock and pasture management in the tropics

    PubMed Central

    Thornton, Philip K.; Herrero, Mario

    2010-01-01

    We estimate the potential reductions in methane and carbon dioxide emissions from several livestock and pasture management options in the mixed and rangeland-based production systems in the tropics. The impacts of adoption of improved pastures, intensifying ruminant diets, changes in land-use practices, and changing breeds of large ruminants on the production of methane and carbon dioxide are calculated for two levels of adoption: complete adoption, to estimate the upper limit to reductions in these greenhouse gases (GHGs), and optimistic but plausible adoption rates taken from the literature, where these exist. Results are expressed both in GHG per ton of livestock product and in Gt CO2-eq. We estimate that the maximum mitigation potential of these options in the land-based livestock systems in the tropics amounts to approximately 7% of the global agricultural mitigation potential to 2030. Using historical adoption rates from the literature, the plausible mitigation potential of these options could contribute approximately 4% of global agricultural GHG mitigation. This could be worth on the order of $1.3 billion per year at a price of $20 per t CO2-eq. The household-level and sociocultural impacts of some of these options warrant further study, however, because livestock have multiple roles in tropical systems that often go far beyond their productive utility. PMID:20823225

  19. Managing Errors to Reduce Accidents in High Consequence Networked Information Systems

    SciTech Connect

    Ganter, J.H.

    1999-02-01

    Computers have always helped to amplify and propagate errors made by people. The emergence of Networked Information Systems (NISs), which allow people and systems to quickly interact worldwide, has made understanding and minimizing human error more critical. This paper applies concepts from system safety to analyze how hazards (from hackers to power disruptions) penetrate NIS defenses (e.g., firewalls and operating systems) to cause accidents. Such events usually result from both active, easily identified failures and more subtle latent conditions that have resided in the system for long periods. Both active failures and latent conditions result from human errors. We classify these into several types (slips, lapses, mistakes, etc.) and provide NIS examples of how they occur. Next we examine error minimization throughout the NIS lifecycle, from design through operation to reengineering. At each stage, steps can be taken to minimize the occurrence and effects of human errors. These include defensive design philosophies, architectural patterns to guide developers, and collaborative design that incorporates operational experiences and surprises into design efforts. We conclude by looking at three aspects of NISs that will cause continuing challenges in error and accident management: immaturity of the industry, limited risk perception, and resource tradeoffs.

  20. Potential for reduced methane and carbon dioxide emissions from livestock and pasture management in the tropics.

    PubMed

    Thornton, Philip K; Herrero, Mario

    2010-11-16

    We estimate the potential reductions in methane and carbon dioxide emissions from several livestock and pasture management options in the mixed and rangeland-based production systems in the tropics. The impacts of adoption of improved pastures, intensifying ruminant diets, changes in land-use practices, and changing breeds of large ruminants on the production of methane and carbon dioxide are calculated for two levels of adoption: complete adoption, to estimate the upper limit to reductions in these greenhouse gases (GHGs), and optimistic but plausible adoption rates taken from the literature, where these exist. Results are expressed both in GHG per ton of livestock product and in Gt CO(2)-eq. We estimate that the maximum mitigation potential of these options in the land-based livestock systems in the tropics amounts to approximately 7% of the global agricultural mitigation potential to 2030. Using historical adoption rates from the literature, the plausible mitigation potential of these options could contribute approximately 4% of global agricultural GHG mitigation. This could be worth on the order of $1.3 billion per year at a price of $20 per t CO(2)-eq. The household-level and sociocultural impacts of some of these options warrant further study, however, because livestock have multiple roles in tropical systems that often go far beyond their productive utility.

  1. As low as reasonably achievable: Methods for reducing radiation exposure during the management of renal and ureteral stones

    PubMed Central

    Cabrera, Fernando; Preminger, Glenn M.; Lipkin, Michael E.

    2014-01-01

    Imaging for urolithiasis has evolved over the past 30 years. Currently, non-contrast computed tomography (NCCT) remains the first line imaging modality for the evaluation of patients with suspected urolithiasis. NCCT is a dominant source of ionizing radiation for patients and one of its major limitation. However, new low dose NCCT protocols may help to reduce the risk. Fluoroscopy use during operating room (OR) surgical procedures can be a substantial source of radiation for patients, OR staff and surgeons. It is important to consider the amount of radiation patients are exposed to from fluoroscopy during operative interventions for stones. Radiation reduction can be accomplished by appropriate selection of imaging studies and multiple techniques, which minimize the use of fluoroscopy whenever possible. The purpose of this manuscript is to review common imaging modalities used for diagnosing and management of renal and ureteral stones associated with radiation exposure. We also review alternatives and techniques to reduce radiation exposure. PMID:24497684

  2. As low as reasonably achievable: Methods for reducing radiation exposure during the management of renal and ureteral stones.

    PubMed

    Cabrera, Fernando; Preminger, Glenn M; Lipkin, Michael E

    2014-01-01

    Imaging for urolithiasis has evolved over the past 30 years. Currently, non-contrast computed tomography (NCCT) remains the first line imaging modality for the evaluation of patients with suspected urolithiasis. NCCT is a dominant source of ionizing radiation for patients and one of its major limitation. However, new low dose NCCT protocols may help to reduce the risk. Fluoroscopy use during operating room (OR) surgical procedures can be a substantial source of radiation for patients, OR staff and surgeons. It is important to consider the amount of radiation patients are exposed to from fluoroscopy during operative interventions for stones. Radiation reduction can be accomplished by appropriate selection of imaging studies and multiple techniques, which minimize the use of fluoroscopy whenever possible. The purpose of this manuscript is to review common imaging modalities used for diagnosing and management of renal and ureteral stones associated with radiation exposure. We also review alternatives and techniques to reduce radiation exposure.

  3. Weight Management to Reduce Prostate Cancer Risk: A Survey of Men’s Needs and Interests

    PubMed Central

    Schleper, Amy; Sullivan, Debra K.; Thrasher, J. Brantley; Holzbeierlein, Jeffrey M.; Klemp, Jennifer; Befort, Christie; Hamilton-Reeves, Jill M.

    2016-01-01

    Obese men have a higher rate of prostate cancer-related death than non-obese men, and obesity increases the risk of prostate cancer progression and biochemical recurrence. The purpose of this study was to assess needs and interests of men for a technology-driven weight loss intervention to reduce prostate cancer risk. We distributed a survey collecting demographic characteristics, health history, exercise and eating habits (and perception of those habits), current and prior attempts of health behavior change, and technology use. Survey answers were summarized by count and percent of total respondents. Completed surveys (N = 109) described men with a family history of prostate cancer (25%), a history of elevated prostate specific antigen (26%), and prostate cancer survivors (22%). We compared body mass index (BMI) to perception of weight; overweight and obese men perceived their weight as more normal than their BMI category suggests. Most men reported their diet needed minor improvement (74%), and 65% of men reported they are either currently trying to lose weight or interested in weight loss. Most respondents access the internet (92%), while text messaging (60%) and smartphone application use (40%) are less frequent, especially in men over 60. Our results revealed a need and willingness for lifestyle modification and suggest a need for evidence-based weight loss strategies and for addressing the misperception of weight status. A male-tailored intervention that implements technology could improve energy balance, hold men accountable to healthy behavior change, and promote dietary patterns in order to reduce prostate cancer risk. PMID:27547287

  4. Reduced use of erythropoiesis-stimulating agents and intravenous iron with ferric citrate: a managed care cost-offset model

    PubMed Central

    Mutell, Richard; Rubin, Jaime L; Bond, T Christopher; Mayne, Tracy

    2013-01-01

    Background Ferric citrate (FC) is a phosphate binder in development for the treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). In clinical trials, FC improved patient serum phosphorus levels and increased serum ferritin and percent transferrin saturation. Because nephrologists respond to increases in these iron measures by reducing intravenous (IV) iron and erythropoiesis-stimulating agent (ESA) doses, the decreased use of iron and ESA associated with FC may reduce costs. Objectives To develop a cost-offset model from a managed care perspective estimating the cost savings associated with FC use. Methods We created a cost-offset model from the managed care payer perspective that compared the treatment costs of ESRD for patients given FC. The model considered the number of dialysis sessions per month; number of ESRD patients enrolled in the health plan; cost of ESAs, iron, and dialysis sessions; and the proportion of patients on phosphate binder therapy. The model assumed equivalent efficacy and cost neutrality between FC and other phosphate binders. Monte Carlo simulations were conducted by varying model inputs. Results When FC was compared to other phosphate binders, the monthly cost of ESA and IV iron per 500 patients with ESRD (85% treated with phosphate binders) was reduced by 8.15% and 33.2%, respectively. When incorporated into the total cost of dialysis for patients with ESRD (dialysis, ESA, and IV iron), the decrease in the monthly cost of dialysis care was US$80,214 per 500 ESRD patients. Monte Carlo simulations suggest that a plan serving 500 dialysis patients could save between US$626,000 and US$1,106,000 annually with the use of FC. Conclusion The use of FC in ESRD patients with hyperphosphatemia may help reduce treatment costs. PMID:23662073

  5. Reduced use of erythropoiesis-stimulating agents and intravenous iron with ferric citrate: a managed care cost-offset model.

    PubMed

    Mutell, Richard; Rubin, Jaime L; Bond, T Christopher; Mayne, Tracy

    2013-01-01

    Ferric citrate (FC) is a phosphate binder in development for the treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). In clinical trials, FC improved patient serum phosphorus levels and increased serum ferritin and percent transferrin saturation. Because nephrologists respond to increases in these iron measures by reducing intravenous (IV) iron and erythropoiesis-stimulating agent (ESA) doses, the decreased use of iron and ESA associated with FC may reduce costs. To develop a cost-offset model from a managed care perspective estimating the cost savings associated with FC use. We created a cost-offset model from the managed care payer perspective that compared the treatment costs of ESRD for patients given FC. The model considered the number of dialysis sessions per month; number of ESRD patients enrolled in the health plan; cost of ESAs, iron, and dialysis sessions; and the proportion of patients on phosphate binder therapy. The model assumed equivalent efficacy and cost neutrality between FC and other phosphate binders. Monte Carlo simulations were conducted by varying model inputs. When FC was compared to other phosphate binders, the monthly cost of ESA and IV iron per 500 patients with ESRD (85% treated with phosphate binders) was reduced by 8.15% and 33.2%, respectively. When incorporated into the total cost of dialysis for patients with ESRD (dialysis, ESA, and IV iron), the decrease in the monthly cost of dialysis care was US$80,214 per 500 ESRD patients. Monte Carlo simulations suggest that a plan serving 500 dialysis patients could save between US$626,000 and US$1,106,000 annually with the use of FC. The use of FC in ESRD patients with hyperphosphatemia may help reduce treatment costs.

  6. Managing population immunity to reduce or eliminate the risks of circulation following the importation of polioviruses.

    PubMed

    Thompson, Kimberly M; Kalkowska, Dominika A; Duintjer Tebbens, Radboud J

    2015-03-24

    Poliovirus importations into polio-free countries represent a major concern during the final phases of global eradication of wild polioviruses (WPVs). We extend dynamic transmission models to demonstrate the dynamics of population immunity out through 2020 for three countries that only used inactivated poliovirus vaccine (IPV) for routine immunization: the US, Israel, and The Netherlands. For each country, we explore the vulnerability to re-established transmission following an importation for each poliovirus serotype, including the impact of immunization choices following the serotype 1 WPV importation that occurred in 2013 in Israel. As population immunity declines below the threshold required to prevent transmission, countries become at risk for re-established transmission. Although importations represent stochastic events that countries cannot fully control because people cross borders and polioviruses mainly cause asymptomatic infections, countries can ensure that any importations die out. Our results suggest that the general US population will remain above the threshold for transmission through 2020. In contrast, Israel became vulnerable to re-established transmission of importations of live polioviruses by the late 2000s. In Israel, the recent WPV importation and outbreak response use of bivalent oral poliovirus vaccine (bOPV) eliminated the vulnerability to an importation of poliovirus serotypes 1 and 3 for several years, but not serotype 2. The Netherlands experienced a serotype 1 WPV outbreak in 1992-1993 and became vulnerable to re-established transmission in religious communities with low vaccine acceptance around the year 2000, although the general population remains well-protected from widespread transmission. All countries should invest in active management of population immunity to avoid the potential circulation of imported live polioviruses. IPV-using countries may wish to consider prevention opportunities and/or ensure preparedness for response

  7. Spatial and temporal changes in sulphate-reducing groundwater bacterial community structure in response to Managed Aquifer Recharge.

    PubMed

    Reed, D A; Toze, S; Chang, B

    2008-01-01

    The population dynamics of bacterial able to be cultured under sulphate reducing condition was studied in conjunction with changes in aquifer geochemistry using multivariate statistics for two contrasting Managed Aquifer Recharge (MAR) techniques at two different geographical locations (Perth, Western Australia and Adelaide, South Australia). Principal component analysis (PCA) was used to investigate spatial and temporal changes in the overall chemical signature of the aquifers using an array of chemical analytes which demonstrated a migrating geochemical plume. Denaturing Gradient Gel Electrophoresis (DGGE) using DNA from sulphate-reducing bacteria cultures was used to detect spatial and temporal changes in population dynamics. Bacterial and geochemical evidence suggested that groundwater at greatest distance from the nutrient source was least affected by treated effluent recharge. The results suggested that bacterial populations that were able to be cultured in sulphate reducing media responded to the migrating chemical gradient and to the changes in aquifer geochemistry. Most noticeably, sulphate-reducing bacterial populations associated with the infiltration galleries were stable in community structure over time. Additionally, the biodiversity of these culturable bacteria was restored when aquifer geochemistry returned to ambient conditions during the recovery phase at the Adelaide Aquifer Storage and Recovery site.

  8. Alternate Wetting and Drying as an Effective Management Practice to Reduce Methane in Arkansas Rice Production

    NASA Astrophysics Data System (ADS)

    Runkle, B.; Smith, S. F.; Suvocarev, K.; Reba, M. L.

    2015-12-01

    Approximately 15% of the global 308 Tg CH4 emitted by anthropogenic sources is currently attributed to rice cultivation. Arkansas, the leading state in rice cultivation, produces over 42% of the total rice and represents over 43% of total land planted to rice in the US. Although rice production is generally water-intensive, some rice producers have adopted a conservation practice, 'Alternate Wetting and Drying' (AWD), in which the flood is released periodically during the growing season. In addition, implementing AWD can reduce CH4 emissions though the introduction of aerobic conditions. To assess the magnitude of this reduction, conventionally flooded (CONV) and AWD fields were identically instrumented for the 2015 season and fluxes of CH4 were measured with an open path IRGA. Other biophysical variables were monitored to determine the relative dominance of potential drivers. Half-hourly CH4 fluxes from the AWD and CONV fields during their similar initial flood (DOY 138-161) were well correlated (R2 = 0.762), indicating similar mechanisms controlling CH4 emissions in both fields. After the initial drydown event in the AWD field (162 DOY), daily median CH4 fluxes continued to rise to 7.80 mg CH4 m-2 h-1 on 163 DOY before subsiding to a local minimum of 0.162 mg CH4 m-2 h-1 on 171 DOY. Daily median CH4 fluxes between 9.24 and 16.0 mg CH4 m-2 h-1 were observed in the CONV field during this same period. Cumulative emissions from both fields following the drydown event and prior to rewetting demonstrated a reduction in CH4 emissions by the AWD treatment by 82%. The substantial decrease in CH4 emissions by AWD in the early growing season supports and expands upon previous chamber-based research and offers strong evidence for the efficacy of AWD in reducing CH4 emissions in AR rice production. The presentation will also assess the latter portion of the growing season, currently underway, and will provide process-based relationships between biophysical parameters and CH

  9. Chronotherapy with conventional blood pressure medications improves management of hypertension and reduces cardiovascular and stroke risks.

    PubMed

    Hermida, Ramón C; Ayala, Diana E; Smolensky, Michael H; Fernández, José R; Mojón, Artemio; Portaluppi, Francesco

    2016-05-01

    Correlation between blood pressure (BP) and target organ damage, vascular risk and long-term patient prognosis is greater for measurements derived from around-the-clock ambulatory BP monitoring than in-clinic daytime ones. Numerous studies consistently substantiate the asleep BP mean is both an independent and a much better predictor of cardiovascular disease (CVD) risk than either the awake or 24 h means. Sleep-time hypertension is much more prevalent than suspected, not only in patients with sleep disorders, but also among those who are elderly or have type 2 diabetes, chronic kidney disease or resistant hypertension. Hence, cost-effective adequate control of sleep-time BP is of marked clinical relevance. Ingestion time, according to circadian rhythms, of hypertension medications of six different classes and their combinations significantly affects BP control, particularly sleep-time BP, and adverse effects. For example, because the high-amplitude circadian rhythm of the renin-angiotensin-aldosterone system activates during nighttime sleep, bedtime vs. morning ingestion of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers better reduces the asleep BP mean, with additional benefit, independent of medication terminal half-life, of converting the 24 h BP profile into more normal dipper patterning. The MAPEC (Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares) study, first prospective randomized treatment-time investigation designed to test the worthiness of bedtime chronotherapy with ⩾1 conventional hypertension medications so as to specifically target attenuation of asleep BP, demonstrated, relative to conventional morning therapy, 61% reduction of total CVD events and 67% decrease of major CVD events, that is, CVD death, myocardial infarction, and ischemic and hemorrhagic stroke. The MAPEC study, along with other earlier conducted less refined trials, documents the asleep BP mean is the most significant

  10. Improving patient care over weekends by reducing on-call work load and better time management.

    PubMed

    Gardezi, Syed Anjum Ali

    2014-01-01

    The Royal College of Physicians states that "handover, particularly of temporary 'on-call' responsibility, has been identified as a point at which errors are likely to occur."[1] Working a weekend on-call covering medical wards is often busy and stressful for all junior doctors. The high volume of routine and unplanned tasks make the situation even worse. In Nevill Hall hospital Abergavenny, we measured the workload on a junior doctor for medical ward cover on weekends by counting the number of times he/she was bleeped for routine tasks. Initial study demonstrated that on average 30-40% of time on a long day shift was spent on jobs which could have been done on the preceding Friday. The "FRIDAYS" checklist was introduced for clinical staff (particularly junior doctors) to identify these jobs. According to this model, all the junior doctors were encouraged to review: F: Phlebotomy R: Rewriting drug charts I: IV fluids D: discharge summaries A: Antibiotic review Y: Yellow book/Warfarin dose S: Status of resuscitation and escalation plans before leaving the wards on Friday afternoon. This implementation successfully showed reduction in weekend workload, allowing the ward cover to be focused on care and safety of comparatively sick patients while at the same time reducing the stress for the on-call team.

  11. Different causes of reduced sensitivity to thyroid hormone: diagnosis and clinical management.

    PubMed

    Visser, W Edward; van Mullem, Alies A A; Visser, Theo J; Peeters, Robin P

    2013-11-01

    Normal thyroid hormone (TH) metabolism and action require adequate cellular TH signalling. This entails proper function of TH transporters in the plasma membrane, intracellular deiodination of TH and action of the bioactive hormone T3 at its nuclear receptors (TRs). The present review summarizes the discoveries of different syndromes with reduced sensitivity at the cellular level. Mutations in the TH transporter MCT8 cause psychomotor retardation and abnormal thyroid parameters. Mutations in the SBP2 protein, which is required for normal deiodination, give rise to a multisystem disorder including abnormal thyroid function tests. Mutations in TRβ1 are a well-known cause of resistance to TH with mostly a mild phenotype, while only recently, patients with mutations in TRα1 were identified. The latter patients have slightly abnormal TH levels, growth retardation and cognitive defects. This review will describe the mechanisms of disease, clinical phenotype, diagnostic testing and suggestions for treatment strategies for each of these syndromes. © 2013 John Wiley & Sons Ltd.

  12. Improving patient care over weekends by reducing on-call work load and better time management

    PubMed Central

    Gardezi, Syed Anjum Ali

    2014-01-01

    The Royal College of Physicians states that “handover, particularly of temporary ‘on-call’ responsibility, has been identified as a point at which errors are likely to occur.”[1] Working a weekend on-call covering medical wards is often busy and stressful for all junior doctors. The high volume of routine and unplanned tasks make the situation even worse. In Nevill Hall hospital Abergavenny, we measured the workload on a junior doctor for medical ward cover on weekends by counting the number of times he/she was bleeped for routine tasks. Initial study demonstrated that on average 30–40% of time on a long day shift was spent on jobs which could have been done on the preceding Friday. The “FRIDAYS” checklist was introduced for clinical staff (particularly junior doctors) to identify these jobs. According to this model, all the junior doctors were encouraged to review: F: Phlebotomy R: Rewriting drug charts I: IV fluids D: discharge summaries A: Antibiotic review Y: Yellow book/Warfarin dose S: Status of resuscitation and escalation plans before leaving the wards on Friday afternoon. This implementation successfully showed reduction in weekend workload, allowing the ward cover to be focused on care and safety of comparatively sick patients while at the same time reducing the stress for the on-call team. PMID:26734257

  13. Therapeutic Interactive Voice Response (TIVR) to Reduce Analgesic Medication Use for Chronic Pain Management

    PubMed Central

    Naylor, Magdalena R.; Naud, Shelly; Keefe, Francis J.; Helzer, John E.

    2011-01-01

    This paper examines whether a telephone-based, automated maintenance enhancement program can help to reduce opioid and NSAID analgesics use in patients with chronic pain. Following 11 weeks of group CBT, fifty-one subjects with chronic musculoskeletal pain were randomized to one of two study groups. Twenty-six subjects participated in 4 months of a Therapeutic Interactive Voice Response (TIVR) program in addition to standard follow-up care, while a control group of twenty-five subjects received standard follow-up care only. TIVR is an automated, telephone-based tool developed for the maintenance and enhancement of CBT skills. Opioid analgesic use decreased in the experimental group in both follow-ups: 4- and 8-months post-CBT. In addition, at 8-month follow up, 21% of the TIVR subjects had discontinued the use of opioid analgesics, 23% had discontinued NSAIDS, and 10% had discontinued antidepressant medications. In contrast, the control group showed increases in opioid and NSAIDS use. Analysis of covariance (ANCOVA) revealed significant between-group differences in opioid analgesic use at 8-month follow up (p=0.004). We have previously demonstrated the efficacy of Therapeutic IVR to decrease pain and improve coping; this analysis demonstrates that the use of TIVR may also result in concurrent reductions in opioid analgesic and NSAID medications use. PMID:20620119

  14. Complication Reducing Effect of the Information Technology-Based Diabetes Management System on Subjects with Type 2 Diabetes

    PubMed Central

    Cho, Jae-Hyoung; Lee, Jin-Hee; Oh, Jeong-Ah; Kang, Mi-Ja; Choi, Yoon-Hee; Kwon, Hyuk-Sang; Chang, Sang-Ah; Cha, Bong-Yun; Son, Ho-Young; Yoon, Kun-Ho

    2008-01-01

    Objective We introduced a new information technology-based diabetes management system, called the Internet-based glucose monitoring system (IBGMS), and demonstrated its short-term and long-term favorable effects. However, there has been no report on clinical effects of such a new diabetes management system on the development of diabetic complications so far. This study was used to simulate the complication reducing effect of the IBGMS, given in addition to existing treatments in patients with type 2 diabetes. Research Design and Methods The CORE Diabetes Model, a peer-reviewed, published, validated computer simulation model, was used to project long-term clinical outcomes in type 2 diabetes patients receiving the IBGMS in addition to their existing treatment. The model combined standard Markov submodels to simulate the incidence and progression of diabetes-related complications. Results The addition of IBGMS was associated with improvements in reducing diabetic complications, mainly microangiopathic complications, including diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and diabetic foot ulcer. The IBGMS also delayed the development of all diabetic complications for more than 1 year. Conclusions This study demonstrated that the simulated IBGMS, compared to existing treatment, was associated with a reduction of diabetic complications. As a result, it provides valuable evidence for practical application to the public in the world. PMID:19885180

  15. Integrated soil-crop system management: reducing environmental risk while increasing crop productivity and improving nutrient use efficiency in China.

    PubMed

    Zhang, Fusuo; Cui, Zhenling; Fan, Mingsheng; Zhang, Weifeng; Chen, Xinping; Jiang, Rongfeng

    2011-01-01

    During the past 47 yr (1961-2007), Chinese cereal production has increased by 3.2-fold, successfully feeding 22% of the global human population with only 9% of the world's arable land, but at high environmental cost and resource consumption. Worse, crop production has been stagnant since 1996 while the population and demand for food continue to rise. New advances for sustainability of agriculture and ecosystem services will be needed during the coming 50 yr to reduce environmental risk while increasing crop productivity and improving nutrient use efficiency. Here, we advocate and develop integrated soil-crop system management (ISSM). In this approach, the key points are (i) to take all possible soil quality improvement measures into consideration, (ii) to integrate the utilization of various nutrient resources and match nutrient supply to crop requirements, and (iii) to integrate soil and nutrient management with high-yielding cultivation systems. Recent field experiments have shed light on how ISSM can lead to significant increases in crop yields while increasing nutrient use efficiency and reducing environmental risk.

  16. Reducing fertilization for cut roses: effect on crop productivity and twospotted spider mite abundance, distribution, and management.

    PubMed

    Chow, Andrew; Chau, Amanda; Heinz, Kevin M

    2009-10-01

    Fertilization reduction could be a useful pest management tactic for floriculture crops if it reduced pest populations with little loss in crop yield and quality. We evaluated the response of the twospotted spider mite, Tetranychus urticae Koch (Acari: Tetranychidae), to different fertilization levels for cut roses, Rosa hybrida L. 'Tropicana' and quantified fertilization effects on (1) management of T. urticae on roses, (2) abundance and distribution of T. urticae on roses, and (3) yield and quality of the cut rose crop. We tested two fertilization levels, 10% (15 ppm N) and 100% (150 ppm N) of the recommended level for commercial production, and three control methods: no control measure; a predatory mite, Phytoseiulus persimilis Athias-Henriot; and a miticide, bifenazate. Combinations of both bottom up (fertilization) and top down (biological or chemical control) tactics provided a greater degree of T. urticae control than either tactic alone. Rose productivity was reduced with fertilization at 10% of the recommended level; therefore, we conducted studies with T. urticae on roses fertilized with 33% (50 ppm N), 50% (75 ppm N), and 100% (150 ppm N) of the recommended level. Mean numbers of T. urticae and T. urticae eggs per flower shoot were twice as high on roses fertilized with 100 versus 33% or 50% of the recommended level. Number of rose leaves and total leaf area infested by T. urticae were similar at all fertilization levels. Cut rose yield and marketability were not compromised on plants fertilized with 50% of the recommended level.

  17. Water management reduces greenhouse gas emissions in a Mediterranean rice paddy field

    NASA Astrophysics Data System (ADS)

    Gruening, Carsten; Meijide, Ana; Manca, Giovanni; Goded, Ignacio; Seufert, Guenther; Cescatti, Alessandro

    2016-04-01

    Rice paddy fields are one of the biggest anthropogenic sources of methane (CH4), the second most important greenhouse gas (GHG) after carbon dioxide (CO2). Therefore most studies on greenhouse gases (GHG) in these agricultural systems focus on the evaluation of CH4 production. However, there are other GHGs such as CO2 and nitrous oxide (N2O) also exchanged within the atmosphere. Since each of the GHGs has its own radiative forcing effect, the total GHG budget of rice cultivation and its global warming potential (GWP) must be assessed. For this purpose a field experiment was carried out in a Mediterranean rice paddy field in the Po Valley (Italy), the largest rice producing region in Europe. Ecosystem CO2 and CH4 fluxes were assessed using the eddy covariance technique, while soil respiration and soil CH4 and N2O fluxes were measured with closed chambers for two complete years. Combining all GHGs measured, the rice paddy field acted as a sink of -368 and -828 g CO2 eq m-2 year-1 in the first and second years respectively. Both years, it was a CO2 sink and a CH4 source, while the N2O contribution to the GWP was relatively small. Differences in the GHG budget between the two years of measurements were mainly caused by the greater CH4 emissions in the first year (37.4 g CH4 m-2 compared to 21.03 g CH4 m-2 in the second year), probably as a consequence of the drainage of the water table in the middle of the growing season during the second year, which resulted in lower CH4 emissions without significant increases of N2O and CO2 fluxes. However, midseason drainage also resulted in small decreases of yield, indicating that GHG budget studies from agricultural systems should consider carbon exports through the harvest. The balance between net GWP and carbon yield indicated a loss of carbon equivalents from the system, which was more than 30-fold higher in the first year. Our results therefore suggest that an adequate management of the water table has the potential to be an

  18. Reducing environmental risk by improving N management in intensive Chinese agricultural systems.

    PubMed

    Ju, Xiao-Tang; Xing, Guang-Xi; Chen, Xin-Ping; Zhang, Shao-Lin; Zhang, Li-Juan; Liu, Xue-Jun; Cui, Zhen-Ling; Yin, Bin; Christie, Peter; Zhu, Zhao-Liang; Zhang, Fu-Suo

    2009-03-03

    Excessive N fertilization in intensive agricultural areas of China has resulted in serious environmental problems because of atmospheric, soil, and water enrichment with reactive N of agricultural origin. This study examines grain yields and N loss pathways using a synthetic approach in 2 of the most intensive double-cropping systems in China: waterlogged rice/upland wheat in the Taihu region of east China versus irrigated wheat/rainfed maize on the North China Plain. When compared with knowledge-based optimum N fertilization with 30-60% N savings, we found that current agricultural N practices with 550-600 kg of N per hectare fertilizer annually do not significantly increase crop yields but do lead to about 2 times larger N losses to the environment. The higher N loss rates and lower N retention rates indicate little utilization of residual N by the succeeding crop in rice/wheat systems in comparison with wheat/maize systems. Periodic waterlogging of upland systems caused large N losses by denitrification in the Taihu region. Calcareous soils and concentrated summer rainfall resulted in ammonia volatilization (19% for wheat and 24% for maize) and nitrate leaching being the main N loss pathways in wheat/maize systems. More than 2-fold increases in atmospheric deposition and irrigation water N reflect heavy air and water pollution and these have become important N sources to agricultural ecosystems. A better N balance can be achieved without sacrificing crop yields but significantly reducing environmental risk by adopting optimum N fertilization techniques, controlling the primary N loss pathways, and improving the performance of the agricultural Extension Service.

  19. Maintaining yields and reducing nitrogen loss in rice-wheat rotation system in Taihu Lake region with proper fertilizer management

    NASA Astrophysics Data System (ADS)

    Xue, Lihong; Yu, Yingliang; Yang, Linzhang

    2014-11-01

    In the Tailake region of China, heavy nitrogen (N) loss of rice-wheat rotation systems, due to high fertilizer-N input with low N use efficiency (NUE), was widely reported. To alleviate the detrimental impacts caused by N loss, it is necessary to improve the fertilizer management practices. Therefore, a 3 yr field experiments with different N managements including organic combined chemical N treatment (OCN, 390 kg N ha-1 yr-1, 20% organic fertilizer), control-released urea treatment (CRU, 390 kg N ha-1 yr-1, 70% resin-coated urea), reduced chemical N treatment (RCN, 390 kg N ha-1 yr-1, all common chemical fertilizer), and site-specific N management (SSNM, 333 kg N ha-1 yr-1, all common chemical fertilizer) were conducted in the Taihu Lake region with the ‘farmer’s N’ treatment (FN, 510 kg N ha-1 yr-1, all common chemical fertilizer) as a control. Grain yield, plant N uptake (PNU), NUE, and N losses via runoff, leaching, and ammonia volatilization were assessed. In the rice season, the FN treatment had the highest N loss and lowest NUE, which can be attributed to an excessive rate of N application. Treatments of OCN and RCN with a 22% reduced N rate from FN had no significant effect on PNU nor the yield of rice in the 3 yr; however, the NUE was improved and N loss was reduced 20-32%. OCN treatment achieved the highest yield, while SSNM has the lowest N loss and highest NUE due to the lowest N rate. In wheat season, N loss decreased about 28-48% with the continuous reduction of N input, but the yield also declined, with the exception of OCN treatment. N loss through runoff, leaching and ammonia volatilization was positively correlated with the N input rate. When compared with the pure chemical fertilizer treatment of RCN under the same N input, OCN treatment has better NUE, better yield, and lower N loss. 70% of the urea replaced with resin-coated urea had no significant effect on yield and NUE improvement, but decreased the ammonia volatilization loss. Soil

  20. Innovative Water Management Technology to Reduce Environmental Impacts of Produced Water

    SciTech Connect

    Castle, James; Rodgers, John; Alley, Bethany; Beebe, Alex; Coffey, Ruthanne; Jurinko, Kristen; Pardue, Michael; Ritter, Tina; Spacil, Michael

    2013-05-15

    -reverse osmosis produced water was designed to promote oxidizing conditions within the first wetland cell for nitrification of ammonia, and the subsequent three cells were designed to promote reducing conditions for denitrification of nitrate. By incorporating multiple wetland cells in a CWTS, the conditions within each cell can be modified for removal of specific COCs. In addition, a CWTS designed with multiple cells allows for convenient sample collection points so that biogeochemical conditions of individual cells can be monitored and performance evaluated. Removal rate coefficients determined from the pilot-scale CWTS experiments and confirmed by the demonstration system can be used to calculate HRTs required to treat COCs in full-scale CWTSs. The calculated HRTs can then be used to determine the surface area or ?footprint? of a full-size CWTS for a given inflow rate of produced water.

  1. Innovative Water Management Technology to Reduce Environment Impacts of Produced Water

    SciTech Connect

    Castle, James; Rodgers, John; Alley, Bethany; Coffey, Ruthanne; Jurinko, Kristen; Pardue, Michael; Ritter, Tina; Spacil, Michael

    2013-05-15

    -reverse osmosis produced water was designed to promote oxidizing conditions within the first wetland cell for nitrification of ammonia, and the subsequent three cells were designed to promote reducing conditions for denitrification of nitrate. By incorporating multiple wetland cells in a CWTS, the conditions within each cell can be modified for removal of specific COCs. In addition, a CWTS designed with multiple cells allows for convenient sample collection points so that biogeochemical conditions of individual cells can be monitored and performance evaluated. Removal rate coefficients determined from the pilot-scale CWTS experiments and confirmed by the demonstration system can be used to calculate HRTs required to treat COCs in full-scale CWTSs. The calculated HRTs can then be used to determine the surface area or footprint of a full-size CWTS for a given inflow rate of produced water.

  2. Innovative Water Management Technology to Reduce Environment Impacts of Produced Water

    SciTech Connect

    Castle, James W.; Rodgers, John H.; Alley, Bethany; Beebe, Alex; Coffey, Ruthanne; Jurinko, Kristen; Pardue, Michael; Ritter, Tina; Spacil, Michael M.

    2013-08-08

    -reverse osmosis produced water was designed to promote oxidizing conditions within the first wetland cell for nitrification of ammonia, and the subsequent three cells were designed to promote reducing conditions for denitrification of nitrate. By incorporating multiple wetland cells in a CWTS, the conditions within each cell can be modified for removal of specific COCs. In addition, a CWTS designed with multiple cells allows for convenient sample collection points so that biogeochemical conditions of individual cells can be monitored and performance evaluated. Removal rate coefficients determined from the pilot-scale CWTS experiments and confirmed by the demonstration system can be used to calculate HRTs required to treat COCs in full-scale CWTSs. The calculated HRTs can then be used to determine the surface area or footprint of a full-size CWTS for a given inflow rate of produced water.

  3. Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review

    PubMed Central

    2011-01-01

    Background Infection is a well acknowledged cause of stillbirths and may account for about half of all perinatal deaths today, especially in developing countries. This review presents the impact of interventions targeting various important infections during pregnancy on stillbirth or perinatal mortality. Methods We undertook a systematic review including all relevant literature on interventions dealing with infections during pregnancy for assessment of effects on stillbirths or perinatal mortality. The quality of the evidence was assessed using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach by Child Health Epidemiology Reference Group (CHERG). For the outcome of interest, namely stillbirth, we applied the rules developed by CHERG to recommend a final estimate for reduction in stillbirth for input to the Lives Saved Tool (LiST) model. Results A total of 25 studies were included in the review. A random-effects meta-analysis of observational studies of detection and treatment of syphilis during pregnancy showed a significant 80% reduction in stillbirths [Relative risk (RR) = 0.20; 95% confidence interval (CI): 0.12 - 0.34) that is recommended for inclusion in the LiST model. Our meta-analysis showed the malaria prevention interventions i.e. intermittent preventive treatment (IPTp) and insecticide-treated mosquito nets (ITNs) can reduce stillbirths by 22%, however results were not statistically significant (RR = 0.78; 95% CI: 0.59 – 1.03). For human immunodeficiency virus infection, a pooled analysis of 6 radomized controlled trials (RCTs) failed to show a statistically significant reduction in stillbirth with the use of antiretroviral in pregnancy compared to placebo (RR = 0.93; 95% CI: 0.45 – 1.92). Similarly, pooled analysis combining four studies for the treatment of bacterial vaginosis (3 for oral and 1 for vaginal antibiotic) failed to yield a significant impact on perinatal mortality (OR = 0.88; 95% CI: 0.50

  4. Reducing psychosocial risks through supervisors' development: a contribution for a brief version of the "Stress Management Competency Indicator Tool".

    PubMed

    Toderi, Stefano; Gaggia, Andrea; Balducci, Cristian; Sarchielli, Guido

    2015-06-15

    With the recent changes in the world of work psychosocial risks are increasingly prevalent, causing work stress and physical and mental illnesses, which have a tremendous impact on public health and social participation. Supervisors' behaviour development was proposed as an innovative intervention that can reduce psychosocial risks. The "Stress Management Competency Indicator Tool" is one of the most important questionnaires that assess managers' preventive behaviour. However, its psychometric properties have never been evaluated and the length of the questionnaire (66 items) limits its practical applicability. The aim of this study was to contribute to the development of the questionnaire by providing psychometric evidence on a brief version of the tool focusing on the "Managing and Communicating existing and future Work" cluster of behaviours, which has been found to be the crucial one in terms of stress prevention. A questionnaire was administered to 178 employees of two Italian public organizations (a municipality and a hospital), measuring the supervisors' "Managing and Communicating existing and future Work" competency, and the affective well-being and work team effectiveness. The results showed excellent psychometric properties of the supervisors' behaviour scale and confirmed the expected relationships with criterion outcomes (affective well-being and team effectiveness). Overall, the factorial structure and dimensionality, the construct validity and reliability, and the concurrent validity of the tool were strongly supported by this study. We concluded that the brief version of the scale is a valid and reliable measure that can be easily used in practice and that can contribute to the development of research and practice on this topic. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay

    PubMed Central

    Karolinski, Ariel; Mazzoni, Agustina; Belizán, José M; Althabe, Fernando; Bergel, Eduardo; Buekens, Pierre

    2010-01-01

    Objective To review the use of evidence-based practices in the care of mothers who died or had severe morbidity attending public hospitals in two Latin American countries. Methods This study is part of a multicenter intervention to increase the use of evidence-based obstetric practice. Data on maternal deaths and women admitted to intensive care units whose deliveries occurred in 24 hospitals in Argentina and Uruguay were analyzed. Primary outcomes were use rates of effective interventions to reduce maternal mortality (MM) and severe maternal morbidity (SMM). Results A total of 106 women were included: 26 maternal deaths and 80 women with SMM. Some effective interventions for severe acute hemorrhage had a high use rate, such as blood transfusion (91%) and timely cesarean delivery (75%), while active management of the third stage of labor (25%) showed a lower rate. The overall use rate of effective interventions was 58% (95% CI, 49%–67%). This implies that 42% of the women did not receive one of the effective interventions to reduce MM and SMM. Conclusion This study shows a low use of effective interventions to reduce MM and SMM in public hospitals in Argentina and Uruguay. Dissemination and implementation of evidence-based practices must be guaranteed to effectively achieve progress on maternal health. PMID:20605151

  6. Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay.

    PubMed

    Karolinski, Ariel; Mazzoni, Agustina; Belizán, José M; Althabe, Fernando; Bergel, Eduardo; Buekens, Pierre

    2010-08-01

    To review the use of evidence-based practices in the care of mothers who died or had severe morbidity attending public hospitals in two Latin American countries. This study is part of a multicenter intervention to increase the use of evidence-based obstetric practice. Data on maternal deaths and women admitted to intensive care units whose deliveries occurred in 24 hospitals in Argentina and Uruguay were analyzed. Primary outcomes were use rates of effective interventions to reduce maternal mortality (MM) and severe maternal morbidity (SMM). A total of 106 women were included: 26 maternal deaths and 80 women with SMM. Some effective interventions for severe acute hemorrhage had a high use rate, such as blood transfusion (91%) and timely cesarean delivery (75%), while active management of the third stage of labor (25%) showed a lower rate. The overall use rate of effective interventions was 58% (95% CI, 49%-67%). This implies that 42% of the women did not receive one of the effective interventions to reduce MM and SMM. This study shows a low use of effective interventions to reduce MM and SMM in public hospitals in Argentina and Uruguay. Dissemination and implementation of evidence-based practices must be guaranteed to effectively achieve progress on maternal health. Copyright 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients.

    PubMed

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

    2008-07-01

    Contingency management (CM) is efficacious in reducing drug use. This study examined whether CM also reduces human immunodeficiency virus (HIV) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment. Data were analyzed from a subset of participants in a combined data set of three published randomized controlled trials of CM treatments. A community-based methadone maintenance clinic. One-hundred and sixty-five cocaine-abusing methadone maintenance patients. Participants received either standard methadone treatment or standard methadone treatment with CM for 3 months. The HIV Risk Behavior Scale (HRBS) was administered prior to randomization to a study condition and 3 months after the study treatments ended. The primary objective indicator of drug use was longest duration of cocaine and opioid abstinence achieved during treatment. Relative to those assigned to standard care, participants receiving CM significantly decreased overall HIV risk behaviors and injection drug use risk behaviors. CM participants also achieved longer durations of consecutive cocaine and opioid abstinence during treatment. Duration of abstinence achieved mediated the relationship between treatment condition and HRBS difference scores. These results suggest that CM treatment reduces HIV drug use risk behaviors in cocaine-abusing methadone maintenance patients.

  8. Use of drinking water treatment residuals as a potential best management practice to reduce phosphorus risk index scores.

    PubMed

    Dayton, E A; Basta, N T

    2005-01-01

    The P risk index system has been developed to identify agricultural fields vulnerable to P loss as a step toward protecting surface water. Because of their high Langmuir phosphorus adsorption maxima (P(max)), use of drinking water treatment residuals (WTRs) should be considered as a best management practice (BMP) to lower P risk index scores. This work discusses three WTR application methods that can be used to reduce P risk scores: (i) enhanced buffer strip, (ii) incorporation into a high soil test phosphorus (STP) soil, and (iii) co-blending with manure or biosolids. The relationship between WTR P(max) and reduction in P extractability and runoff P was investigated. In a simulated rainfall experiment, using a buffer strip enhanced with 20 Mg WTR ha(-1), runoff P was reduced by from 66.8 to 86.2% and reductions were related to the WTR P(max). When 25 g kg(-1) WTR was incorporated into a high STP soil of 315 mg kg(-1) determined using Mehlich-3 extraction, 0.01 M calcium chloride-extractable phosphorus (CaCl(2)-P) reductions ranged from 60.9 to 96.0% and were strongly (P < 0.01) related to WTR P(max). At a 100 g kg(-1) WTR addition, Mehlich 3-extractable P reductions ranged from 41.1 to 86.7% and were strongly (P < 0.01) related to WTR P(max). Co-blending WTR at 250 g kg(-1) to manure or biosolids reduced CaCl(2)-P by >75%. The WTR P(max) normalized across WTR application rates (P(max) x WTR application) was significantly related to reductions in CaCl(2)-P or STP. Using WTR as a P risk index modifying factor will promote effective use of WTR as a BMP to reduce P loss from agricultural land.

  9. Can Parental Monitoring and Peer Management Reduce the Selection or Influence of Delinquent Peers? Testing the Question Using a Dynamic Social Network Approach

    ERIC Educational Resources Information Center

    Tilton-Weaver, Lauree C.; Burk, William J.; Kerr, Margaret; Stattin, Håkan

    2013-01-01

    We tested whether parents can reduce affiliation with delinquent peers through 3 forms of peer management: soliciting information, monitoring rules, and communicating disapproval of peers. We examined whether peer management interrupted 2 peer processes: selection and influence of delinquent peers. Adolescents' feelings of being overcontrolled by…

  10. ICONS: Managing Care and Costs: The Sustained Cost Impact of Reduced Hospitalizations in a Partnership-Measurement Model of Disease Management.

    PubMed

    Paradis, Pierre Emmanuel; Nemis-White, Joanna; Meilleur, Marie-Claude; Ginn, Marissa; Cox, Jafna; Montague, Terrence

    2010-01-01

    Improving Cardiovascular Outcomes in Nova Scotia (ICONS) was a multidisciplinary-partnership, measurement-driven disease management project designed to improve the care and outcomes of patients with acute and chronic heart diseases in Nova Scotia. Previous analyses demonstrated beneficial clinical and macroeconomic end points at the population and system levels, including heightened awareness of the value of team care, increased use of proven therapies, decreased re-hospitalizations and a positive dollar return on investment for the economies of Nova Scotia and Canada. This article analyzes the additional cost-reduction benefits resulting from the reduced re-hospitalizations that occurred among patient populations with heart attacks and heart failure. Over the five-year course of ICONS, one-year readmissions and readmission rates fell continuously for both index disease states. Despite a general inflationary rise in real hospital costs, the per-event cost of readmissions expressed in constant 2002 dollars also decreased: from $10,377 in 1997 to $9,022 in 2002 for the heart attack patient population; and from $9,020 to $8,697 for patients with heart failure. Total real yearly costs for heart attack readmissions fell from $7.4 million in 1997 to $6.4 million in 2002, a 14% decrease; for heart failure, yearly costs decreased by 26%, from $9.2 million to $6.8 million. These microeconomic data supplement the previously reported improvements in patient care and the positive macroeconomic impact of ICONS. Overall, ICONS demonstrated that quality and cost of healthcare could be simultaneously and successfully managed over a sustained period of time for whole patient populations in a real-world setting. ICONS offers strong evidence of the value of the partnership-measurement model of disease management and prevention as a reproducible and desirable template for next-generation healthcare in Canada.

  11. Effectiveness of a Reduced-Risk Insecticide Based Bed Bug Management Program in Low-Income Housing.

    PubMed

    Singh, Narinderpal; Wang, Changlu; Cooper, Richard

    2013-11-28

    Bed bug (Cimex lectularius L.) infestations are becoming increasingly common in low-income communities. Once they are introduced, elimination is very difficult. As part of the efforts to develop effective and safe bed bug management programs, we conducted a laboratory study evaluating the efficacy of a reduced-risk insecticide-Alpine aerosol (0.5% dinotefuran). We then conducted a field evaluation of a reduced-risk insecticide based integrated pest management (IPM) program in low-income family apartments with young children. In laboratory evaluations, direct spray and 5 min exposure to dry Alpine aerosol residue caused 100.0 ± 0.0 and 91.7 ± 8.3% mortality to bed bug nymphs, respectively. Direct Alpine aerosol spray killed 91.3 ± 4.3% of the eggs. The IPM program included education, steam, bagging infested linens, placing intercepting devices under furniture legs and corners of rooms, applying Alpine aerosol and Alpine dust (0.25% dinotefuran, 95% diatomaceous earth dust), and regularly scheduled monitoring and re-treatment. Nine apartments ranging from 1-1,428 (median: 29) bed bugs based on visual inspection and Climbup interceptor counts were included. Over a 6-month period, an average 172 g insecticide (Alpine aerosol + Alpine dust) was used in each apartment, a 96% reduction in pesticide usage compared to chemical only treatment reported in a similar environment. The IPM program resulted in an average of 96.8 ± 2.2% reduction in the number of bed bugs. However, elimination of bed bugs was only achieved in three lightly infested apartments (<30 bed bugs at the beginning). Elimination success was closely correlated with the level of bed bug populations.

  12. Effectiveness of a Reduced-Risk Insecticide Based Bed Bug Management Program in Low-Income Housing

    PubMed Central

    Singh, Narinderpal; Wang, Changlu; Cooper, Richard

    2013-01-01

    Bed bug (Cimex lectularius L.) infestations are becoming increasingly common in low-income communities. Once they are introduced, elimination is very difficult. As part of the efforts to develop effective and safe bed bug management programs, we conducted a laboratory study evaluating the efficacy of a reduced-risk insecticide—Alpine aerosol (0.5% dinotefuran). We then conducted a field evaluation of a reduced-risk insecticide based integrated pest management (IPM) program in low-income family apartments with young children. In laboratory evaluations, direct spray and 5 min exposure to dry Alpine aerosol residue caused 100.0 ± 0.0 and 91.7 ± 8.3% mortality to bed bug nymphs, respectively. Direct Alpine aerosol spray killed 91.3 ± 4.3% of the eggs. The IPM program included education, steam, bagging infested linens, placing intercepting devices under furniture legs and corners of rooms, applying Alpine aerosol and Alpine dust (0.25% dinotefuran, 95% diatomaceous earth dust), and regularly scheduled monitoring and re-treatment. Nine apartments ranging from 1–1,428 (median: 29) bed bugs based on visual inspection and Climbup interceptor counts were included. Over a 6-month period, an average 172 g insecticide (Alpine aerosol + Alpine dust) was used in each apartment, a 96% reduction in pesticide usage compared to chemical only treatment reported in a similar environment. The IPM program resulted in an average of 96.8 ± 2.2% reduction in the number of bed bugs. However, elimination of bed bugs was only achieved in three lightly infested apartments (<30 bed bugs at the beginning). Elimination success was closely correlated with the level of bed bug populations. PMID:26462533

  13. The efficacy of asthma case management in an urban school district in reducing school absences and hospitalizations for asthma.

    PubMed

    Levy, Marian; Heffner, Brenda; Stewart, Tara; Beeman, Gail

    2006-08-01

    Pediatric asthma rates are reaching epidemic proportions, adversely affecting children's quality of life, educational potential, and health care costs, especially those in the inner city. This study evaluated the effectiveness of a school-based asthma case management (CM) approach with medically underserved inner-city children attending Memphis City schools. Fourteen elementary schools with high rates of asthma-related hospital utilization were grouped according to school size, percentage of children with asthma enrolled, and percentage of children eligible for free or reduced-price lunch. Schools were randomized to either a nurse CM intervention or a usual care (UC) condition. The CM group included 115 students; 128 students were in the UC group. A longitudinal design was used to follow students' progress. Students were primarily African-American children diagnosed with asthma. In CM schools, nurse case managers conducted weekly group sessions incorporating the Open Airways curriculum, followed up on students' school absences, and coordinated students' asthma care with families, school personnel, and medical providers. In UC schools, students received routine school nursing services. CM students had fewer school absences than their counterparts in UC schools (mean 4.38 vs 8.18 days, respectively) and experienced significantly fewer emergency department visits (p < .0001) and fewer hospital days (p < .05) than UC students. No such differences existed before program initiation. Replication and follow-up in year 2 showed continued significant improvements. School-based nurse CM can achieve significant improvements in school attendance and medical utilization.

  14. Active management of the third stage of labor may reduce breastfeeding duration due to pain and physical complications.

    PubMed

    Brown, Amy; Jordan, Sue

    2014-12-01

    Evidence is growing that active management of the third stage of labor using prophylactic uterotonics may be associated with lower breastfeeding rates. The reasons underlying this relationship are incompletely understood. The aim of this article is to examine the experiences of mothers who stopped breastfeeding in relation to administration of parenteral uterotonics for postpartum hemorrhage prophylaxis. Two hundred eighty-eight mothers with an infant 0-6 months of age who had a vaginal birth completed a self-report questionnaire examining injections of uterotonics during the third stage of labor, breastfeeding at birth, breastfeeding duration, and, where applicable, reasons for breastfeeding cessation, whether physical, social, or psychological. No significant association was found between infant feeding mode at birth (breast/formula) and injection of uterotonics. However, mothers who had received uterotonics were significantly less likely to be breastfeeding at all at 2 and 6 weeks. Among mothers who had stopped breastfeeding, those who had received parenteral prophylactic uterotonics were significantly more likely to report stopping breastfeeding for physical reasons such as pain or difficulty. These findings suggest that injection of prophylactic uteronics may reduce breastfeeding duration, but not initiation. This may be attributable to the effects of oxytocin or ergometrine on the physiology of lactation, leading to difficulties with infant latch and milk supply. If breastfeeding rates are to be optimized, this hypothesis needs to be explored in randomized controlled trials of third-stage management. Meanwhile, mothers who receive parenteral uterotonics may need additional support to establish breastfeeding.

  15. Application of strategies for sanitation management in wastewater treatment plants in order to control/reduce greenhouse gas emissions.

    PubMed

    Préndez, Margarita; Lara-González, Scarlette

    2008-09-01

    Greenhouse gases (GHG), basically methane (CH(4)), carbon dioxide (CO(2)) and nitrous oxide (N(2)O), occur at atmospheric concentrations of ppbv to ppmv under natural conditions. GHG have long mean lifetimes and are an important factor for the mean temperature of the Earth. However, increasing anthropogenic emissions could produce a scenario of progressive and cumulative effects over time, causing a potential "global climate change". Biological degradation of the organic matter present in wastewater is considered one of the anthropogenic sources of GHG. In this study, GHG emissions for the period 1990-2027 were estimated considering the sanitation process and the official domestic wastewater treatment startup schedule approved for the Metropolitan Region (MR) of Santiago, Chile. The methodology considers selected models proposed by the Intergovernmental Panel on Climate Change (IPCC) and some others published by different authors; these were modified according to national conditions and different sanitation and temporal scenarios. For the end of the modeled period (2027), results show emissions of about 65 Tg CO(2) equiv./year (as global warming potential), which represent around 50% of national emissions. These values could be reduced if certain sanitation management strategies were introduced in the environmental management by the sanitation company in charge of wastewater treatment.

  16. The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting.

    PubMed

    Triplett, Patrick; Dearholt, Sandra; Cooper, Mary; Herzke, John; Johnson, Erin; Parks, Joyce; Sullivan, Patricia; Taylor, Karin F; Rohde, Judith

    2017-07-01

    Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.

  17. Has the shift to managed care reduced Medicaid expenditures? Evidence from state and local-level mandates.

    PubMed

    Duggan, Mark; Hayford, Tamara

    2013-01-01

    From 1991 to 2009, the fraction of Medicaid recipients enrolled in HMOs and other forms of Medicaid managed care (MMC) increased from 11 percent to 71 percent. This increase was largely driven by state and local mandates that required most Medicaid recipients to enroll in an MMC plan. Theoretically, it is ambiguous whether the shift from fee-for-service into managed care would lead to an increase or a reduction in Medicaid spending. This paper investigates this effect using a data set on state- and local-level MMC mandates and detailed data from the Centers for Medicare and Medicaid Services (CMS) on state Medicaid expenditures. The findings suggest that shifting Medicaid recipients from fee-for-service into MMC did not on average reduce Medicaid spending. If anything, our results suggest that the shift to MMC increased Medicaid spending and that this effect was especially present for risk-based HMOs. However, the effects of the shift to MMC on Medicaid spending varied significantly across states as a function of the generosity of the state's baseline Medicaid provider reimbursement rates.

  18. Challenges in the Management of Patients with Chronic Obstructive Pulmonary Disease and Heart Failure With Reduced Ejection Fraction.

    PubMed

    Jaiswal, Abhishek; Chichra, Astha; Nguyen, Vinh Q; Gadiraju, Taraka V; Le Jemtel, Thierry H

    2016-02-01

    Chronic obstructive pulmonary disease (COPD) and heart failure with reduced ejection fraction (HFrEF) commonly coexist in clinical practice. The prevalence of COPD among HFrEF patients ranges from 20 to 32 %. On the other hand; HFrEF is prevalent in more than 20 % of COPD patients. With an aging population, the number of patients with coexisting COPD and HFrEF is on rise. Coexisting COPD and HFrEF presents a unique diagnostic and therapeutic clinical conundrum. Common symptoms shared by both conditions mask the early referral and detection of the other. Beta blockers (BB), angiotensin-converting enzyme inhibitors, and aldosterone antagonists have been shown to reduce hospitalizations, morbidity, and mortality in HFrEF while long-acting inhaled bronchodilators (beta-2-agonists and anticholinergics) and corticosteroids have been endorsed for COPD treatment. The opposing pharmacotherapy of BBs and beta-2-agonists highlight the conflict in prescribing BBs in COPD and beta-2-agonists in HFrEF. This has resulted in underutilization of evidence-based therapy for HFrEF in COPD patients owing to fear of adverse effects. This review aims to provide an update and current perspective on diagnostic and therapeutic management of patients with coexisting COPD and HFrEF.

  19. Shift work: health, performance and safety problems, traditional countermeasures, and innovative management strategies to reduce circadian misalignment.

    PubMed

    Smith, Mark R; Eastman, Charmane I

    2012-01-01

    There are three mechanisms that may contribute to the health, performance, and safety problems associated with night-shift work: (1) circadian misalignment between the internal circadian clock and activities such as work, sleep, and eating, (2) chronic, partial sleep deprivation, and (3) melatonin suppression by light at night. The typical countermeasures, such as caffeine, naps, and melatonin (for its sleep-promoting effect), along with education about sleep and circadian rhythms, are the components of most fatigue risk-management plans. We contend that these, while better than nothing, are not enough because they do not address the underlying cause of the problems, which is circadian misalignment. We explain how to reset (phase-shift) the circadian clock to partially align with the night-work, day-sleep schedule, and thus reduce circadian misalignment while preserving sleep and functioning on days off. This involves controlling light and dark using outdoor light exposure, sunglasses, sleep in the dark, and a little bright light during night work. We present a diagram of a sleep-and-light schedule to reduce circadian misalignment in permanent night work, or a rotation between evenings and nights, and give practical advice on how to implement this type of plan.

  20. Shift work: health, performance and safety problems, traditional countermeasures, and innovative management strategies to reduce circadian misalignment

    PubMed Central

    Smith, Mark R; Eastman, Charmane I

    2012-01-01

    There are three mechanisms that may contribute to the health, performance, and safety problems associated with night-shift work: (1) circadian misalignment between the internal circadian clock and activities such as work, sleep, and eating, (2) chronic, partial sleep deprivation, and (3) melatonin suppression by light at night. The typical countermeasures, such as caffeine, naps, and melatonin (for its sleep-promoting effect), along with education about sleep and circadian rhythms, are the components of most fatigue risk-management plans. We contend that these, while better than nothing, are not enough because they do not address the underlying cause of the problems, which is circadian misalignment. We explain how to reset (phase-shift) the circadian clock to partially align with the night-work, day-sleep schedule, and thus reduce circadian misalignment while preserving sleep and functioning on days off. This involves controlling light and dark using outdoor light exposure, sunglasses, sleep in the dark, and a little bright light during night work. We present a diagram of a sleep-and-light schedule to reduce circadian misalignment in permanent night work, or a rotation between evenings and nights, and give practical advice on how to implement this type of plan. PMID:23620685

  1. Cool temperatures reduce antifungal activity of symbiotic bacteria of threatened amphibians--implications for disease management and patterns of decline.

    PubMed

    Daskin, Joshua H; Bell, Sara C; Schwarzkopf, Lin; Alford, Ross A

    2014-01-01

    Chytridiomycosis, caused by the fungus Batrachochytrium dendrobatidis (Bd), is a widespread disease of amphibians responsible for population declines and extinctions. Some bacteria from amphibians' skins produce antimicrobial substances active against Bd. Supplementing populations of these cutaneous antifungal bacteria might help manage chytridiomycosis in wild amphibians. However, the activity of protective bacteria may depend upon environmental conditions. Biocontrol of Bd in nature thus requires knowledge of how environmental conditions affect their anti-Bd activity. For example, Bd-driven amphibian declines have often occurred at temperatures below Bd's optimum range. It is possible these declines occurred due to reduced anti-Bd activity of bacterial symbionts at cool temperatures. Better understanding of the effects of temperature on chytridiomycosis development could also improve risk evaluation for amphibian populations yet to encounter Bd. We characterized, at a range of temperatures approximating natural seasonal variation, the anti-Bd activity of bacterial symbionts from the skins of three species of rainforest tree frogs (Litoria nannotis, Litoria rheocola, and Litoria serrata). All three species declined during chytridiomycosis outbreaks in the late 1980s and early 1990s and have subsequently recovered to differing extents. We collected anti-Bd bacterial symbionts from frogs and cultured the bacteria at constant temperatures from 8 °C to 33 °C. Using a spectrophotometric assay, we monitored Bd growth in cell-free supernatants (CFSs) from each temperature treatment. CFSs from 11 of 24 bacteria showed reduced anti-Bd activity in vitro when they were produced at cool temperatures similar to those encountered by the host species during population declines. Reduced anti-Bd activity of metabolites produced at low temperatures may, therefore, partially explain the association between Bd-driven declines and cool temperatures. We show that to avoid

  2. Cost-effectiveness of the diabetes care protocol, a multifaceted computerized decision support diabetes management intervention that reduces cardiovascular risk.

    PubMed

    Cleveringa, Frits G W; Welsing, Paco M J; van den Donk, Maureen; Gorter, Kees J; Niessen, Louis W; Rutten, Guy E H M; Redekop, William K

    2010-02-01

    The Diabetes Care Protocol (DCP), a multifaceted computerized decision support diabetes management intervention, reduces cardiovascular risk of type 2 diabetic patients. We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective. A cluster randomized trial provided data of DCP versus usual care. The 1-year follow-up patient data were extrapolated using a modified Dutch microsimulation diabetes model, computing individual lifetime health-related costs, and health effects. Incremental costs and effectiveness (quality-adjusted life-years [QALYs]) were estimated using multivariate generalized estimating equations to correct for practice-level clustering and confounding. Incremental cost-effectiveness ratios (ICERs) were calculated and cost-effectiveness acceptability curves were created. Stroke costs were calculated separately. Subgroup analyses examined patients with and without cardiovascular disease (CVD+ or CVD- patients, respectively). Excluding stroke, DCP patients lived longer (0.14 life-years, P = NS), experienced more QALYs (0.037, P = NS), and incurred higher total costs (euro 1,415, P = NS), resulting in an ICER of euro 38,243 per QALY gained. The likelihood of cost-effectiveness given a willingness-to-pay threshold of euro 20,000 per QALY gained is 30%. DCP had a more favorable effect on CVD+ patients (ICER = euro 14,814) than for CVD- patients (ICER = euro 121,285). Coronary heart disease costs were reduced (euro-587, P < 0.05). DCP reduces cardiovascular risk, resulting in only a slight improvement in QALYs, lower CVD costs, but higher total costs, with a high cost-effectiveness ratio. Cost-effective care can be achieved by focusing on cardiovascular risk factors in type 2 diabetic patients with a history of CVD.

  3. Modeling of solar radiation management: a comparison of simulations using reduced solar constant and stratospheric sulphate aerosols

    NASA Astrophysics Data System (ADS)

    Kalidindi, Sirisha; Bala, Govindasamy; Modak, Angshuman; Caldeira, Ken

    2015-05-01

    The climatic effects of Solar Radiation Management (SRM) geoengineering have been often modeled by simply reducing the solar constant. This is most likely valid only for space sunshades and not for atmosphere and surface based SRM methods. In this study, a global climate model is used to evaluate the differences in the climate response to SRM by uniform solar constant reduction and stratospheric aerosols. Our analysis shows that when global mean warming from a doubling of CO2 is nearly cancelled by both these methods, they are similar when important surface and tropospheric climate variables are considered. However, a difference of 1 K in the global mean stratospheric (61-9.8 hPa) temperature is simulated between the two SRM methods. Further, while the global mean surface diffuse radiation increases by ~23 % and direct radiation decreases by about 9 % in the case of sulphate aerosol SRM method, both direct and diffuse radiation decrease by similar fractional amounts (~1.0 %) when solar constant is reduced. When CO2 fertilization effects from elevated CO2 concentration levels are removed, the contribution from shaded leaves to gross primary productivity (GPP) increases by 1.8 % in aerosol SRM because of increased diffuse light. However, this increase is almost offset by a 15.2 % decline in sunlit contribution due to reduced direct light. Overall both the SRM simulations show similar decrease in GPP (~8 %) and net primary productivity (~3 %). Based on our results we conclude that the climate states produced by a reduction in solar constant and addition of aerosols into the stratosphere can be considered almost similar except for two important aspects: stratospheric temperature change and the consequent implications for the dynamics and the chemistry of the stratosphere and the partitioning of direct versus diffuse radiation reaching the surface. Further, the likely dependence of global hydrological cycle response on aerosol particle size and the latitudinal and

  4. Group Training of Stress Management vs. Group Cognitive-Behavioral Therapy in Reducing Depression, Anxiety and Perceived Stress Among HIV-Positive Men.

    PubMed

    Hemmati Sabet, Akbar; Khalatbari, Javad; Abbas Ghorbani, Maryam; Haghighi, Mohammad; Ahmadpanah, Mohammad

    2013-01-01

    To compare the effectiveness of group training of stress management with cognitive-behavioral therapy (CBT) in reducing depression, anxiety and stress perceived among HIV-positive men. Inthis semi-experimental study, three groups of HIV-positive men (CBT group, stress management group, and control group) including 15 patients in each group were compared regarding depression, anxiety, and stress using pre-test and post-test tools. Both interventions (CBT and stress management) were effective in reducing depression, anxiety and perceived stress. Evaluating adjustedmean showed the more effectivenessofthe group stressmanagementtraining than CBT. Group stress management training is more effective than group CBT in HIV-positive mentodecreasedepression, anxiety and stress management. None. URL: http://.irct.ir. Unique identifier: 2012121711782N1.

  5. Group Training of Stress Management vs. Group Cognitive-Behavioral Therapy in Reducing Depression, Anxiety and Perceived Stress Among HIV-Positive Men

    PubMed Central

    Hemmati Sabet, Akbar; Khalatbari, Javad; Abbas Ghorbani, Maryam; Haghighi, Mohammad; Ahmadpanah, Mohammad

    2013-01-01

    Objective: To compare the effectiveness of group training of stress management with cognitive-behavioral therapy (CBT) in reducing depression, anxiety and stress perceived among HIV-positive men. Methods:Inthis semi-experimental study, three groups of HIV-positive men (CBT group, stress management group, and control group) including 15 patients in each group were compared regarding depression, anxiety, and stress using pre-test and post-test tools. Results: Both interventions (CBT and stress management) were effective in reducing depression, anxiety and perceived stress. Evaluating adjustedmean showed the more effectivenessofthe group stressmanagementtraining than CBT. Conclusion: Group stress management training is more effective than group CBT in HIV-positive mentodecreasedepression, anxiety and stress management. Declaration of interest: None. Clinical Trial Registration: URL: http://.irct.ir. Unique identifier: 2012121711782N1 PMID:24644493

  6. Determining which land management practices reduce catchment scale flood risk and where to implement them for optimum effect

    NASA Astrophysics Data System (ADS)

    Pattison, Ian; Lane, Stuart; Hardy, Richard; Reaney, Sim

    2010-05-01

    The theoretical basis for why changes in land management might increase flood risk are well known, but proving them through numerical modelling still remains a challenge. In large catchments, like the River Eden in Cumbria, NW England, one of the reasons for this is that it is unfeasible to test multiple scenarios in all their possible locations. We have developed two linked approaches to refine the number of scenarios and locations using 1) spatial downscaling and 2) participatory decision making, which potentially should increase the likelihood of finding a link between land use and downstream flooding. Firstly, land management practices can have both flood reducing and flood increasing effects, depending on their location. As a result some areas of the catchment are more important in determining downstream flood risk than others, depending on the land use and hydrological connectivity. We apply a downscaling approach to identify which sub-catchments are most important in explaining downstream flooding. This is important because it is in these areas that management options are most likely to have a positive and detectable effect. Secondly, once the dominant sub-catchment has been identified, the land management scenarios that are both feasible and likely to impact flood risk need to be determined. This was done through active stakeholder engagement. The stakeholder group undertook a brainstorming exercise, which suggested about 30 different rural land management scenarios, which were mapped on to a literature-based conceptual framework of hydrological processes. Then these options were evaluated based on five criteria: relevance to catchment, scientific effectiveness, testability, robustness/uncertainty and feasibility of implementation. The suitability of each scenario was discussed and prioritised by the stakeholder group based on scientific needs and expectations and local suitability and feasibility. The next stage of the participatory approach was a mapping

  7. Effective allergen avoidance for reducing exposure to house dust mite allergens and improving disease management in adult atopic asthmatics.

    PubMed

    Tsurikisawa, Naomi; Saito, Akemi; Oshikata, Chiyako; Yasueda, Hiroshi; Akiyama, Kazuo

    2016-10-01

    We investigated the best strategy for adult asthmatics to avoid exposure to Dermatophagoides group (Der-1) allergens. Adult atopic asthmatics (n = 111) followed a 32-item checklist for avoiding Der-1 allergen exposure. Twenty-five patients were excluded through incomplete sampling; 50 remaining patients encased their pillows/futons/mattresses in microfine-fiber covers, 13 used vacuum cleaners with dust-mite-collection nozzles, and 23 acted as non-intervention controls. During August-October 2010 and August-October 2011, dust samples were collected in Petri dishes placed in bedrooms for 2 weeks and from mattresses/futons by using adhesive tape on one morning. A Der-1 level decrease was defined as a mean 2011 Der-1 level of <1 as a ratio of the 2010 level on tape or Petri dish samples. We analyzed the associations between Der-1 level change (by ELISA) and % weekly variability in peak expiratory flow (PEF) or fraction of exhaled nitric oxide (FeNO) after intervention. Der-1 levels decreased significantly in the covers group but not the vacuuming group. FeNO levels and PEF variability were unchanged in both groups. In patients whose Petri dish or tape samples showed decreased Der-1 levels, the % PEF variability was lower in 2011 than in 2010, but FeNO levels were unchanged. Three interventions (vacuuming all family members' mattress/futon surfaces at least weekly or after exposure of the futons to sunlight, and floor wiping before vacuuming), plus using covers, were the most effective management strategy in reducing Der-1 levels. This environmental and bedding maintenance program may help manage adult atopic asthma.

  8. Reducing the predictive uncertainty associated with groundwater management decision-making in the Perth regional aquifer system of Western Australia

    NASA Astrophysics Data System (ADS)

    Siade, A. J.

    2015-12-01

    The Perth Regional Aquifer Model (PRAMS) framework has been used for about a decade now to evaluate the potential anthropogenic impacts associated with management decisions that affect Perth's groundwater resources. A great wealth of data, expertise and numerical analysis have gone into the development of PRAMS over the years. However, there has been little quantitative work conducted on systemically addressing the uncertainty in the model's structure and predictions. PRAMS is designed to make a variety of regional and local-scale predictions and, both the nature and magnitude of the uncertainty associated with these predictions can vary significantly. A primary prediction to be addressed using the PRAMS framework, will be the effects of various deep-aquifer groundwater management scenarios on both the environmental and social concerns surrounding the superficial aquifer, which supports sensitive wetlands, and the negative impacts of seawater intrusion into the deep aquifers. A particular model-structure component that greatly affects the predictions associated with deep-aquifer groundwater extraction is the characterization of the local fault structure, i.e., whether or not faults are acting as barriers to groundwater flow. Therefore, uncertainty in fault characterization can subsequently lead to significant predictive uncertainty. However, new observation data can be obtained to reduce this uncertainty. In this study, an experimental design methodology is employed to optimally acquire new observations of state in such a way as to maximize the information obtained about the hydraulic properties of faults. Various information criteria are employed to develop optimal locations of new observation wells. The A-optimality criterion was found to be the most effective for comparing sampling strategies given the design assumptions, which include the parameter sets employed, hydraulic forcing, temporal considerations, and the use of the existing observation network. A

  9. Estimation and evaluation of management options to control and/or reduce the risk of not complying with commercial sterility.

    PubMed

    Pujol, Laure; Albert, Isabelle; Magras, Catherine; Johnson, Nicholas Brian; Membré, Jeanne-Marie

    2015-11-20

    In a previous study, a modular process risk model, from the raw material reception to the final product storage, was built to estimate the risk of a UHT-aseptic line of not complying with commercial sterility (Pujol et al., 2015). This present study was focused on demonstrating how the model (updated version with uncertainty and variability separated and 2(nd) order Monte Carlo procedure run) could be used to assess quantitatively the influence of management options. This assessment was done in three steps: pinpoint which process step had the highest influence on the risk, identify which management option(s) could be the most effective to control and/or reduce the risk, and finally evaluate quantitatively the influence of changing process setting(s) on the risk. For Bacillus cereus, it was identified that during post-process storage in an aseptic tank, there was potentially an air re-contamination due to filter efficiency loss (efficiency loss due to successive in-place sterilizations after cleaning operations), followed by B. cereus growth. Two options were then evaluated: i) reducing by one fifth of the number of filter sterilizations before renewing the filters, ii) designing new UHT-aseptic lines without an aseptic tank, i.e. without a storage period after the thermal process and before filling. Considering the uncertainty in the model, it was not possible to confirm whether these options had a significant influence on the risk associated with B. cereus. On the other hand, for Geobacillus stearothermophilus, combinations of heat-treatment time and temperature enabling the control or reduction in risk by a factor of ca. 100 were determined; for ease of operational implementation, they were presented graphically in the form of iso-risk curves. For instance, it was established that a heat treatment of 138°C for 31s (instead of 138°C for 25s) enabled a reduction in risk to 18×10(-8) (95% CI=[10; 34]×10(-8)), instead of 578×10(-8) (95% CI=[429; 754]×10

  10. Leveraging management strategies for seedborne plant diseases to reduce Salmonella enterica Serovar Typhimurium incidence on tomato seed and seedlings.

    PubMed

    Lewis Ivey, Melanie L; Xu, Xiulan; Miller, Sally A

    2014-03-01

    Tomatoes have been linked to many outbreaks of salmonellosis over the last decade, but the routes of contamination have yet to be discerned. Many phytopathogens of tomato are seedborne and are effectively managed using seed sanitizers. Seed sanitizers effective against bacterial phytopathogens were evaluated for their efficacy in killing bioluminescent Salmonella enterica serovar Typhimurium strain SeT-A14 on tomato seed infested with moderately high and high levels of pathogen. SeT-A14 incidence on seedlings produced from contaminated seed following sanitation was also determined. At a moderately high infestation rate (40%), SeT-A14 was eradicated on seed sanitized with 1.2% sodium hypochlorite (NaClO) mixed with 0.03% surfactant for 2 min, hydrochloric acid (HCl) for 30 min, and trichloromelamine for 2 min. At a higher infestation rate (94%), only NaClO and HCl were effective in eradicating SeT-A14 from the seed. At both infestation rates, 2% Virkon-S for 15 min significantly reduced SeT-A14 incidence compared with the nontreated infested controls but did not eradicate the pathogen. Hot water, a commonly used sanitizer for managing seedborne bacterial plant diseases, significantly reduced SeT-A14 on heavily infested seed, but incidence was still moderate at 17.5%. On seedlings produced from moderately highly infested seed, SeT-A14 was not detected using RapidChek Salmonella test strips. Using heavily infested seed, SeT-A14 was detected with the test strips in one of four pooled samples of 14-day-old seedlings produced from nonsanitized seed and from seed sanitized with hot water and trichloromelamine. However, bioluminescence was not observed on 14-day-old seedlings. To our knowledge, this is the first report that provides evidence that S. enterica serovar Typhimurium can be seed transmitted and can lead to the contamination of tomato seedlings. In addition to eliminating important bacterial phytopathogens from tomato seed, NaClO or HCl may mitigate the risk of

  11. A managed protocol for treatment of deceased potential donors reduces the incidence of cardiac arrest before organ explant

    PubMed Central

    Westphal, Glauco Adrieno; Zaclikevis, Viviane Renata; Vieira, Kalinca Daberkow; Cordeiro, Rodrigo de Brito; Horner, Marina Borges W.; de Oliveira, Thamy Pellizzaro; Duarte, Robson; Sperotto, Geonice; da Silveira, Georgiana; Caldeira, Milton; Coll, Elisabeth; Yus-Teruel, Santiago

    2012-01-01

    Objective To assess the effect of the application of a managed protocol for the maintenance care of deceased potential multiple organ donors at two hospitals. Methods A before (Phase 1)/after (Phase 2) study conducted at two general hospitals, which included consecutively potential donors admitted to two intensive care units. In Phase 1 (16 months), the data were collected retrospectively, and the maintenance care measures of the potential donors were instituted by the intensivists. In Phase 2 (12 months), the data collection was prospective, and a managed protocol was used for maintenance care. The two phases were compared in terms of their demographic variables, physiological variables at diagnosis of brain death and the end of the process, time to performance of brain death confirmatory test and end of the process, adherence to bundles of maintenance care essential measures, losses due to cardiac arrest, family refusal, contraindications, and the conversion rate of potential into actual donors. Student's t- and chi-square tests were used, and p-value < 0.05 was considered to be significant. Results A total of 42 potential donors were identified (18 in Phase 1 and 24 in Phase 2). The time interval between the first clinical assessment and the recovery decreased in Phase 2 (Phase 1: 35.0±15.5 hours versus Phase 2: 24.6±6.2 hours; p = 0.023). Adherence increased to 10 out of the 19 essential items of maintenance care, and losses due to cardiac arrest also decreased in Phase 2 (Phase 1: 27.8 versus 0% in Phase 2; p = 0.006), while the convertion rate increased (Phase 1: 44.4 versus 75% in Phase 2; p = 0.044). The losses due to family refusal and medical contraindication did not vary. Conclusion The adoption of a managed protocol focused on the application of essential measures for the care of potential deceased donors might reduce the loss of potential donors due to cardiac arrest. PMID:23917929

  12. Success of commonly used operating room management tools in reducing tardiness of first case of the day starts: evidence from German hospitals.

    PubMed

    Ernst, Christian; Szczesny, Andrea; Soderstrom, Naomi; Siegmund, Frank; Schleppers, Alexander

    2012-09-01

    One of the declared objectives of surgical suite management in Germany is to increase operating room (OR) efficiency by reducing tardiness of first case of the day starts. We analyzed whether the introduction of OR management tools by German hospitals in response to increasing economic pressure was successful in achieving this objective. The OR management tools we considered were the appointment of an OR manager and the development and adoption of a surgical suite governance document (OR charter). We hypothesized that tardiness of first case starts was less in ORs that have adopted one or both of these tools. Using representative 2005 survey data from 107 German anesthesiology departments, we used a Tobit model to estimate the effect of the introduction of an OR manager or OR charter on tardiness of first case starts, while controlling for hospital size and surgical suite complexity. Adoption reduced tardiness of first case starts by at least 7 minutes (mean reduction 15 minutes, 95% confidence interval (CI): 7-22 minutes, P < 0.001). Reductions in tardiness of first case starts figure prominently the objectives of surgical suite management in Germany. Our results suggest that the appointment of an OR manager or the adoption of an OR charter support this objective. For short-term decision making on the day of surgery, this reduction in tardiness may have economic implications, because it reduced overutilized OR time.

  13. Reduced fine sediment flux and channel change in response to the managed diversion of an upland river channel

    NASA Astrophysics Data System (ADS)

    Perks, Matthew Thomas; Warburton, Jeff

    2016-09-01

    This paper describes the implementation of a novel mitigation approach and subsequent adaptive management, designed to reduce the transfer of fine sediment (< 2 mm) in Glaisdale Beck, a small, predominantly upland catchment in the UK. Hydro-meteorological and suspended sediment data sets are collected over a 2-year period spanning pre- and post-diversion periods in order to assess the impact of the channel reconfiguration scheme on the fluvial suspended sediment dynamics. Analysis of the river response demonstrates that the fluvial sediment system has become more restrictive with reduced fine sediment transfer. This is characterized by reductions in flow-weighted mean suspended sediment concentrations from 77.93 mg L-1 prior to mitigation, to 74.36 mg L-1 following the diversion. A Mann-Whitney U test found statistically significant differences (p < 0.001) between the pre- and post-monitoring median suspended sediment concentrations (SSCs). Whilst application of one-way analysis of covariance (ANCOVA) on the coefficients of sediment rating curves developed before and after the diversion found statistically significant differences (p < 0.001), with both Loga and b coefficients becoming smaller following the diversion. Non-parametric analysis indicates a reduction in residuals through time (p < 0.001), with the developed LOWESS model over-predicting sediment concentrations as the channel stabilizes. However, the channel is continuing to adjust to the reconfigured morphology, with evidence of a headward propagating knickpoint which has migrated 120 m at an exponentially decreasing rate over the last 7 years since diversion. The study demonstrates that channel reconfiguration can be effective in mitigating fine sediment flux in headwater streams but the full value of this may take many years to achieve whilst the fluvial system slowly readjusts.

  14. Cost-effectiveness of reducing glycaemic episodes through community pharmacy management of patients with type 2 diabetes mellitus.

    PubMed

    Hendrie, Delia; Miller, Ted R; Woodman, Richard J; Hoti, Kreshnik; Hughes, Jeff

    2014-12-01

    Accessibility, availability and frequent public contact place community pharmacists in an ideal position to provide medically necessary, intensive health education and preventive health services to diabetes patients, thus reducing physician burden. We assessed the cost-effectiveness of reducing glycaemic episodes in patients with type 2 diabetes mellitus through a pharmacist-led Diabetes Management Education Program (DMEP) compared to standard care. We recruited eight metropolitan community pharmacies in Perth, Western Australia for the study. We paired them based on geographical location and the socioeconomic status of the population served, and then randomly selected one pharmacy in each pair to be in the intervention group, with the other assigned to the control group. We conducted an incremental cost-effectiveness analysis to compare the costs and effectiveness of DMEP with standard pharmacy care. Cost per patient of implementing DMEP was AU$394 (US$356) for the 6-month intervention period. Significantly greater reductions in number of hyperglycaemic and hypoglycaemic episodes occurred in the intervention relative to the control group [OR 0.34 (95 % CI 0.22, 0.52), p = 0.001; OR 0.54 (95 % CI 0.34, 0.86), p = 0.009], respectively, with a net reduction of 1.86 days with glycaemic episodes per patient per month. The cost-effectiveness of DMEP relative to standard pharmacy care was AU$43 (US$39) per day of glycaemic symptoms avoided. Patients with type 2 diabetes in three surveys were willing to pay an average of 1.9 times that amount to avoid a hypoglycaemic day. We conclude that DMEP decreased days with glycaemic symptoms at a reasonable cost. If a larger-scale replication study confirms these findings, widespread adoption of this approach would improve diabetes health without burdening general practitioners.

  15. Niacin-a critical component to the management of atherosclerosis: contemporary management of dyslipidemia to prevent, reduce, or reverse atherosclerotic cardiovascular disease.

    PubMed

    Mason, Carol M; Doneen, Amy L

    2012-01-01

    Niacin (nicotinic acid) is the most effective agent for raising high-density lipoprotein cholesterol levels and can improve the entire lipid panel in patients with dyslipidemia. Niacin-containing regimens are among the few treatments studied for dyslipidemia that have both elicited significant reductions in atherosclerotic progression (by angiography or imaging) and also significantly reduced (by approximately 90% vs control) the incidence of cardiovascular events in a single clinical trial. However, cutaneous flushing-an uncomfortable but typically transient adverse effect of niacin-often results in patient nonadherence with this potentially life-saving therapy. Effective counseling regarding the highly favorable benefit-risk ratio for niacin and management strategies such as careful dose escalation, follow-up monitoring, regimen adjustments, and the use of treatment adjuncts (eg, aspirin) can improve patient adherence with niacin therapy. Clinicians are uniquely positioned to provide such counseling to appropriate patients for niacin treatment and hence encourage wider use of this important and necessary cardioprotective medication.

  16. Design of experiments with multiple independent variables: a resource management perspective on complete and reduced factorial designs.

    PubMed

    Collins, Linda M; Dziak, John J; Li, Runze

    2009-09-01

    An investigator who plans to conduct an experiment with multiple independent variables must decide whether to use a complete or reduced factorial design. This article advocates a resource management perspective on making this decision, in which the investigator seeks a strategic balance between service to scientific objectives and economy. Considerations in making design decisions include whether research questions are framed as main effects or simple effects; whether and which effects are aliased (confounded) in a particular design; the number of experimental conditions that must be implemented in a particular design and the number of experimental subjects the design requires to maintain the desired level of statistical power; and the costs associated with implementing experimental conditions and obtaining experimental subjects. In this article 4 design options are compared: complete factorial, individual experiments, single factor, and fractional factorial. Complete and fractional factorial designs and single-factor designs are generally more economical than conducting individual experiments on each factor. Although relatively unfamiliar to behavioral scientists, fractional factorial designs merit serious consideration because of their economy and versatility.

  17. Design of Experiments with Multiple Independent Variables: A Resource Management Perspective on Complete and Reduced Factorial Designs

    PubMed Central

    Collins, Linda M.; Dziak, John J.; Li, Runze

    2009-01-01

    An investigator who plans to conduct experiments with multiple independent variables must decide whether to use a complete or reduced factorial design. This article advocates a resource management perspective on making this decision, in which the investigator seeks a strategic balance between service to scientific objectives and economy. Considerations in making design decisions include whether research questions are framed as main effects or simple effects; whether and which effects are aliased (confounded) in a particular design; the number of experimental conditions that must be implemented in a particular design and the number of experimental subjects the design requires to maintain the desired level of statistical power; and the costs associated with implementing experimental conditions and obtaining experimental subjects. In this article four design options are compared: complete factorial, individual experiments, single factor, and fractional factorial designs. Complete and fractional factorial designs and single factor designs are generally more economical than conducting individual experiments on each factor. Although relatively unfamiliar to behavioral scientists, fractional factorial designs merit serious consideration because of their economy and versatility. PMID:19719358

  18. Combined effects of constant versus variable intensity simulated rainfall and reduced tillage management on cotton preemergence herbicide runoff.

    PubMed

    Potter, Thomas L; Truman, Clint C; Strickland, Timothy C; Bosch, David D; Webster, Theodore M; Franklin, Dorcas H; Bednarz, Craig W

    2006-01-01

    Pesticide runoff research relies heavily on rainfall simulation experiments. Most are conducted at a constant intensity, i.e., at a fixed rainfall rate; however, large differences in natural rainfall intensity is common. To assess implications we quantified runoff of two herbicides, fluometuron and pendimethalin, and applied preemergence after planting cotton on Tifton loamy sand. Rainfall at constant and variable intensity patterns representative of late spring thunderstorms in the Atlantic Coastal Plain region of Georgia (USA) were simulated on 6-m2 plots under strip- (ST) and conventional-tillage (CT) management. The variable pattern produced significantly higher runoff rates of both compounds from CT but not ST plots. However, on an event-basis, runoff totals (% applied) were not significantly different, with one exception: fluometuron runoff from CT plots. There was about 25% more fluometuron runoff with the variable versus the constant intensity pattern (P = 0.10). Study results suggest that conduct of simulations using variable intensity storm patterns may provide more representative rainfall simulation-based estimates of pesticide runoff and that the greatest impacts will be observed with CT. The study also found significantly more fluometuron in runoff from ST than CT plots. Further work is needed to determine whether this behavior may be generalized to other active ingredients with similar properties [low K(oc) (organic carbon partition coefficient) approximately 100 mL g(-1); high water solubility approximately 100 mg L(-1)]. If so, it should be considered when making tillage-specific herbicide recommendations to reduce runoff potential.

  19. Application of Sleeper Cab Thermal Management Technologies to Reduce Idle Climate Control Loads in Long-Haul Trucks

    SciTech Connect

    Lustbader, J. A.; Venson, T.; Adelman, S.; Dehart, C.; Yeakel, S.; Castillo, M. S.

    2012-10-01

    Each intercity long-haul truck in the U.S. idles approximately 1,800 hrs per year, primarily for sleeper cab hotel loads. Including workday idling, over 2 billion gallons of fuel are used annually for truck idling. NREL's CoolCab project works closely with industry to design efficient thermal management systems for long-haul trucks that keep the cab comfortable with minimized engine idling and fuel use. The impact of thermal load reduction technologies on idle reduction systems were characterized by conducting thermal soak tests, overall heat transfer tests, and 10-hour rest period A/C tests. Technologies evaluated include advanced insulation packages, a solar reflective film applied to the vehicle's opaque exterior surfaces, a truck featuring both film and insulation, and a battery-powered A/C system. Opportunities were identified to reduce heating and cooling loads for long-haul truck idling by 36% and 34%, respectively, which yielded a 23% reduction in battery pack capacity of the idle-reduction system. Data were also collected for development and validation of a CoolCalc HVAC truck cab model. CoolCalc is an easy-to-use, simplified, physics-based HVAC load estimation tool that requires no meshing, has flexible geometry, excludes unnecessary detail, and is less time-intensive than more detailed computer-aided engineering modeling approaches.

  20. Proposal to reduce greenhouse gas emissions via landfill gas management in Greater Buenos Aires, Argentina. Final report

    SciTech Connect

    Jones, D.B.

    1998-10-01

    The purpose of this project was to evaluate the feasibility of reducing the emission of greenhouse gases by collection, flaring, and possibly beneficially using the gas from landfills in Greater Buenos Aires, Argentina (GBA). Another purpose was to prepare a proposal to the US Initiative on Joint Implementation (USIJI) for a project to collect and possibly use the landfill gas (LFG). The project was carried out from September 30, 1997 through September 30, 1998. Collection and flaring of gas is feasible provided private firms have sufficient incentive to obtain greenhouse gas emission reduction benefits. The value of those benefits that would be required to motivate funding of an LFG management project was not explicitly determined. However, one independent power producer has expressed an interest in funding the first phase of the proposed project and paid for a detailed feasibility study which was conducted in August and September of 1998. As a result of this project, a proposal was submitted to the USIJI Evaluation Panel in June, 1998. In August, 1998, an office was established for reviewing and approving joint implementation proposals. The proposal is currently under review by that office.

  1. An Internet-based health management platform may effectively reduce the risk factors of metabolic syndrome among career women.

    PubMed

    Chen, Yi-Ching; Tsao, Lee-Ing; Huang, Chih-Hsung; Yu, Yi-Yen; Liu, I-Li; Jou, Hei-Jen

    2013-06-01

    The purpose of this study is to target career women with metabolic syndrome (Mets) risk factors and investigate the effectiveness of using a health management platform (HMP) to improve health behavior and reduce Mets risk factors. This study adopted the structure of a randomized control trial, and targeted full-time career women aged ≥ 20 years, who possessed Mets risk factors. Intervention was performed via an Internet-based HMP, and changes in health behavior 1.5 months and 3 months after intervention and Mets risk factors 3 months after intervention were analyzed. A total of 66 career women participated in this study. At 3 months, the HMP group displayed better results than the control group in terms of waist circumference, fasting glucose, and the mean number of Mets components. In terms of the group and time interaction analysis on health behavior, the HMP group only displayed significantly better results in exercise scores than the control group at 1.5 months. The application of an Internet-based tailored HMP can facilitate an effective improvement in Mets components of career women with Mets risk factors. Copyright © 2013. Published by Elsevier B.V.

  2. Beneficial effect of compost utilization on reducing greenhouse gas emissions in a rice cultivation system through the overall management chain.

    PubMed

    Jeong, Seung Tak; Kim, Gil Won; Hwang, Hyun Young; Kim, Pil Joo; Kim, Sang Yoon

    2017-09-11

    Livestock manure application can stimulate greenhouse gas (GHG) emissions, especially methane (CH4) in rice paddy. The stabilized organic matter (OM) is recommended to suppress CH4 emission without counting the additional GHG emission during the composting process. To evaluate the effect of compost utilization on the net global warming potential (GWP) of a rice cropping system, the fluxes of GHGs from composting to land application were calculated by a life cycle assessment (LCA) method. The model framework was composed of GHG fluxes from industrial activities and biogenic GHG fluxes from the composting and rice cultivation processes. Fresh manure emitted 30MgCO2-eq.ha(-1), 90% and 10% of which were contributed by CH4 and nitrous oxide (N2O) fluxes, respectively, during rice cultivation. Compost utilization decreased net GWP by 25% over that of the fresh manure during the whole process. The composting process increased the GWP of the industrial processes by 35%, but the 60% reduction in CH4 emissions from the rice paddy mainly influenced the reduction of GWP during the overall process. Therefore, compost application could be a good management strategy to reduce GHG emissions from rice paddy systems. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Introduction to Special Edition (of the Journal of Nuclear Materials Management) on Reducing the Threat from Radioactive Materials

    SciTech Connect

    Mladineo, Stephen V.

    2007-03-01

    Introductory article for special edition of the JOURNAL OF NUCLEAR MATERIALS MANAGEMENT outlining the Institute of Nuclear Materials Management Nonproliferation and Arms Control Technical Division. In particular the International Nuclear and Radiological Security Standing Committee and its initial focus covering four topical areas--Radiological Threat Reduction, Nuclear Smuggling and Illicit Trafficking, Countering Nuclear Terrorism, and Radioligical Terrorism Consequence Management.

  4. Impact of an integrated disease management program in reducing exacerbations in patients with severe asthma and COPD.

    PubMed

    Jain, Vipul V; Allison, Richard; Beck, Sandra J; Jain, Ratnali; Mills, Paul K; McCurley, James W; Van Gundy, Karl P; Peterson, Michael W

    2014-12-01

    Conflicting data exists on the effectiveness of integrated programs in reducing recurrent exacerbations and hospitalizations in patients with Asthma and chronic obstructive lung disease (COPD). We developed a Pulmonologist-led Chronic Lung Disease Program (CLDP) for patients with severe asthma and COPD and analyzed its impact on healthcare utilization and predictors of its effectiveness. CLDP elements included clinical evaluation, onsite pulmonary function testing, health education, and self-management action plan along with close scheduled and on-demand follow-up. Patients with ≥2 asthma or COPD exacerbations requiring emergency room visit or hospitalization within the prior year were enrolled, and followed for respiratory related ER visits (RER) and hospitalizations (RHA) over the year (357 ± 43 days) after CLDP interventions. A total of 106 patients were enrolled, and 104 patients were subject to analyses. During the year of follow-up after CLDP enrollment, there was a significant decrease in mean RER (0.56 ± 1.48 versus 2.62 ± 2.81, p < 0.0001), mean RHA (0.39 ± 0.08 versus 1.1 ± 1.62, p < 0.0001), and 30 day rehospitalizations (0.05 ± 0.02 versus 0.28 ± 0.07, p < 0.0001). Reduction of healthcare utilization was strongly associated with GERD and sinusitis therapy, and was independent of pulmonary rehabilitation. Direct variable cost analyses estimated annual savings at $1.17 million. Multivariate logistic regression analysis revealed lack of spirometry utilization as an independent risk factor for severe exacerbations. A Pulmonologist-led disease management program integrating key elements of care is cost effective and significantly decreases severe exacerbations. Integrated programs should be encouraged for care of frequent exacerbators of asthma and COPD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Can an Internal Locus of Control and Social Support Reduce Work-Related Levels of Stress and Strain?: A Comparative Study Between Spanish Owners and Managers.

    PubMed

    Ariza-Montes, Antonio; Leal-Rodríguez, Antonio L; Rodríguez-Félix, Lucía; Albort-Morant, Gema

    2017-09-01

    The aim of this article is to assess the role played by both individual and contextual factors in reducing the manager's levels of stress and strain within the workplace setting. This article also highlights the manager's locus of control (LOC) as an internal factor and emphasizes the social support variable as a contextual factor. We use a sample of 332 respondents belonging to Spanish manufacturing and services firms and a structural equation modeling technique (partial least squares path modeling). The results reveal that there are significant differences between managers and owners about stress-strain relationship. The study provides support for the literature on stress management, which emphasizes the importance of a LOC and social support in influencing stress and strain between managers and owners.

  6. Automatic notifications mediated by anesthesia information management systems reduce the frequency of prolonged gaps in blood pressure documentation.

    PubMed

    Ehrenfeld, Jesse M; Epstein, Richard H; Bader, Stephen; Kheterpal, Sachin; Sandberg, Warren S

    2011-08-01

    on a convenience sample of 500 paper records from Hospital A (99% upper confidence limit = 0.83%). BP gaps of ≥10 minutes were common in electronic anesthesia records, and their incidence was reduced but not eliminated by near real-time feedback to providers. The American Society of Anesthesiologists' standard for BP documentation every 5 minutes might not be achievable with current practices and technology. Anesthesia information management systems users need to be cognizant of the potential for gaps in BP measurement, take steps to minimize their occurrence, and document an explanation when such failures occur.

  7. Automatic Notifications Mediated by Anesthesia Information Management Systems Reduce the Frequency of Prolonged Gaps in Blood Pressure Documentation

    PubMed Central

    Ehrenfeld, Jesse M.; Epstein, Richard H.; Bader, Stephen; Kheterpal, Sachin; Sandberg, Warren S.

    2011-01-01

    BP gaps were noted on a convenience sample of 500 paper records from Hospital A (99% upper confidence limit = 0.83%). Conclusions BP gaps of ≥ 10 minutes were common in electronic anesthesia records, and their incidence was reduced but not eliminated by near real-time feedback to providers. The ASA standard for every 5 min BP documentation may not be achievable with current practices and technology. Anesthesia information management systems users need to be cognizant of the potential for gaps in BP measurement, take steps to minimize their occurrence, and document an explanation when such failures occur. PMID:21415437

  8. A Vehicle Management End-to-End Testing and Analysis Platform for Validation of Mission and Fault Management Algorithms to Reduce Risk for NASA's Space Launch System

    NASA Technical Reports Server (NTRS)

    Trevino, Luis; Johnson, Stephen B.; Patterson, Jonathan; Teare, David

    2015-01-01

    The development of the Space Launch System (SLS) launch vehicle requires cross discipline teams with extensive knowledge of launch vehicle subsystems, information theory, and autonomous algorithms dealing with all operations from pre-launch through on orbit operations. The characteristics of these systems must be matched with the autonomous algorithm monitoring and mitigation capabilities for accurate control and response to abnormal conditions throughout all vehicle mission flight phases, including precipitating safing actions and crew aborts. This presents a large complex systems engineering challenge being addressed in part by focusing on the specific subsystems handling of off-nominal mission and fault tolerance. Using traditional model based system and software engineering design principles from the Unified Modeling Language (UML), the Mission and Fault Management (M&FM) algorithms are crafted and vetted in specialized Integrated Development Teams composed of multiple development disciplines. NASA also has formed an M&FM team for addressing fault management early in the development lifecycle. This team has developed a dedicated Vehicle Management End-to-End Testbed (VMET) that integrates specific M&FM algorithms, specialized nominal and off-nominal test cases, and vendor-supplied physics-based launch vehicle subsystem models. The flexibility of VMET enables thorough testing of the M&FM algorithms by providing configurable suites of both nominal and off-nominal test cases to validate the algorithms utilizing actual subsystem models. The intent is to validate the algorithms and substantiate them with performance baselines for each of the vehicle subsystems in an independent platform exterior to flight software test processes. In any software development process there is inherent risk in the interpretation and implementation of concepts into software through requirements and test processes. Risk reduction is addressed by working with other organizations such as S

  9. Modeling of Solar Radiation Management: A Comparison of Simulations Using Reduced Solar Constant and Stratospheric Sulphate Aerosols

    NASA Astrophysics Data System (ADS)

    Bala, G.; Kalidindi, S.; Modak, A.; Caldeira, K.

    2014-12-01

    Several climate modelling studies in the past have used reduction in solar constant to simulate the climatic effects of Solar Radiation Management (SRM) geoengineering. This is most likely valid only for space-based mirrors/reflectors but not for SRM methods that rely on stratospheric aerosols. In this study, we use a climate model to evaluate the differences in climate response to SRM by uniform solar constant reduction and stratospheric aerosols. The experiments are designed such that global mean warming from a doubling of atmospheric CO2 concentration (2xCO2) is nearly cancelled in each case. In such a scenario, the residual climate effects are similar when important surface and tropospheric climate variables such as temperature and precipitation are considered. However, there are significant differences in stratospheric temperature response and diffuse and direct radiation reaching the surface. A difference of 1K in the global mean stratospheric (61-9.8 hPa) temperature is simulated between the two SRM methods, with warming in the aerosol scheme and a slight cooling for sunshades. While the global mean surface diffuse radiation increases by ~23% and direct radiation decreases by about 9% in the case of aerosol SRM method, both direct and diffuse radiation decrease by similar fractional amounts (~1.0%) when solar constant is reduced. When CO2 fertilization effects from elevated CO2 concentration levels are removed, the contribution from shaded leaves to gross primary productivity (GPP) increases by 1.8 % in aerosol SRM because of increased diffuse light. However, this increase is almost offset by a 15.2% decline in sunlit contribution due to reduced direct light. Overall both the SRM simulations show similar decrease in GPP (~ 8%) and NPP (~3%) relative to 2xCO2, indicating the negligible effect of the fractional changes in direct/diffuse radiation on the overall plant productivity. Based on our modelling study, we conclude that the climate states produced by a

  10. Management of hydro-biogeochemical connectivity of geographically isolated wetlands to reduce the risk of eutrophication of Lake Winnipeg

    NASA Astrophysics Data System (ADS)

    Creed, Irena F.; Ameli, Ali

    2017-04-01

    Lake Winnipeg - a transboundary water resource that is the 10th largest freshwater lake in the world - was recently listed as the most threatened lake in the world due to eutrophication. Its watershed has experienced amongst the highest geographically isolated wetland (GIW) drainage rates in the world, leading to increased nutrient loads to remaining wetlands and downstream streams and lakes. GIWs are surrounded by uplands - and thus collect and store water from the surrounding landscape during snowmelt or storm events, and filter nutrients before slowly returning water to the water cycle. When drained, GIWs become connected to downstream flows and nutrients move unimpeded from and through them to downstream waters. Therefore, effective GIW management strategies can reduce nutrient loads to regional surface water bodies in the Lake Winnipeg watershed. But, how do we prioritize wetland protection and restoration efforts? We know that hydrologic connections to GIWs vary in length and timing, and hypothesize that long and slow hydrologic connections to a GIW have higher potential for P retention, while short and fast hydrologic connections to a GIW have lower potential for P retention along the flow path, leading to higher P concentrations within the GIW. We test these hypotheses in a watershed that drains into the North Saskatchewan River and ultimately to Lake Winnipeg. Using a novel model that quantifies the continuum of time and length variations of subsurface-surface hydrological connections to each GIW, we explore the relationship between length and time and time of hydrologic connection to a GIW and nutrients in the GIW. We found that GIWs are not always "isolated" islands - rather, they are connected to other surface waters in diverse ways. GIWs with no modeled surface or subsurface hydrological connections had the lowest nutrient concentrations and algal biomass. Recharge GIWs have lower concentrations of nutrients than discharge wetlands. Discharge GIWs with

  11. Managing runoff and flow pathways in a small rural catchment to reduce flood risk with other multi-purpose benefits

    NASA Astrophysics Data System (ADS)

    Wilkinson, Mark; Welton, Phil; Kerr, Peter; Quinn, Paul; Jonczyk, Jennine

    2010-05-01

    From 2000 to 2009 there have been a high number of flood events throughout Northern Europe. Meanwhile, there is a demand for land in which to construct homes and businesses on, which is encroaching on land which is prone to flooding. Nevertheless, flood defences usually protect us from this hazard. However, the severity of floods and this demand for land has increased the number of homes which have been flooded in the past ten years. Public spending on flood defences can only go so far which targets the large populations first. Small villages and communities, where in many cases normal flood defences are not cost effective, tend to wait longer for flood mitigation strategies. The Belford Burn (Northumberland, UK) catchment is a small rural catchment that drains an area of 6 km2. It flows through the village of Belford. There is a history of flooding in Belford, with records of flood events dating back to 1877. Normal flood defences are not suitable for this catchment as it failed the Environment Agency (EA) cost benefit criteria for support. There was a desire by the local EA Flood Levy Team and the Northumbria Regional Flood Defence Committee at the Environment Agency to deliver an alternative catchment-based solution to the problem. The EA North East Flood Levy team and Newcastle University have created a partnership to address the flood problem using soft engineered runoff management features. Farm Integrated Runoff Management (FIRM) plans manage flow paths directly by storing slowing and filtering runoff at source on farms. The features are multipurpose addressing water quality, trapping sediment, creating new habitats and storing and attenuating flood flow. Background rainfall and stream stage data have been collected since November 2007. Work on the first mitigation features commenced in July 2008. Since that date five flood events have occurred in the catchment. Two of these flood events caused widespread damage in other areas of the county. However, in

  12. Evaluation of Impaired Driving Assessments and Special Management Reviews in Reducing Impaired Driving Fatal Crashes in the United States

    PubMed Central

    Fell, James; Auld-Owens, Amy; Snowden, Cecelia

    2013-01-01

    Since 1991, State Impaired-Driving Assessments (IDAs) and Special Management Reviews (SMRs) have been conducted by the National Highway Traffic Safety Administration (NHTSA) to serve as a mechanism to assess the impaired-driving problem in the State, document the existing system, recommend improvements, and garner both political and public support to fund and implement improvements. Did these assessments and reviews serve the States as intended and provide a catalyst to reduce impaired driving? Almost half of the priority recommendations from IDAs in seven States and 60% of the priority recommendations in SMR States were implemented. Barriers to the implementation of some recommendations are discussed. IDAs and SMRs implemented at varying times were examined using logistic regression analyses of the Fatality Analysis Reporting System (FARS) for the years 1990 to 2008 to determine the effect they may have triggered on impaired driving rates in fatal crashes. States receiving IDAs and SMRs were compared to similar States not receiving them. Paired comparisons of similar States (e.g. IDA-State vs. non-IDA State) did not reveal any significant differences in impaired driving rates, but IDA and SMR States as a group showed significantly greater impaired driving declines in fatal crashes compared to non-IDA and non-SMR States as a group. IDAs and SMRs appear to provide a mechanism to examine the State’s impaired-driving program by an external team of experts and reveal areas where improvement is needed and confirm strategies that appear to be effective. PMID:24406944

  13. The use of LeptiCore® in reducing fat gain and managing weight loss in patients with metabolic syndrome

    PubMed Central

    2010-01-01

    Background LeptiCore® is a proprietary combination of various ingredients which have been shown to have properties which could be beneficial to weight loss in obese and overweight human subjects. This study evaluates the effect of Lepticore® on bodyweight as well as parameters associated with obesity and metabolic syndrome. Methods The study was an 8 week randomized, double-blind, placebo-controlled design involving 92 obese (mean BMI > 30 kg/m2) participants (37 males; 55 females; ages 19-52; mean age = 30.7). The participants were randomly divided into three groups: placebo (n = 30), LeptiCore® formula A (low dose) (n = 31) and LeptiCore® formula B (high dose) (n = 31). Capsules containing the placebo or active formulations were administered twice daily before meals with 300 ml of water. None of the participants followed any specific diet nor took any weight-reducing medications for the duration of the study. A total of 12 anthropomorphic and serological measurements were taken at the beginning of the study and after 2, 4, 6, and 8 weeks of treatment. Results Compared to the placebo group, the two active groups showed statistically significant differences on all 12 variables by week 8. These included four anthropomorphic variables (body weight, body fat, waist and hip size) and eight measures of serological levels (plasma total cholesterol, LDL, HDL, triglycerides, blood glucose, serotonin, leptin, C-reactive protein). The two active groups also showed significant intra-group differences on all 12 variables between study onset and week 8. Conclusion The LeptiCore® formulation at both the low and high dosages appears to be helpful in the management of fat gain and its related complications. The higher dosage resulted in significantly greater reductions in body weight and triglyceride, blood glucose, and C-reactive protein levels, as well as increased serotonin levels. PMID:20170522

  14. Nitrate accumulation and leaching potential reduced by coupled water and nitrogen management in the Huang-Huai-Hai Plain.

    PubMed

    Huang, Ping; Zhang, Jiabao; Zhu, Anning; Li, Xiaopeng; Ma, Donghao; Xin, Xiuli; Zhang, Congzhi; Wu, Shengjun; Garland, Gina; Pereira, Engil Isadora Pujol

    2017-08-22

    Irrigation and nitrogen (N) fertilization in excess of crop requirements are responsible for substantial nitrate accumulation in the soil profile and contamination of groundwater by nitrate leaching during intensive agricultural production. In this on-farm field trial, we compared 16 different water and N treatments on nitrate accumulation and its distribution in the soil profile (0-180cm), nitrate leaching potential, and groundwater nitrate concentration within a summer-maize (Zea mays L.) and winter-wheat (Triticum aestivum L.) rotation system in the Huang-Huai-Hai Plain over five cropping cycles (2006-2010). The results indicated that nitrate remaining in the soil profile after crop harvest and nitrate concentration of soil solutions at two depths (80cm and 180cm) declined with increasing irrigation amounts and increased greatly with increasing N application rates, especially for seasonal N application rates higher than 190kgNha(-1). During the experimental period, continuous torrential rainfall was the main cause for nitrate leaching beyond the root zone (180cm), which could pose potential risks for contamination of groundwater. Nitrate concentration of groundwater varied from 0.2 to 2.9mgL(-1), which was lower than the limit of 10mgL(-1) as the maximum safe level for drinking water. In view of the balance between grain production and environmental consequences, seasonal N application rates of 190kgNha(-1) and 150kgNha(-1) were recommended for winter wheat and summer maize, respectively. Irrigation to the field capacity of 0-40cm and 0-60cm soil depth could be appropriate for maize and wheat, respectively. Therefore, taking grain yields, mineral N accumulation in the soil profile, nitrate leaching potential, and groundwater quality into account, coupled water and N management could provide an opportunity to promote grain production while reducing negative environmental impacts in this region. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Developing a national computerised absence monitoring and management system to reduce nursing student attrition: evaluation of staff and student perspectives.

    PubMed

    Currie, Kay; McCallum, Jacqueline; Murray, John; Scott, Janine; Strachan, Evelyn; Yates, Lynda; Wright, Marty

    2014-05-01

    Reducing avoidable nursing student attrition is an international challenge. A pattern of falling attendance is recognised as a frequent precursor to withdrawal from nursing programmes. To address concerns regarding nursing student attrition, the Scottish Government implemented a pilot project for a centralised Computerised Absence Management and Monitoring System (CAMMS). The CAMMS adopted an 'assertive outreach' approach, contacting students every two weeks via colour coded letters to tell them whether their attendance was 'excellent', 'good, but potentially causing concern'; or 'warning; attendance concerns/contact academic staff for support'. This article reports key findings from an evaluation of CAMMS. To explore the perceived impact of CAMMS on student support and attrition, from the perspectives of academic and administrative staff and students. Mixed methods evaluation design. Three large geographically dispersed Schools of Nursing in Scotland. 83 students; 20 academic staff; and 3 lead administrators. On-line cohort survey of academic staff and students; structured interviews with lead administrators. Findings reflected a spectrum of negative and positive views of CAMMS. Students who are attending regularly seem pleased that their commitment is recognised. Lecturers who teach larger groups report greater difficulty getting to know students individually and acknowledge the benefit of identifying potential attendance concerns at an early stage. Conversely, some students who received a 'warning' letter were frequently annoyed or irritated, rather than feeling supported. Increased staff workload resulted in negative perceptions and a consequent reluctance to use CAMMS. However, students who were causing concern reported subsequent improvement in attendance. CAMMS has the potential to identify 'at-risk' students at an early stage; however, the system should have flexibility to tailor automatically generated letters in response to individual circumstances, to

  16. A Randomized, Controlled Pragmatic Trial of Telephonic Medication Therapy Management to Reduce Hospitalization in Home Health Patients

    PubMed Central

    Zillich, Alan J; Snyder, Margie E; Frail, Caitlin K; Lewis, Julie L; Deshotels, Donny; Dunham, Patrick; Jaynes, Heather A; Sutherland, Jason M

    2014-01-01

    Objective To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing hospitalizations among home health patients. Setting Forty randomly selected, geographically diverse home health care centers in the United States. Design Two-stage, randomized, controlled trial with 60-day follow-up. All Medicare- insured home health care patients were eligible to participate. Twenty-eight consecutive patients within each care center were recruited and randomized to usual care or MTM intervention. The MTM intervention consisted of the following: (1) initial phone call by a pharmacy technician to verify active medications; (2) pharmacist-provided medication regimen review by telephone; and (3) follow-up pharmacist phone calls at day seven and as needed for 30 days. The primary outcome was 60-day all-cause hospitalization. Data Collection Data were collected from in-home nursing assessments using the OASIS-C. Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients’ baseline risk of hospitalization, number of medications taken daily, and other OASIS-C data elements. Principal Findings A total of 895 patients (intervention n = 415, control n = 480) were block-randomized to the intervention or usual care. There was no significant difference in the 60-day probability of hospitalization between the MTM intervention and control groups (Adjusted OR: 1.26, 95 percent CI: 0.89–1.77, p = .19). For patients within the lowest baseline risk quartile (n = 232), the intervention group was three times more likely to remain out of the hospital at 60 days (Adjusted OR: 3.79, 95 percent CI: 1.35–10.57, p = .01) compared to the usual care group. Conclusions This MTM intervention may not be effective for all home health patients; however, for those patients with the lowest-risk profile, the MTM intervention prevented patients from being hospitalized at 60 days. PMID

  17. A Vehicle Management End-to-End Testing and Analysis Platform for Validation of Mission and Fault Management Algorithms to Reduce Risk for NASAs Space Launch System

    NASA Technical Reports Server (NTRS)

    Trevino, Luis; Johnson, Stephen B.; Patterson, Jonathan; Teare, David

    2015-01-01

    ) early in the development lifecycle for the SLS program, NASA formed the M&FM team as part of the Integrated Systems Health Management and Automation Branch under the Spacecraft Vehicle Systems Department at the Marshall Space Flight Center (MSFC). To support the development of the FM algorithms, the VMET developed by the M&FM team provides the ability to integrate the algorithms, perform test cases, and integrate vendor-supplied physics-based launch vehicle (LV) subsystem models. Additionally, the team has developed processes for implementing and validating the M&FM algorithms for concept validation and risk reduction. The flexibility of the VMET capabilities enables thorough testing of the M&FM algorithms by providing configurable suites of both nominal and off-nominal test cases to validate the developed algorithms utilizing actual subsystem models such as MPS, GNC, and others. One of the principal functions of VMET is to validate the M&FM algorithms and substantiate them with performance baselines for each of the target vehicle subsystems in an independent platform exterior to the flight software test and validation processes. In any software development process there is inherent risk in the interpretation and implementation of concepts from requirements and test cases into flight software compounded with potential human errors throughout the development and regression testing lifecycle. Risk reduction is addressed by the M&FM group but in particular by the Analysis Team working with other organizations such as S&MA, Structures and Environments, GNC, Orion, Crew Office, Flight Operations, and Ground Operations by assessing performance of the M&FM algorithms in terms of their ability to reduce Loss of Mission (LOM) and Loss of Crew (LOC) probabilities. In addition, through state machine and diagnostic modeling, analysis efforts investigate a broader suite of failure effects and associated detection and responses to be tested in VMET to ensure reliable failure

  18. Investigating the use of Barrows Cards to improve self-management and reduce healthcare costs in adolescents with blood cancer: a pilot study.

    PubMed

    Bagnasco, Annamaria; Calza, Simona; Petralia, Paolo; Aleo, Giuseppe; Fornoni, Laura; Sasso, Loredana

    2016-04-01

    To test if the Barrows Cards method improves adherence to immunosuppressive therapy self-management following hematopoietic stem-cell transplantation in adolescents affected by blood cancer and reduce costs. Chronically ill adolescents need to be helped to improve self-management, make sure they can confidently and safely manage therapy at home and reduce readmissions and costs. We identified the Barrows Cards method, originally used to test decision-making skills and critical thinking in medical students. In this pilot study, we tested the efficacy of the Barrows Cards Method in improving adhesion to immunosuppressive therapy in a group of adolescents following hematopoietic stem-cell transplantation and analysed its cost-effectiveness. A mixed-method study. The Barrows Cards method is an educational intervention based on the theory of problem-based learning that uses at least 15 cards specially designed to teach participants how to manage a specific problem. We piloted the Barrows cards method in terms of adherence to immunosuppressive therapy and self-management in a group of 17 adolescents affected by blood cancer before being discharged. Participants were enrolled between 2013-2015. Activity Based Costing was used to analyse the cost-effectiveness. The Barrows Cards method significantly improved adherence to immunosuppressive therapy in blood cancer adolescents and reduced readmissions. We also showed how this method could significantly reduce healthcare costs. Further research is required, but the Barrows Cards method could be effectively used by nurses to improve self-management in chronic patients and reduce health costs. © 2016 John Wiley & Sons Ltd.

  19. Modelling Coral Reef Futures to Inform Management: Can Reducing Local-Scale Stressors Conserve Reefs under Climate Change?

    PubMed Central

    Gurney, Georgina G.; Melbourne-Thomas, Jessica; Geronimo, Rollan C.; Aliño, Perry M.; Johnson, Craig R.

    2013-01-01

    Climate change has emerged as a principal threat to coral reefs, and is expected to exacerbate coral reef degradation caused by more localised stressors. Management of local stressors is widely advocated to bolster coral reef resilience, but the extent to which management of local stressors might affect future trajectories of reef state remains unclear. This is in part because of limited understanding of the cumulative impact of multiple stressors. Models are ideal tools to aid understanding of future reef state under alternative management and climatic scenarios, but to date few have been sufficiently developed to be useful as decision support tools for local management of coral reefs subject to multiple stressors. We used a simulation model of coral reefs to investigate the extent to which the management of local stressors (namely poor water quality and fishing) might influence future reef state under varying climatic scenarios relating to coral bleaching. We parameterised the model for Bolinao, the Philippines, and explored how simulation modelling can be used to provide decision support for local management. We found that management of water quality, and to a lesser extent fishing, can have a significant impact on future reef state, including coral recovery following bleaching-induced mortality. The stressors we examined interacted antagonistically to affect reef state, highlighting the importance of considering the combined impact of multiple stressors rather than considering them individually. Further, by providing explicit guidance for management of Bolinao's reef system, such as which course of management action will most likely to be effective over what time scales and at which sites, we demonstrated the utility of simulation models for supporting management. Aside from providing explicit guidance for management of Bolinao's reef system, our study offers insights which could inform reef management more broadly, as well as general understanding of reef

  20. Modelling coral reef futures to inform management: can reducing local-scale stressors conserve reefs under climate change?

    PubMed

    Gurney, Georgina G; Melbourne-Thomas, Jessica; Geronimo, Rollan C; Aliño, Perry M; Johnson, Craig R

    2013-01-01

    Climate change has emerged as a principal threat to coral reefs, and is expected to exacerbate coral reef degradation caused by more localised stressors. Management of local stressors is widely advocated to bolster coral reef resilience, but the extent to which management of local stressors might affect future trajectories of reef state remains unclear. This is in part because of limited understanding of the cumulative impact of multiple stressors. Models are ideal tools to aid understanding of future reef state under alternative management and climatic scenarios, but to date few have been sufficiently developed to be useful as decision support tools for local management of coral reefs subject to multiple stressors. We used a simulation model of coral reefs to investigate the extent to which the management of local stressors (namely poor water quality and fishing) might influence future reef state under varying climatic scenarios relating to coral bleaching. We parameterised the model for Bolinao, the Philippines, and explored how simulation modelling can be used to provide decision support for local management. We found that management of water quality, and to a lesser extent fishing, can have a significant impact on future reef state, including coral recovery following bleaching-induced mortality. The stressors we examined interacted antagonistically to affect reef state, highlighting the importance of considering the combined impact of multiple stressors rather than considering them individually. Further, by providing explicit guidance for management of Bolinao's reef system, such as which course of management action will most likely to be effective over what time scales and at which sites, we demonstrated the utility of simulation models for supporting management. Aside from providing explicit guidance for management of Bolinao's reef system, our study offers insights which could inform reef management more broadly, as well as general understanding of reef

  1. Formula food-reducing diets:A new evidence-based addition to the weight management tool box

    PubMed Central

    Leeds, A R

    2014-01-01

    The changing pattern of obesity-related disease has created a need for a greater range of weight management options for the increasing number of people for whom weight loss and maintenance cannot be addressed by conventional dietary methods. Formula diet weight loss programmes [very low-calorie diets (VLCDs) (400–800 kcal/day) and low-calorie diets (LCDs) (800–1200 kcal/day)] can deliver weight loss at rates of 1–2 kg/week. This rate of weight loss can result in 10–20 kg weight loss in 8–12 weeks. Many health benefits associated with weight reduction seem to require between 10 and 20 kg weight loss. Formula diet programmes can result in weight loss, reduction of liver volume and reduction of visceral fat before bariatric surgery; weight loss before knee joint replacement surgery has also been shown. The benefit of pre-operative weight loss is still under investigation and such practices before bariatric surgery are variable in surgical units across the UK. Weight loss with formula diet in obesity-associated conditions where inflammation is an important component, such as osteoarthritis and psoriasis, has been demonstrated. Maintenance of about 10% of initial bodyweight loss, with symptom improvement in elderly obese people with knee osteoarthritis, has been shown over a period of 4 years. In obese people with psoriasis, weight loss with skin improvement has been maintained for 1 year. Clinical trials are currently underway to examine the merits of an initial weight loss with formula diet in pre-diabetes, in early type 2 diabetes and in insulin-treated type 2 diabetes. Rapid initial weight loss can result in rapid symptom improvement, such as reduced joint pain in osteoarthritis, improved sleep quality in obstructive sleep apnoea, reduced shortness of breath on exertion, reduced peripheral oedema and rapid improvement in metabolic control in diabetes, all changes that are highly motivating and conducive towards compliance. There is also some

  2. Woodland biodiversity management as a tool for reducing human exposure to Ixodes ricinus ticks: a preliminary study in an english woodland.

    PubMed

    Medlock, J M; Shuttleworth, H; Copley, V; Hansford, K M; Leach, S

    2012-12-01

    This paper presents preliminary findings towards developing a UK-specific approach to reducing public exposure to woodland questing Ixodes ricinus tick populations by harnessing existing biodiversity-enhancing woodland ride (i.e., linear non-wooded herbaceous habitat either side of track within woodland) management strategies. This preliminary study in an English woodland firstly assesses whether ecological and environmental factors determine presence and density of questing Ixodes ricinus along woodland rides. Secondly, it sets these findings in the context of woodland ride management guidelines in England in order to understand what impact ride management strategies might have on numbers of questing ticks and tick survival. Nymph and adult I. ricinus presence and abundance were modelled in relation to relevant microclimate and ecological parameter variables. Predictor variables for increased questing nymph abundance included ride orientation, mat depth, occurrence of bracken/bramble and animal tracks, ride/path width, and sward height. Ticks thrive in the ecotonal habitat of a woodland ride, therefore we urge woodland managers to consider the impact of their ride management on ticks and human exposure to ticks. Possible recommendations for mitigating questing I. ricinus in line with biodiversity management guidelines rides are discussed in this paper and include seasonal mowing regimes, management of mulch/mat, and bracken/bramble management through use of scalloped ride edges. © 2012 The Society for Vector Ecology.

  3. Improved Battery Pack Thermal Management to Reduce Cost and Increase Energy Density: Cooperative Research and Development Final Report, CRADA Number CRD-12-499

    SciTech Connect

    Smith, K.

    2013-10-01

    Under this CRADA NREL will support Creare's project for the Department of Energy entitled 'Improved Battery Pack Thermal Management to Reduce Cost and Increase Energy Density' which involves the development of an air-flow based cooling product that increases energy density, safety, and reliability of hybrid electric vehicle battery packs.

  4. A Vehicle Management End-to-End Testing and Analysis Platform for Validation of Mission and Fault Management Algorithms to Reduce Risk for NASA's Space Launch System

    NASA Technical Reports Server (NTRS)

    Trevino, Luis; Patterson, Jonathan; Teare, David; Johnson, Stephen

    2015-01-01

    integrates specific M&FM algorithms, specialized nominal and off-nominal test cases, and vendor-supplied physics-based launch vehicle subsystem models. Additionally, the team has developed processes for implementing and validating these algorithms for concept validation and risk reduction for the SLS program. The flexibility of the Vehicle Management End-to-end Testbed (VMET) enables thorough testing of the M&FM algorithms by providing configurable suites of both nominal and off-nominal test cases to validate the developed algorithms utilizing actual subsystem models such as MPS. The intent of VMET is to validate the M&FM algorithms and substantiate them with performance baselines for each of the target vehicle subsystems in an independent platform exterior to the flight software development infrastructure and its related testing entities. In any software development process there is inherent risk in the interpretation and implementation of concepts into software through requirements and test cases into flight software compounded with potential human errors throughout the development lifecycle. Risk reduction is addressed by the M&FM analysis group working with other organizations such as S&MA, Structures and Environments, GNC, Orion, the Crew Office, Flight Operations, and Ground Operations by assessing performance of the M&FM algorithms in terms of their ability to reduce Loss of Mission and Loss of Crew probabilities. In addition, through state machine and diagnostic modeling, analysis efforts investigate a broader suite of failure effects and associated detection and responses that can be tested in VMET to ensure that failures can be detected, and confirm that responses do not create additional risks or cause undesired states through interactive dynamic effects with other algorithms and systems. VMET further contributes to risk reduction by prototyping and exercising the M&FM algorithms early in their implementation and without any inherent hindrances such as meeting FSW

  5. Reducing Students' Carbon Footprints Using Personal Carbon Footprint Management System Based on Environmental Behavioural Theory and Persuasive Technology

    ERIC Educational Resources Information Center

    Lin, Shyh-ming

    2016-01-01

    This study applied environmental behavioural theories to develop a personal carbon footprint management system and used persuasive technology to implement it. The system serves as an educational system to improve the determinants of students' low-carbon behaviours, to promote low-carbon concepts and to facilitate their carbon management. To assess…

  6. Reducing Students' Carbon Footprints Using Personal Carbon Footprint Management System Based on Environmental Behavioural Theory and Persuasive Technology

    ERIC Educational Resources Information Center

    Lin, Shyh-ming

    2016-01-01

    This study applied environmental behavioural theories to develop a personal carbon footprint management system and used persuasive technology to implement it. The system serves as an educational system to improve the determinants of students' low-carbon behaviours, to promote low-carbon concepts and to facilitate their carbon management. To assess…

  7. Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis.

    PubMed

    He, Xiaoqin; Li, Jie; Wang, Bin; Yao, Qiuming; Li, Ling; Song, Ronghua; Shi, Xiaohong; Zhang, Jin-An

    2017-03-01

    Diabetes self-management education is an essential part of diabetes care, but its impact on all-cause mortality risk of type 2 diabetes patients is unclear. A systematic review and meta-analysis aiming to elucidate the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed. Randomised controlled trials were identified though literature search in Medline, Embase, CENTRAL, conference abstracts, and reference lists. Only randomised controlled trials comparing diabetes self-management education with usual care in type 2 diabetes patients and reporting outcomes after a follow-up of at least 12 months were considered eligible. Risk ratios with 95 %CIs were pooled. This study was registered at PROSPERO with the number of CRD42016043911. 42 randomised controlled trials containing 13,017 participants were included. The mean time of follow-up was 1.5 years. There was no heterogeneity among those included studies (I (2) = 0 %). Mortality occurred in 159 participants (2.3 %) in the diabetes self-management education group and in 187 (3.1 %) in the usual care group, and diabetes self-management education significantly reduced risk of all-cause mortality in type 2 diabetes patients (pooled risk ratios : 0.74, 95 %CI 0.60-0.90, P = 0.003; absolute risk difference: -0.8 %, 95 %CI -1.4 to -0.3). Both multidisciplinary team education and nurse-led education could significantly reduce mortality risk in type 2 diabetes patients, and the pooled risk ratios were 0.66 (95 %CI 0.46-0.96, P = 0.02; I (2) = 0 %) and 0.64 (95 % CI 0.47- 0.88, P = 0.005; I (2) = 0 %), respectively. Subgroup analyses of studies with longer duration of follow-up (≥1.5 years) or larger sample size (≥300) also found a significant effect of diabetes self-management education in reducing mortality risk among type 2 diabetes. Significant effect of diabetes self-management education in reducing mortality risk

  8. Managing phosphorus fertilizer to reduce algae, maintain water quality, and sustain yields in water-seeded rice

    USDA-ARS?s Scientific Manuscript database

    In water-seeded rice systems blue-green algae (cyanobacteria) hinder early-season crop growth by dislodging rice seedlings and reducing light. Since algae are often phosphorus (P) limited, we investigated whether changing the timing of P fertilizer application could reduce algae without reducing cro...

  9. Salter-Harris II fractures of the distal tibia: does surgical management reduce the risk of premature physeal closure?

    PubMed

    Russo, Franco; Moor, Molly A; Mubarak, Scott J; Pennock, Andrew T

    2013-01-01

    postreduction displacement, patient age (P=0.36), sex (P=0.39), mechanism of injury (P=0.13), time to fracture management (P=0.51), amount of initial displacement (P=0.34), number of reduction attempts (P=0.43), and operative treatment (P=0.47) did not significantly influence PPC. Patients with displaced SH II distal tibia fractures pose a challenging problem for the treating physician with a high rate of PPC (43% overall). Although surgical fixation with anatomic reduction and removal of interposed tissue may be necessary to improve joint alignment, it does not reduce the incidence of PPC and may increase the need for subsequent surgeries.

  10. Reducing Length of Stay, Direct Cost, and Readmissions in Total Joint Arthroplasty Patients With an Outcomes Manager-Led Interprofessional Team.

    PubMed

    Arana, Melissa; Harper, Licia; Qin, Huanying; Mabrey, Jay

    The purpose of this quality improvement project was to determine whether an outcomes manager-led interprofessional team could reduce length of stay and direct cost without increasing 30-day readmission rates in the total joint arthroplasty patient population. The goal was to promote interprofessional relationships combined with collaborative practice to promote coordinated care with improved outcomes. Results from this project showed that length of stay (total hip arthroplasty [THA] reduced by 0.4 days and total knee arthroplasty [TKA] reduced by 0.6 days) and direct cost (THA reduced by $1,020 per case and TKA reduced by $539 per case) were significantly decreased whereas 30-day readmission rates of both populations were not significantly increased.

  11. Reducing the dimensionality of soil microinvertebrate community datasets using Indicator Species Analysis: Implications for ecosystem monitoring and soil management

    USDA-ARS?s Scientific Manuscript database

    Soil microinvertebrates are closely associated with soil decomposition and nutrient cycles and may be particularly responsive indicators for soil management practices. However, identification of appropriate bioindicator species for many systems has been severely limited by a lack of information on ...

  12. Ship Maintenance Processes with Collaborative Product Lifecycle Management and 3D Terrestrial Laser Scanning Tools: Reducing Costs and Increasing Productivity

    DTIC Science & Technology

    2012-04-30

    approach that incorporates the 3D terrestrial laser scanning (3D TLS) and collaborative product lifecycle management (collab- PLM ) tool suite. Results...incorporated into final implementation of the 3D TLS and collab- PLM tools. 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...terrestrial laser scanning (3D TLS) and collaborative product lifecycle management (collab- PLM ) tool suite. Results suggest that when the SHIPMAIN process

  13. Comparative Effectiveness of Risk-Stratified Care Management in Reducing Readmissions in Medicaid Adults With Chronic Disease.

    PubMed

    Hewner, Sharon; Wu, Yow-Wu Bill; Castner, Jessica

    2016-01-01

    Hospitalized adult Medicaid recipients with chronic disease are at risk for rehospitalization within 90 days of discharge, but most research has focused on the Medicare population. The purpose of this study is to examine the impact of population-based care management intensity on inpatient readmissions in Medicaid adults with pre-existing chronic disease. Retrospective analyses of 2,868 index hospital admissions from 2012 New York State Medicaid Data Warehouse claims compared 90-day post-discharge utilization in populations with and without transitional care management interventions. High intensity managed care organization interventions were associated with higher outpatient and lower emergency department post-discharge utilization than low intensity fee-for-service management. However, readmission rates were higher for the managed care cases. Shorter time to readmission was associated with managed care, diagnoses that include heart and kidney failure, shorter length of stay for index hospitalization, and male sex; with no relationship to age. This unexpected result flags the need to re-evaluate readmission as a quality indicator in the complex Medicaid population. Quality improvement efforts should focus on care continuity during transitions and consider population-specific factors that influence readmission. Optimum post-discharge utilization in the Medicaid population requires a balance between outpatient, emergency and inpatient services to improve access and continuity.

  14. Comparative Effectiveness of Risk-Stratified Care Management in Reducing Readmissions in Medicaid Adults With Chronic Disease.

    PubMed

    Hewner, Sharon; Wu, Yow-Wu Bill; Castner, Jessica

    2015-03-06

    Hospitalized adult Medicaid recipients with chronic disease are at risk for rehospitalization within 90 days of discharge, but most research has focused on the Medicare population. The purpose of this study is to examine the impact of population-based care management intensity on inpatient readmissions in Medicaid adults with pre-existing chronic disease. Retrospective analyses of 2,868 index hospital admissions from 2012 New York State Medicaid Data Warehouse claims compared 90-day post-discharge utilization in populations with and without transitional care management interventions. High intensity managed care organization interventions were associated with higher outpatient and lower emergency department post-discharge utilization than low intensity fee-for-service management. However, readmission rates were higher for the managed care cases. Shorter time to readmission was associated with managed care, diagnoses that include heart and kidney failure, shorter length of stay for index hospitalization, and male sex; with no relationship to age. This unexpected result flags the need to re-evaluate readmission as a quality indicator in the complex Medicaid population. Quality improvement efforts should focus on care continuity during transitions and consider population-specific factors that influence readmission. Optimum post-discharge utilization in the Medicaid population requires a balance between outpatient, emergency and inpatient services to improve access and continuity.

  15. Risk assessment and management of brucellosis in the southern greater Yellowstone area (II): Cost-benefit analysis of reducing elk brucellosis prevalence.

    PubMed

    Boroff, Kari; Kauffman, Mandy; Peck, Dannele; Maichak, Eric; Scurlock, Brandon; Schumaker, Brant

    2016-11-01

    Recent cases of bovine brucellosis (Brucella abortus) in cattle (Bos taurus) and domestic bison (Bison bison) of the southern Greater Yellowstone Area (SGYA) have been traced back to free-ranging elk (Cervus elaphus). Several management activities have been implemented to reduce brucellosis seroprevalence in elk, including test-and-slaughter, low-density feeding at elk winter feedgrounds, and elk vaccination. It is unclear which of these activities are most cost-effective at reducing the risk of elk transmitting brucellosis to cattle. In a companion paper, a stochastic risk model was used to translate a reduction in elk seroprevalence to a reduction in the risk of transmission to cattle. Here, we use those results to estimate the expected economic benefits and costs of reducing seroprevalence in elk using three different management activities: vaccination of elk with Brucella strain 19 (S19), low-density feeding of elk, and elk test-and-slaughter. Results indicate that the three elk management activities yield negative expected net benefits, ranging from -$2983 per year for low-density feeding to -$595,471 per year for test-and-slaughter. Society's risk preferences will determine whether strategies that generate small negative net benefit, such as low-density feeding, are worth implementing. However, activities with large negative net benefits, such as test-and-slaughter and S19 vaccination, are unlikely to be economically worthwhile. Given uncertainty about various model parameters, we identify some circumstances in which individual management activities might generate positive expected net benefit.

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

    PubMed

    Taylor, J B; Dungan, R S; Lewis, G S

    2012-01-01

    Our objective was to establish doses of orally administered NaClO(3) that reduced the presence of generic Escherichia coli in intestines of ewes and neonatal lambs managed in a shed-lambing system. Neonatal lambs (n = 32; age = 7.1 ± 1.2 d; BW = 6.8 ± 1.0 kg) and yearling ewes (n = 44; BW = 74.8 ± 5.6 kg) were used in 2 experiments. In both experiments, lambs and ewes were randomly assigned to 1 of 4 groups, and groups were randomly assigned to 1 of 4 treatments. In Exp. 1, neonatal lambs were given single, aqueous, oral doses of saline (control; NaCl, 30 mg·kg of BW(-1)) or 30, 60, or 90 mg of NaClO(3)·kg(-1) of BW. At 25.9 ± 1.3 h after treatment, lambs were euthanized, and intestinal contents were collected aseptically. In Exp. 2, ewes were given single, aqueous, oral doses of saline (NaCl, 150 mg·kg of BW(-1)) or 150, 300, or 450 mg of NaClO(3)·kg(-1) of BW. At 24.0 ± 0.8 h after treatment, fecal samples were collected aseptically from the rectum of each ewe. For both experiments, generic E. coli were enumerated from intestinal contents and feces within 4 to 12 h after collection. In Exp. 1, the effect (P = 0.08) of NaClO(3) on the presence of generic E. coli in colon contents was dose-dependent. This effect was linear (P < 0.01) and negative, which indicated that as NaClO(3) dose increased, generic E. coli that could be isolated from colon contents decreased. Specifically, lambs dosed with 60 and 90 mg of NaClO(3)·kg(-1) of BW had fewer E. coli cfu·g(-1) of content than control lambs (P < 0.06). Lambs dosed with 90 mg of NaClO(3)·kg(-1) of BW had fewer E. coli cfu·g(-1) of content than lambs dosed with 30 mg of NaClO(3)·kg(-1) of BW (P = 0.09). Sodium chlorate dose did not influence (P = 0.58) the presence of generic E. coli in contents collected from the cecum. In Exp. 2, the effect (P < 0.0001) of NaClO(3) on the presence of E. coli in fecal contents from ewes was dose-dependent. This effect was quadratic (P < 0.0001) and negative; ewes dosed

  17. Reduced-risk pest management programs for eastern U.S. peach orchards: effects on arthropod predators, parasitoids, and select pests.

    PubMed

    Biddinger, David J; Leslie, Timothy W; Joshi, Neelendra K

    2014-06-01

    We developed new integrated pest management programs for eastern U.S. peaches with minimal use of organophosphates. From 2002-2005, we assessed the ecological impacts of these reduced-risk programs versus grower standard conventional programs that still relied primarily on the use of organophosphorous and carbamate insecticides. Using a split-plot design replicated at four commercial Pennsylvania peach orchards, we quantified pesticide rates, environmental impact, and arthropod community response. We used Environmental Impact Quotient (EIQ) analysis based on the growers' pesticide records from each orchard to calculate seasonal cumulative EIQ field ratings for all years. Ecological effects of the reduced-risk and conventional program were also measured as the abundance and diversity of nontarget arthropod predators, parasitoids, and selected pest taxa. Pesticide inputs and EIQ values were substantially lower in reduced-risk programs compared with conventional spray programs. Arthropod arrays differed significantly between pest management programs: most beneficial predator and parasitoid taxa were positively associated with the reduced-risk program and negatively associated with the standard grower program. Regardless of the pest management program, we observed significant differences in species arrays in the peach tree canopy compared with the ground cover of the orchards, but the arthropod community did not differ among the field sites or based on distance from the edge of the orchard. We conclude that reduced-risk programs not only provide control comparable with that of conventional programs, but they also reduce negative environmental effects while conserving key arthropod biological control agents within eastern U.S. peach orchards.

  18. Bumps on the managed care road: the search for an alternative model to reduce collisions between HMOs, physicians, and patients.

    PubMed

    Reece, R L

    2000-01-01

    Managed care is experiencing political, litigious, and financial bumps on the road. There are various reasons for this bumpy ride: out-of-control costs, prescription drug expense, negative media reports, public revolt at denials of care or limited access to specialists, bad physician relations, patients' rights legislation, dropping health maintenance organization (HMO) stock prices, the ripple effect of the Harvard Pilgrim bankruptcy, and threat of massive litigation against HMOs. Two reasons not often mentioned, but explored in this article, are the orthodox managed care's flawed market model and lack of enough understanding of physician culture and emerging consumer trends to effectively address these two key constituencies.

  19. Defense Management: DOD Needs Better Information and Guidance to More Effectively Manage and Reduce Operating and Support Costs of Major Weapon Systems

    DTIC Science & Technology

    2010-07-01

    contractor logistics support arrangements since before 2005, the estimates included the costs for government -provided logistics support of the aircraft . For...GAO United States Government Accountability Office Report to Congressional Committees DEFENSE MANAGEMENT DOD Needs Better... Government Accountability Office,441 G Street NW,Washington,DC,20548 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S

  20. The Slope of Change: An Environmental Management Approach to Reduce Drinking on a Day of Celebration at a U.S. College

    PubMed Central

    Marchell, Timothy C.; Lewis, Deborah D.; Croom, Katherine; Lesser, Martin L.; Murphy, Susan H.; Reyna, Valerie F.; Frank, Jeremy; Staiano-Coico, Lisa

    2013-01-01

    OBJECTIVE This research extends the literature on event-specific environmental management with a case study evaluation of an intervention designed to reduce student drinking at a university's year-end celebration. PARTICIPANTS Cornell University undergraduates were surveyed each May from 2001 through 2009. Sample sizes ranged from 322 to 1,973. METHODS Randomly sampled surveys were conducted after a large, annual spring campus celebration. An environmental management plan was initiated in 2003 that included increased enforcement of the minimum age drinking law (MADL). RESULTS In the short-term, drinking at the campus celebration decreased while drinking before the event increased. Over time, the intervention significantly reduced high-risk drinking on the day of the event, especially among those under the age of 21. CONCLUSION These findings are contrary to the argument that enforcement of MADLs simply lead to increased high-risk drinking, and therefore have implications for how colleges approach the challenge of student alcohol misuse. PMID:23930747

  1. The Efficacy of Asthma Case Management in an Urban School District in Reducing School Absences and Hospitalizations for Asthma

    ERIC Educational Resources Information Center

    Levy, Marian; Heffner, Brenda; Stewart, Tara; Beeman, Gail

    2006-01-01

    Pediatric asthma rates are reaching epidemic proportions, adversely affecting children's quality of life, educational potential, and health care costs, especially those in the inner city. This study evaluated the effectiveness of a school-based asthma case management (CM) approach with medically undeserved inner-city children attending Memphis…

  2. Manure and inorganic fertilizer management practices for reducing methane and nitrous oxide emissions in conservation tillage systems

    USDA-ARS?s Scientific Manuscript database

    Conservation tillage and use of poultry litter (PL) as a fertilizer are widely being recommended for soil conservation, C sequestration, and environmentally sustainable animal waste disposal methods in the southeastern U.S. There is a need to develop and evaluate fertilizer management practices for...

  3. Efficiencies of forestry best management practices for reducing sediment and nutrient losses in the eastern United States

    Treesearch

    Pamela Edwards; Karl W.J. Williard

    2010-01-01

    Quantifying the effects of forestry best management practices (BMPs) on sediment and nutrient loads is a critical need. Through an exhaustive literature search, three paired forested watershed studies in the eastern United States were found that permitted the calculation of BMP efficiencies--the percent reduction in sediment or nutrients achieved by BMPs. For sediment...

  4. The Effectiveness of Stress Management and Test-Taking Workshops in Reducing Test Anxiety of Community College Students.

    ERIC Educational Resources Information Center

    Price, Elsa C.

    A study was conducted to determine the effectiveness of a Stress Management Seminar and a Test-Taking Skills Workshop in improving the scores of pre-nursing and guidance examinees at Wallace Community College in Dothan, Alabama. The 73 subjects took the Pre-Nursing and Guidance Examination (PNGE) in June 1984, September 1984, or January 1985.…

  5. The Efficacy of Asthma Case Management in an Urban School District in Reducing School Absences and Hospitalizations for Asthma

    ERIC Educational Resources Information Center

    Levy, Marian; Heffner, Brenda; Stewart, Tara; Beeman, Gail

    2006-01-01

    Pediatric asthma rates are reaching epidemic proportions, adversely affecting children's quality of life, educational potential, and health care costs, especially those in the inner city. This study evaluated the effectiveness of a school-based asthma case management (CM) approach with medically undeserved inner-city children attending Memphis…

  6. Has the Shift to Managed Care Reduced Medicaid Expenditures? Evidence from State and Local-Level Mandates

    ERIC Educational Resources Information Center

    Duggan, Mark; Hayford, Tamara

    2013-01-01

    From 1991 to 2009, the fraction of Medicaid recipients enrolled in HMOs and other forms of Medicaid managed care (MMC) increased from 11 percent to 71 percent. This increase was largely driven by state and local mandates that required most Medicaid recipients to enroll in an MMC plan. Theoretically, it is ambiguous whether the shift from…

  7. Has the Shift to Managed Care Reduced Medicaid Expenditures? Evidence from State and Local-Level Mandates

    ERIC Educational Resources Information Center

    Duggan, Mark; Hayford, Tamara

    2013-01-01

    From 1991 to 2009, the fraction of Medicaid recipients enrolled in HMOs and other forms of Medicaid managed care (MMC) increased from 11 percent to 71 percent. This increase was largely driven by state and local mandates that required most Medicaid recipients to enroll in an MMC plan. Theoretically, it is ambiguous whether the shift from…

  8. Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression

    PubMed Central

    Catty, Jocelyn; Dash, Michael; Roberts, Chris; Lockwood, Austin; Marshall, Max

    2007-01-01

    Objectives To explain why clinical trials of intensive case management for people with severe mental illness show such inconsistent effects on the use of hospital care. Design Systematic review with meta-regression techniques applied to data from randomised controlled trials. Data Sources Cochrane central register of controlled trials, CINAHL, Embase, Medline, and PsychINFO databases from inception to January 2007. Additional anonymised data on patients were obtained for multicentre trials. Review methods Included trials examined intensive case management compared with standard care or low intensity case management for people with severe mental illness living in the community. We used a fidelity scale to rate adherence to the model of assertive community treatment. Multicentre trials were disaggregated into individual centres with fidelity data specific for each centre. A multivariate meta-regression used mean days per month in hospital as the dependent variable. Results We identified 1335 abstracts with a total of 5961 participants. Of these, 49 were eligible and 29 provided appropriate data. Trials with high hospital use at baseline (before the trial) or in the control group were more likely to find that intensive case management reduced the use of hospital care (coefficient −0.23, 95% confidence interval −0.36 to −0.09, for hospital use at baseline; −0.44, −0.57 to −0.31, for hospital use in control groups). Case management teams organised according to the model of assertive community treatment were more likely to reduce the use of hospital care (coefficient −0.31, −0.59 to −0.03), but this finding was less robust in sensitivity analyses and was not found for staffing levels recommended for assertive community treatment. Conclusions Intensive case management works best when participants tend to use a lot of hospital care and less well when they do not. When hospital use is high, intensive case management can reduce it, but it is less successful

  9. Management of Sodium-reduced Meals at Worksite Cafeterias: Perceptions, Practices, Barriers, and Needs among Food Service Personnel

    PubMed Central

    Lee, Jounghee; Park, Sohyun

    2015-01-01

    Objectives The sodium content of meals provided at worksite cafeterias is greater than the sodium content of restaurant meals and home meals. The objective of this study was to assess the relationships between sodium-reduction practices, barriers, and perceptions among food service personnel. Methods We implemented a cross-sectional study by collecting data on perceptions, practices, barriers, and needs regarding sodium-reduced meals at 17 worksite cafeterias in South Korea. We implemented Chi-square tests and analysis of variance for statistical analysis. For post hoc testing, we used Bonferroni tests; when variances were unequal, we used Dunnett T3 tests. Results This study involved 104 individuals employed at the worksite cafeterias, comprised of 35 men and 69 women. Most of the participants had relatively high levels of perception regarding the importance of sodium reduction (very important, 51.0%; moderately important, 27.9%). Sodium reduction practices were higher, but perceived barriers appeared to be lower in participants with high-level perception of sodium-reduced meal provision. The results of the needs assessment revealed that the participants wanted to have more active education programs targeting the general population. The biggest barriers to providing sodium-reduced meals were use of processed foods and limited methods of sodium-reduced cooking in worksite cafeterias. Conclusion To make the provision of sodium-reduced meals at worksite cafeterias more successful and sustainable, we suggest implementing more active education programs targeting the general population, developing sodium-reduced cooking methods, and developing sodium-reduced processed foods. PMID:27169011

  10. Technologic Distractions (Part 1): Summary of Approaches to Manage Alert Quantity With Intent to Reduce Alert Fatigue and Suggestions for Alert Fatigue Metrics.

    PubMed

    Kane-Gill, Sandra L; O'Connor, Michael F; Rothschild, Jeffrey M; Selby, Nicholas M; McLean, Barbara; Bonafide, Christopher P; Cvach, Maria M; Hu, Xiao; Konkani, Avinash; Pelter, Michele M; Winters, Bradford D

    2017-09-01

    To provide ICU clinicians with evidence-based guidance on tested interventions that reduce or prevent alert fatigue within clinical decision support systems. Systematic review of PubMed, Embase, SCOPUS, and CINAHL for relevant literature from 1966 to February 2017. Focus on critically ill patients and included evaluations in other patient care settings, as well. Identified interventions designed to reduce or prevent alert fatigue within clinical decision support systems. Study selection was based on one primary key question to identify effective interventions that attempted to reduce alert fatigue and three secondary key questions that covered the negative effects of alert fatigue, potential unintended consequences of efforts to reduce alert fatigue, and ideal alert quantity. Data were abstracted by two reviewers independently using a standardized abstraction tool. Surveys, meeting abstracts, "gray" literature, studies not available in English, and studies with non-original data were excluded. For the primary key question, articles were excluded if they did not provide a comparator as key question 1 was designed as a problem, intervention, comparison, and outcome question. We anticipated that reduction in alert fatigue, including the concept of desensitization may not be directly measured and thus considered interventions that reduced alert quantity as a surrogate marker for alert fatigue. Twenty-six articles met the inclusion criteria. Approaches for managing alert fatigue in the ICU are provided as a result of reviewing tested interventions that reduced alert quantity with the anticipated effect of reducing fatigue. Suggested alert management strategies include prioritizing alerts, developing sophisticated alerts, customizing commercially available alerts, and including end user opinion in alert selection. Alert fatigue itself is studied less frequently, as an outcome, and there is a need for more precise evaluation. Standardized metrics for alert fatigue is

  11. Randomized Controlled Trial to Reduce Cardiovascular Disease Risk for Patients with Bipolar Disorder: the Self-Management Addressing Heart Risk Trial (SMAHRT)

    PubMed Central

    Kilbourne, Amy M.; Goodrich, David E.; Lai, Zongshan; Post, Edward P.; Schumacher, Karen; Nord, Kristina M.; Bramlet, Margretta; Chermack, Stephen; Bialy, David; Bauer, Mark S.

    2014-01-01

    Objectives Persons with bipolar disorder experience a disproportionate burden of medical conditions, notably cardiovascular disease (CVD), leading to impaired functioning and premature mortality. The study objective was to determine whether the Life Goals Collaborative Care (LGCC) intervention compared to enhanced usual care, reduced CVD risk factors and improved physical and mental health outcomes in VA patients with bipolar disorder. Method Patients with ICD-9 diagnosis of bipolar disorder and >=1 CVD risk factor (n=118) enrolled in the Self-Management Addressing Heart Risk Trial conducted April 2008–May 2010, were randomized to LGCC (N=58) or enhanced usual care (N=60). LGCC included four weekly self-management sessions followed by tailored contacts combining health behavior change strategies, medical care management, registry tracking, and provider guideline support. Enhanced usual care included quarterly wellness newsletters sent over a 12-month period in addition to standard treatment. Results Out of the 180 eligible patients identified for study participation, 134 were enrolled (74%) and 118 completed outcomes assessments (mean age = 53, 17% female, 5% African American). Mixed effects analyses comparing changes in 24-month outcomes among patients in LGCC (N=57) versus enhanced usual care (N=59) groups revealed that patients receiving LGCC had reduced systolic (Beta=−3.1, P=.04) and diastolic blood pressure (Beta=−2.1, P=.04) as well as reduced manic symptoms (Beta=−23.9, P=.01). LGCC had no significant impact on other primary outcomes (total cholesterol, physical health-related quality of life). Conclusions LGCC compared to enhanced usual care may lead to reduced CVD risk factors, notably through decreased blood pressure, as well as reduced manic symptoms. PMID:23945460

  12. Can chronic disease management plans including occupational therapy and physiotherapy services contribute to reducing falls risk in older people?

    PubMed

    Mackenzie, Lynette; Clemson, Lindy

    2014-04-01

    Exercise and home modifications are effective interventions for preventing falls. Chronic disease management (CDM) items are one way for general practitioners (GPs) to access these interventions. This study aimed to evaluate the outcomes and feasibility of using CDM items for occupational therapy (OT) and physiotherapy (PT) sessions to address falls risk. A pre-post pilot study design was used to evaluate five collaborative sessions shared by a private OT and PT using CDM items and a GP management plan. Pre and post intervention measures were used to evaluate outcomes for eight patients aged ≥75 years from two GP practices. At 2 months post-intervention there were significant improvements in everyday functioning (P = 0.04), physical capacity (P = 0.01) and falls efficacy (P =0.01). Adherence to the intervention was excellent. Falls prevention interventions can be effective in primary care settings and sustainable pathways need to be developed to ensure access for older people at risk.

  13. Dynamic Cost-Contingency Management: A Method for Reducing Project Costs While Increasing the Probability of Success

    DTIC Science & Technology

    2007-04-30

    simple Monte Carlo simulation tools such as @Risk® and Crystal Ball®. The premise of this paper is that a credible Probabilistic Cost Analysis...readily performed using commercially available Monte Carlo simulation Excel add-ins. The implementation of a project-wide cost contingency to ensure...deterministic to probabilistic approach is NOT silver bullet • Monte Carlo simulation is only a mathematical tool: GIGO Poor management practices Lack of

  14. Population Care Management and Team-Based Approach to Reduce Racial Disparities among African Americans/Blacks with Hypertension

    PubMed Central

    Bartolome, Rowena E; Chen, Agnes; Handler, Joel; Platt, Sharon Takeda; Gould, Bernice

    2016-01-01

    Objectives: At Kaiser Permanente, national Equitable Care Health Outcomes (ECHO) Reports with a baseline measurement of 16 Healthcare Effectiveness Data and Information Set measures stratified by race and ethnicity showed a disparity of 8.1 percentage points in blood pressure (BP) control rates between African- American/black (black) and white members. The aims of this study were to describe a population care management team-based approach to improve BP control for large populations and to explain how a culturally tailored, patient-centered approach can address this racial disparity. Methods: These strategies were implemented through: 1) physician-led educational programs on treatment intensification, medication adherence, and consistent use of clinical practice guidelines; 2) building strong care teams by defining individual roles and responsibilities in hypertension management; 3) redesign of the care delivery system to expand access; and 4) programs on culturally tailored communication tools and self-management. Results: At a physician practice level where 65% of patients with hypertension were black, BP control rates (< 140/90 mmHg) for blacks improved from 76.6% to 81.4%, and control rates for whites increased from 82.9% to 84.2%. The racial gap narrowed from 6.3% to 2.8%. As these successful practices continue to spread throughout the program, the health disparity gap in BP control has decreased by 50%, from 8.1% to 3.9%. Conclusion: A sustainable program to collect self-reported race, ethnicity, and language preference data integrated with successful population care management programs provided the foundation for addressing health disparities. Cultural tailoring of a multilevel team-based approach closed the gap for blacks with hypertension. PMID:26824963

  15. U.S. Federal Fuel Management Programs: Reducing Risk to Communities and Increasing Ecosystem Resilience and Sustainability

    Treesearch

    Tim Sexton

    2006-01-01

    There is no doubt that wildland fuel conditions on large portions of federal wildlands in the United States have changed significantly over the last 100 years. The changes include: Increased density of woody species; Artificial fragmentation of fuel mosaics; Exotic species invasions; Structural changes which reduce ecosystem resilience to fire.

  16. How School Facilities Managers and Business Officials Are Reducing Operating Costs and Saving Money. Energy-Smart Building Choices.

    ERIC Educational Resources Information Center

    Department of Energy, Washington, DC.

    This guide addresses contributions that school facility administrators and business officials can make in an effort to reduce operating costs and free up money for capital improvements. The guide explores opportunities available to utilize energy-saving strategies at any stage in a building's life, from its initial design phase through renovation.…

  17. The efficacy of combined educational and site management actions in reducing off-trail hiking in an urban-proximate protected area.

    PubMed

    Hockett, Karen S; Marion, Jeffrey L; Leung, Yu-Fai

    2017-12-01

    Park and protected area managers are tasked with protecting natural environments, a particularly daunting challenge in heavily visited urban-proximate areas where flora and fauna are already stressed by external threats. In this study, an adaptive management approach was taken to reduce extensive off-trail hiking along a popular trail through an ecologically diverse and significant area in the Chesapeake and Ohio National Historical Park near Washington DC. Substantial amounts of off-trail hiking there had created an extensive 16.1 km network of informal (visitor-created) trails on a 39 ha island in the Potomac Gorge. A research design with additive treatments integrating educational and site management actions was applied and evaluated using self-reported behavior from an on-site visitor survey and unobtrusive observations of off-trail hiking behavior at two locations along the trail. Study treatments included: 1) trailhead educational signs developed using attribution theory and injunctive-proscriptive wording, 2) symbolic "no hiking" prompter signs attached to logs placed across all informal trails, 3) placement of concealing leaf litter and small branches along initial sections of informal trails, 4) restoration work on selected trails with low fencing, and 5) contact with a trail steward to personally communicate the trailhead sign information. The final, most comprehensive treatment reduced visitor-reported intentional off-trail hiking from 70.3% to 43.0%. Direct observations documented reduction in off-trail hiking from 25.9% to 2.0%. The educational message and site management actions both contributed to the decline in off-trail travel and the two evaluation methods enhanced our ability to describe the efficacy of the different treatments in reducing off-trail travel. Published by Elsevier Ltd.

  18. Managing potential drug-drug interactions between gastric acid-reducing agents and antiretroviral therapy: experience from a large HIV-positive cohort.

    PubMed

    Lewis, J M; Stott, K E; Monnery, D; Seden, K; Beeching, N J; Chaponda, M; Khoo, S; Beadsworth, M B J

    2016-02-01

    Drug-drug interactions between antiretroviral therapy and other drugs are well described. Gastric acid-reducing agents are one such class. However, few data exist regarding the frequency of and indications for prescription, nor risk assessment in the setting of an HIV cohort receiving antiretroviral therapy. To assess prevalence of prescription of gastric acid-reducing agents and drug-drug interaction within a UK HIV cohort, we reviewed patient records for the whole cohort, assessing demographic data, frequency and reason for prescription of gastric acid-reducing therapy. Furthermore, we noted potential drug-drug interaction and whether risk had been documented and mitigated. Of 701 patients on antiretroviral therapy, 67 (9.6%) were prescribed gastric acid-reducing therapy. Of these, the majority (59/67 [88.1%]) were prescribed proton pump inhibitors. We identified four potential drug-drug interactions, which were appropriately managed by temporally separating the administration of gastric acid-reducing agent and antiretroviral therapy, and all four of these patients remained virally suppressed. Gastric acid-reducing therapy, in particular proton pump inhibitor therapy, appears common in patients prescribed antiretroviral therapy. Whilst there remains a paucity of published data, our findings are comparable to those in other European cohorts. Pharmacovigilance of drug-drug interactions in HIV-positive patients is vital. Education of patients and staff, and accurate data-gathering tools, will enhance patient safety.

  19. Outdoor Air Pollution, Genetic Susceptibility, and Asthma Management: Opportunities for Intervention to Reduce the Burden of Asthma

    PubMed Central

    Gilliland, Frank D.

    2009-01-01

    Outdoor air pollution at levels occurring in many urban areas around the world has substantial adverse effects on health. Children in general, and children with asthma in particular, are sensitive to the adverse effects of outdoor air pollutants, including ozone, nitrogen oxides, and respirable particulate matter. A growing number of studies also show that children living in environments near traffic have increased risks of new-onset asthma, asthma symptoms, exacerbations, school absences, and asthma-related hospitalizations. The large population of children exposed to high levels of outdoor air pollutants and the substantial risks for adverse health effects present unexploited opportunities to reduce the burden of asthma. Because the evidence indicates significant adverse effects of air pollution at current levels, there is clearly a need to reduce levels of regulated pollutants such as ozone, as well as unregulated pollutants in tailpipe emissions from motor vehicles. Achieving this long-term goal requires the active involvement of physicians and medical providers to ensure that the health of children is at the top of the list of competing priorities for regulatory policy decision-making. Clinical approaches include treatment to control asthma and patient education to reduce adverse effects of the disease. Reduction in exposures also can be approached at a policy level through changes in schools and school bus operations. Beyond clinical and public health approaches to reduce exposure, another strategy to be used before clean air goals are met is to decrease the susceptibility of children to air pollution. Emerging research indicates that dietary supplementation for individuals with low antioxidant levels is one promising approach to reducing susceptibility to air pollution. A second approach involves induction of enzymatic antioxidant defenses, especially for individuals with at-risk genetic variants of key antioxidant enzymes. PMID:19221160

  20. Many-objective reservoir policy identification and refinement to reduce policy inertia and myopia in water management

    NASA Astrophysics Data System (ADS)

    Giuliani, M.; Herman, J. D.; Castelletti, A.; Reed, P.

    2014-04-01

    This study contributes a decision analytic framework to overcome policy inertia and myopia in complex river basin management contexts. The framework combines reservoir policy identification, many-objective optimization under uncertainty, and visual analytics to characterize current operations and discover key trade-offs between alternative policies for balancing competing demands and system uncertainties. The approach is demonstrated on the Conowingo Dam, located within the Lower Susquehanna River, USA. The Lower Susquehanna River is an interstate water body that has been subject to intensive water management efforts due to competing demands from urban water supply, atomic power plant cooling, hydropower production, and federally regulated environmental flows. We have identified a baseline operating policy for the Conowingo Dam that closely reproduces the dynamics of current releases and flows for the Lower Susquehanna and thus can be used to represent the preferences structure guiding current operations. Starting from this baseline policy, our proposed decision analytic framework then combines evolutionary many-objective optimization with visual analytics to discover new operating policies that better balance the trade-offs within the Lower Susquehanna. Our results confirm that the baseline operating policy, which only considers deterministic historical inflows, significantly overestimates the system's reliability in meeting the reservoir's competing demands. Our proposed framework removes this bias by successfully identifying alternative reservoir policies that are more robust to hydroclimatic uncertainties while also better addressing the trade-offs across the Conowingo Dam's multisector services.

  1. Can telemonitoring reduce hospitalization and cost of care? A health plan's experience in managing patients with heart failure.

    PubMed

    Maeng, Daniel D; Starr, Alison E; Tomcavage, Janet F; Sciandra, Joann; Salek, Doreen; Griffith, David

    2014-12-01

    Telemonitoring provides a potentially useful tool for disease and case management of those patients who are likely to benefit from frequent and regular monitoring by health care providers. Since 2008, Geisinger Health Plan (GHP) has implemented a telemonitoring program that specifically targets those members with heart failure. This study assesses the impact of this telemonitoring program by examining claims data of those GHP Medicare Advantage plan members who were enrolled in the program, measuring its impact in terms of all-cause hospital admission rates, readmission rates, and total cost of care. The results indicate significant reductions in probability of all-cause admission (odds ratio [OR] 0.77; P<0.01), 30-day and 90-day readmission (OR 0.56, 0.62; P<0.05), and cost of care (11.3%; P<0.05). The estimated return on investment was 3.3. These findings imply that telemonitoring can be an effective add-on tool for managing elderly patients with heart failure.

  2. Ship Maintenance Processes with Collaborative Product Lifecycle Management and 3D Terrestrial Laser Scanning Tools: Reducing Costs and Increasing Productivity

    DTIC Science & Technology

    2011-04-30

    decision-makers should view the results as a portfolio of rolled-up projects because the projects are in most cases correlated with one another, and...measure of risk), and the correlation matrix between these assets, sets of portfolios with expected returns greater than any other with the same or...than Portfolio E, as the marginal increase is negative on the y-axis (e.g., Tactical Score). That is, spending too much money may actually reduce

  3. Ship Maintenance Processes with Collaborative Product Lifecycle Management and 3D Terrestrial Laser Scanning Tools: Reducing Costs and Increasing Productivity

    DTIC Science & Technology

    2011-09-20

    diversification , which focused on selecting portfolios based on their overall risk– reward characteristics. He felt that investors should create...standard deviation of each asset’s logarithmic relative returns (measure of risk), and the correlation matrix between these assets, sets of portfolios ... Portfolio E as the marginal increase is negative on the y-axis (Tactical Score). That is, spending too much money may actually reduce the overall

  4. Synthetic fertilizer management for China's cereal crops has reduced N2O emissions since the early 2000s.

    PubMed

    Sun, Wenjuan; Huang, Yao

    2012-01-01

    China has implemented a soil testing and fertilizer recommendation (STFR) program to reduce the over-usage of synthetic nitrogen (N) fertilizer on cereal crops since the late 1990 s. Using province scale datasets, we estimated an annual reduction rate of 2.5-5.1 kg N ha(-1) from 1998 to 2008 and improving grain yields, which were attributed to the balanced application of phosphate and potassium fertilization. Relative to the means for 1998-2000, the synthetic N fertilizer input and the corresponding N-induced N(2)O production in cereal crops were reduced by 22 ± 0.7 Tg N and 241 ± 4 Gg N(2)O-N in 2001-2008. Further investigation suggested that the N(2)O emission related to wheat and maize cultivation could be reduced by 32-43 Gg N(2)O-N per year in China (26%-41% of the emissions in 2008) if the STFR practice is implemented universally in the future.

  5. Food-based recommendations to reduce fat intake: an evidence-based approach to the development of a family-focused child weight management programme.

    PubMed

    Gehling, R K; Magarey, A M; Daniels, L A

    2005-03-01

    To develop food-based recommendations to lower fat and energy intake for use in a family-focussed weight management programme for 6-9 year old children. Secondary analysis of the 1995 National Nutrition Survey (NNS95) informed the development of food-based recommendations aiming to reduce fat and energy intake. Each recommendation was used to progressively modify a model 3-day high fat dietary intake with the accumulative effect on energy and nutrient intake of each recommendation assessed. Six to nine-year-olds in the NNS95 consuming 35-45% energy as fat (n= 280) consumed more total energy (mean +/- SD, 8671 +/- 2741 vs. 7571 +/- 2328 kJ/day) than children consuming a 'low fat' (23-27% energy as fat, n= 85) diet (P < 0.002). Food-based recommendations found to be most effective for reducing energy and fat intake included; changing to reduced fat milk, reducing intake of cereal-based and snack foods and replacing juice or soft drink with water. These changes, together with avoiding adding fat to vegetables and using sources of lean meat, reduced energy intake by approximately 10%, total fat intake by approximately 30% and saturated fat intake by 53%. Modifying six areas of food choices results in a moderate reduction in fat and energy intake. An eating pattern that is consistent with Australian dietary guidelines and uses foods commonly eaten by children is achievable for children aged 6-9 years. These food-based recommendations provide an evidence-based dietary framework for prevention and management of overweight in children.

  6. A Targeted Self-Management Approach for Reducing Stroke Risk Factors in African American Men Who Have Had a Stroke or Transient Ischemic Attack.

    PubMed

    Sajatovic, Martha; Tatsuoka, Curtis; Welter, Elisabeth; Colon-Zimmermann, Kari; Blixen, Carol; Perzynski, Adam T; Amato, Shelly; Cage, Jamie; Sams, Johnny; Moore, Shirley M; Pundik, Svetlana; Sundararajan, Sophia; Modlin, Charles; Sila, Cathy

    2017-01-01

    This study compared a novel self-management (TargetEd MAnageMent Intervention [TEAM]) versus treatment as usual (TAU) to reduce stroke risk in African American (AA) men. Six-month prospective randomized controlled trial with outcomes evaluated at baseline, 3 months, and 6 months. Academic health center. Thirty-eight (age < 65) AA men who had a stroke or transient ischemic attack and a Barthel index score of >60 were randomly assigned to TEAM (n = 19) or TAU (n = 19). Self-management training, delivered in 1 individual and 4 group sessions (over 3 months). Blood pressure, glycosylated hemoglobin (HbA1c), lipids, medication adherence, weight, and standardized measures of health behaviors (diet, exercise, smoking, substances), depression, and quality of life. Qualitative assessments evaluated the perspectives of TEAM participants. T tests for paired differences and nonparametric tests. Thematic content qualitative analysis. Mean age was 52.1 (standard deviation [SD] = 7.4) and mean body mass index was 31.4 (SD = 7.4). Compared to TAU, TEAM participants had significantly lower mean systolic blood pressure by 24 weeks, and there was also improvement in HbA1c and high-density lipoprotein cholesterol ( P = .03). Other biomarker and health behaviors were similar between groups. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support.

  7. Reducing greenhouse gas emissions and adapting agricultural management for climate change in developing countries: providing the basis for action.

    PubMed

    Ogle, Stephen M; Olander, Lydia; Wollenberg, Lini; Rosenstock, Todd; Tubiello, Francesco; Paustian, Keith; Buendia, Leandro; Nihart, Alison; Smith, Pete

    2014-01-01

    Agriculture in developing countries has attracted increasing attention in international negotiations within the United Nations Framework Convention on Climate Change for both adaptation to climate change and greenhouse gas mitigation. However, there is limited understanding about potential complementarity between management practices that promote adaptation and mitigation, and limited basis to account for greenhouse gas emission reductions in this sector. The good news is that the global research community could provide the support needed to address these issues through further research linking adaptation and mitigation. In addition, a small shift in strategy by the Intergovernmental Panel on Climate Change (IPCC) and ongoing assistance from agricultural organizations could produce a framework to move the research and development from concept to reality. In turn, significant progress is possible in the near term providing the basis for UNFCCC negotiations to move beyond discussion to action for the agricultural sector in developing countries.

  8. Scheduling fertilizer applications as a simple mitigation option for reducing N2O emission in intensively managed mown grassland systems

    NASA Astrophysics Data System (ADS)

    Neftel, Albrecht; Calanca, Pierluigi; Felber, Raphael; Grant, Robert; Conen, Franz

    2014-05-01

    A general principle in all proposed N2O mitigation options is the fertilization according to plants' requirements. Meanwhile the amount of N fertilization allowed is regulated in many countries. Due to the high pressure from food security and the need for economic efficiency the given limits are generally used up. In mown grassland systems a simple mitigation option is to optimize the timing of the fertilizer applications. Application of fertilizer, both organic manure and mineral fertilizer, is generally scheduled after each cut in a narrow time window. In practice, the delay between cut and fertilizer application is determined by weather conditions, management conditions and most important by the planning and experience of the individual farmer. Many field experiments have shown that enhanced N2O emissions tend to occur after cuts but before the application of fertilizer, especially when soils are characterized by a high WFPS. These findings suggest that the time of fertilizer application has an important implications for the N2O emission rate and that scheduling fertilization according to soil conditions might be a simple, cheap and efficient measure to mitigate N2O emissions. In this paper we report on results from a sensitivity analysis aiming at quantifying the effects of the timing of the fertilizer applications on N2O emissions from intensively managed, mown grasslands. Simulations for different time schedules were carried out with the comprehensive ecosystem model "ECOSYS" . To our knowledge this aspect has not been systematically investigated from a scientific point of view, but might have been always there within the experiences of attentive environmentally concerned farmers.

  9. A modified portfolio diet complements medical management to reduce cardiovascular risk factors in diabetic patients with coronary artery disease.

    PubMed

    Keith, Mary; Kuliszewski, Michael A; Liao, Christine; Peeva, Valentina; Ahmed, Mavra; Tran, Susan; Sorokin, Kevin; Jenkins, David J; Errett, Lee; Leong-Poi, Howard

    2015-06-01

    Secondary prevention can improve outcomes in high risk patients. This study investigated the magnitude of cardiovascular risk reduction associated with consumption of a modified portfolio diet in parallel with medical management. 30 patients with type II diabetes, 6 weeks post bypass surgery received dietary counseling on a Modified Portfolio Diet (MPD) (low fat, 8 g/1000 kcal viscous fibres, 17 g/1000 kcal soy protein and 22 g/1000 kcal almonds). Lipid profiles, endothelial function and markers of glycemic control, oxidative stress and inflammation were measured at baseline and following two and four weeks of intervention. Seven patients with no diet therapy served as time controls. Consumption of the MPD resulted in a 19% relative reduction in LDL (1.9 ± 0.8 vs 1.6 ± 0.6 mmol/L, p < 0.001) with no change in HDL cholesterol. Homocysteine levels dropped significantly (10.1 ± 2.7 vs 7.9 ± 4 μmol/L, p = 0.006) over the study period. Flow mediated dilatation increased significantly in treated patients (3.8 ± 3.8% to 6.5 ± 3.6%, p = 0.004) while remaining constant in controls (p = 0.6). Endothelial progenitor cells numbers (CD34+, CD 133+ and UEA-1+) increased significantly following MPD consumption (p < 0.02) with no difference in migratory capacity. In contrast, time controls showed no significant changes. Dietary intervention in medically managed, high risk patients resulted in important reductions in risk factors. Clinical Trials registry number NCT00462436. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  10. Modelling the potential of slurry management technologies to reduce the constraints of environmental legislation on pig production.

    PubMed

    Hutchings, Nicholas J; ten Hoeve, Marieke; Jensen, Rikke; Bruun, Sander; Søtoft, Lene F

    2013-11-30

    Limits on land applications of slurry nitrogen (N) and phosphorus (P) are used to restrict losses of nutrients caused by livestock production. Here, we used a model to assess technologies that enable a more even geographic distribution of slurry nutrients to land. Technologies included were screw press slurry separation, with or without solid fraction composting, centrifuge separation with or without liquid fraction ammonia (NH3) stripping, and anaerobic digestion. Regulatory constraints were placed first on the application in slurry of N, then P, then N and P both on the producing (donor) and receiving (recipient) farms. Finally, a constraint preventing an increase in donor farm NH3 emissions was imposed. Separation had little effect on N losses per unit mass of slurry, but NH3 stripping led to a reduction. Centrifuge separation allowed a greater increase in pig production than a screw press, especially with P regulation. NH3 stripping was only advantageous with N regulation or when combined with NH3 scrubbing of pig housing ventilation air, when donor farm NH3 emissions were a constraint. There was a production penalty for using composting or anaerobic digestion. The choice of appropriate slurry management option therefore depends on the focus of the regulation. Nuanced and therefore complex regulations are necessary to take advantage of synergies and avoid cross-policy conflicts and incongruencies.

  11. Efforts to Reduce International Space Station Crew Maintenance for the Management of the Extravehicular Mobility Unit Transport Loop Water Quality

    NASA Technical Reports Server (NTRS)

    Steele, John W.; Etter, David; Rector, Tony; Boyle, Robert; Vandezande, Christopher

    2013-01-01

    The EMU (Extravehicular Mobility Unit) contains a semi-closed-loop re-circulating water circuit (Transport Loop) to absorb heat into a LCVG (Liquid Coolant and Ventilation Garment) worn by the astronaut. A second, single-pass water circuit (Feed-water Loop) provides water to a cooling device (Sublimator) containing porous plates, and that water sublimates through the porous plates to space vacuum. The cooling effect from the sublimation of this water translates to a cooling of the LCVG water that circulates through the Sublimator. The quality of the EMU Transport Loop water is maintained through the use of a water processing kit (ALCLR Airlock Cooling Loop Remediation) that is used to periodically clean and disinfect the water circuit. Opportunities to reduce crew time associated with on-orbit ALCLR operations include a detailed review of the historical water quality data for evidence to support an extension to the implementation cycle. Furthermore, an EMU returned after 2-years of use on the ISS (International Space Station) is being used as a test bed to evaluate the results of extended and repeated ALCLR implementation cycles. Finally, design, use and on-orbit location enhancements to the ALCLR kit components are being considered to allow the implementation cycle to occur in parallel with other EMU maintenance and check-out activities, and to extend the life of the ALCLR kit components. These efforts are undertaken to reduce the crew-time and logistics burdens for the EMU, while ensuring the long-term health of the EMU water circuits for a post-Shuttle 6-year service life.

  12. Managed European-Derived Honey Bee, Apis mellifera sspp, Colonies Reduce African-Matriline Honey Bee, A. m. scutellata, Drones at Regional Mating Congregations.

    PubMed

    Mortensen, Ashley N; Ellis, James D

    2016-01-01

    African honey bees (Apis mellifera scutellata) dramatically changed the South American beekeeping industry as they rapidly spread through the Americas following their introduction into Brazil. In the present study, we aimed to determine if the management of European-derived honey bees (A. mellifera sspp.) could reduce the relative abundance of African-matriline drones at regional mating sites known as drone congregation areas (DCAs). We collected 2,400 drones at six DCAs either 0.25 km or >2.8 km from managed European-derived honey bee apiaries. The maternal ancestry of each drone was determined by Bgl II enzyme digestion of an amplified portion of the mitochondrial Cytochrome b gene. Furthermore, sibship reconstruction via nuclear microsatellites was conducted for a subset of 1,200 drones to estimate the number of colonies contributing drones to each DCA. Results indicate that DCAs distant to managed European apiaries (>2.8 km) had significantly more African-matriline drones (34.33% of the collected drones had African mitochondrial DNA) than did DCAs close (0.25 km) to managed European apiaries (1.83% of the collected drones had African mitochondrial DNA). Furthermore, nuclear sibship reconstruction demonstrated that the reduction in the proportion of African matriline drones at DCAs near apiaries was not simply an increase in the number of European matriline drones at the DCAs but also the result of fewer African matriline colonies contributing drones to the DCAs. Our data demonstrate that the management of European honey bee colonies can dramatically influence the proportion of drones with African matrilines at nearby drone congregation areas, and would likely decreasing the probability that virgin European queens will mate with African drones at those drone congregation areas.

  13. Managed European-Derived Honey Bee, Apis mellifera sspp, Colonies Reduce African-Matriline Honey Bee, A. m. scutellata, Drones at Regional Mating Congregations

    PubMed Central

    Mortensen, Ashley N.; Ellis, James D.

    2016-01-01

    African honey bees (Apis mellifera scutellata) dramatically changed the South American beekeeping industry as they rapidly spread through the Americas following their introduction into Brazil. In the present study, we aimed to determine if the management of European-derived honey bees (A. mellifera sspp.) could reduce the relative abundance of African-matriline drones at regional mating sites known as drone congregation areas (DCAs). We collected 2,400 drones at six DCAs either 0.25 km or >2.8 km from managed European-derived honey bee apiaries. The maternal ancestry of each drone was determined by Bgl II enzyme digestion of an amplified portion of the mitochondrial Cytochrome b gene. Furthermore, sibship reconstruction via nuclear microsatellites was conducted for a subset of 1,200 drones to estimate the number of colonies contributing drones to each DCA. Results indicate that DCAs distant to managed European apiaries (>2.8 km) had significantly more African−matriline drones (34.33% of the collected drones had African mitochondrial DNA) than did DCAs close (0.25 km) to managed European apiaries (1.83% of the collected drones had African mitochondrial DNA). Furthermore, nuclear sibship reconstruction demonstrated that the reduction in the proportion of African matriline drones at DCAs near apiaries was not simply an increase in the number of European matriline drones at the DCAs but also the result of fewer African matriline colonies contributing drones to the DCAs. Our data demonstrate that the management of European honey bee colonies can dramatically influence the proportion of drones with African matrilines at nearby drone congregation areas, and would likely decreasing the probability that virgin European queens will mate with African drones at those drone congregation areas. PMID:27518068

  14. Investigating the potential to reduce flood risk through catchment-based land management techniques and interventions in the River Roe catchment, Cumbria,UK

    NASA Astrophysics Data System (ADS)

    Pearson, Callum; Reaney, Sim; Bracken, Louise; Butler, Lucy

    2015-04-01

    Throughout the United Kingdom flood risk is a growing problem and a significant proportion of the population are at risk from flooding throughout the country. Across England and Wales over 5 million people are believed to be at risk from fluvial, pluvial or coastal flooding (DEFRA, 2013). Increasingly communities that have not dealt with flooding before have recently experienced significant flood events. The communities of Stockdalewath and Highbridge in the Roe catchment, a tributary of the River Eden in Cumbria, UK, are an excellent example. The River Roe has a normal flow of less than 5m3 sec-1 occurring 97 percent of the time however there have been two flash floods of 98.8m3 sec-1 in January 2005 and 86.9m3 sec-1 in May 2013. These two flash flood events resulted in the inundation of numerous properties within the catchment with the 2013 event prompting the creation of the Roe Catchment Community Water Management Group which aims are to deliver a sustainable approach to managing the flood risk. Due to the distributed rural population the community fails the cost-benefit analysis for a centrally funded flood risk mitigation scheme. Therefore the at-risk community within the Roe catchment have to look for cost-effective, sustainable techniques and interventions to reduce the potential negative impacts of future events; this has resulted in a focus on natural flood risk management. This research investigates the potential to reduce flood risk through natural catchment-based land management techniques and interventions within the Roe catchment; providing a scientific base from with further action can be enacted. These interventions include changes to land management and land use, such as soil aeration and targeted afforestation, the creation of runoff attenuation features and the construction of in channel features, such as debris dams. Natural flood management (NFM) application has been proven to be effective when reducing flood risk in smaller catchments and the

  15. Impact of the Creation and Implementation of a Clinical Management Guideline for Personality Disorders in Reducing Use of Mechanical Restraints in a Psychiatric Inpatient Unit

    PubMed Central

    Fernandez-Rivas, Aranzazu; Bustamante, Sonia; Rico-Vilademoros, Fernando; Vivanco, Esther; Martinez, Karmele; Angel Vecino, Miguel; Martín, Melba; Herrera, Sonia; Rodriguez, Jorge; Saenz, Carlos

    2014-01-01

    Objective: To evaluate the impact of the implementation of a guideline for the management of personality disorders on reducing the frequency of use of mechanical restraints in a psychiatric inpatient unit. Method: This retrospective study was conducted in a psychiatric inpatient unit with 42 beds, which serves an urban area of 330,000 inhabitants. The sample consisted of all patients with a clinical diagnosis of personality disorder (DSM-IV-TR criteria) who were admitted to the unit from January 2010 to December 2010 and from January 2011 to December 2011 (ie, before and after, respectively, the implementation of the guideline). The guideline focused on cluster B disorders and follows a psychodynamic perspective. Results: Restraint use was reduced from 38 of 87 patients with personality disorders (43.7%) to 3 of 112 (2.7%), for a relative risk of 0.06 (95% CI, 0.02–0.19) and an absolute risk reduction of 41% (95% CI, 29.9%–51.6%). The risk of being discharged against medical advice increased after the intervention, with a relative risk of 1.84 (95% CI, 0.96–3.51). Restraint use in patients with other diagnoses was also reduced to a similar extent. Conclusions: The use of mechanical restraints was dramatically reduced after the implementation of a clinical practice guideline on personality disorders, suggesting that these coercive measures might be decreased in psychiatric inpatient units. PMID:25834763

  16. Delayed uterine fluid clearance and reduced uterine perfusion in bitches with endometrial hyperplasia and clinical management with postmating antibiotic.

    PubMed

    England, G C W; Moxon, R; Freeman, S L

    2012-10-15

    In many species a transient uterine inflammatory response follows mating and is proposed to remove excess spermatozoa, bacteria, and other contaminants from the uterus. Similar events have been documented in the bitch involving increased uterine contractions, polymorphonuclear neutrophil influx and uterine artery vasodilation. Some healthy bitches with endometrial hyperplasia have increased numbers of uterine luminal polymorphonuclear neutrophils after mating and reduced fertility; it is purported that this represents a presumed postmating endometritis. This study used B-mode and Doppler ultrasonography at the time of mating to measure uterine contractions, clearance of ejaculated fluid, and uterine artery velocity in normal bitches and those with endometrial hyperplasia. Mating resulted in an increase in the number of uterine contractions, although fewer mating-induced contractions were noted in bitches with endometrial hyperplasia. Interestingly, uterine fluid cleared significantly more slowly after mating from the bitches with endometrial hyperplasia than the normal bitches (P = 0.01). In a further study, Doppler ultrasonography showed that in normal bitches there was a significant increase in uterine artery blood velocity (P = 0.04) and a decrease in the resistance index after mating (P = 0.04), indicating vasodilation. In bitches with endometrial hyperplasia the baseline resistance index was significantly higher than normal bitches (P = 0.05), and furthermore, although there was a significant decrease in resistance index after mating, in the bitches with endometrial hyperplasia this was of a smaller magnitude that in normal bitches. These findings indicate lower baseline uterine perfusion, and a blunted vasodilation response to mating in bitches with endometrial hyperplasia. Short-duration postmating administration of systemic antibiotic increased pregnancy rates in bitches with endometrial hyperplasia (P < 0.01). Litter sizes in bitches with endometrial

  17. Potential of forest management to reduce French carbon emissions - regional modelling of the French forest carbon balance from the forest to the wood.

    NASA Astrophysics Data System (ADS)

    Valade, A.; Luyssaert, S.; Bellassen, V.; Vallet, P.

    2015-12-01

    In France the low levels of forest harvest (40 Mm3 per year over a volume increment of 89Mm3) is frequently cited to push for a more intensive management of the forest that would help reducing CO2 emissions. This reasoning overlooks the medium-to-long-term effects on the carbon uptake at the national scale that result from changes in the forest's structure and delayed emissions from products decay and bioenergy burning, both determinant for the overall C fluxes between the biosphere and the atmosphere. To address the impacts of an increase in harvest removal on biosphere-atmosphere carbon fluxes at national scale, we build a consistent regional modeling framework to integrate the forest-carbon system from photosynthesis to wood uses. We aim at bridging the gap between regional ecosystem modeling and land managers' considerations, to assess the synergistic and antagonistic effects of management strategies over C-based forest services: C-sequestration, energy and material provision, fossil fuel substitution. For this, we built on inventory data to develop a spatial forest growth simulator and design a novel method for diagnosing the current level of management based on stand characteristics (density, quadratic mean diameter or exploitability). The growth and harvest simulated are then processed with a life cycle analysis to account for wood transformation and uses. Three scenarii describe increases in biomass removals either driven by energy production target (set based on national prospective with a lock on minimum harvest diameters) or by changes in management practices (shorter or longer rotations, management of currently unmanaged forests) to be compared with business as usual simulations. Our management levels' diagnostics quantifies undermanagement at national scale and evidences the large weight of ownership-based undermanagement with an average of 26% of the national forest (between 10% and 40% per species) and thus represents a huge potential wood resource

  18. A community-based Falls Management Exercise Programme (FaME) improves balance, walking speed and reduced fear of falling.

    PubMed

    Yeung, Pui Yee; Chan, Wayne; Woo, Jean

    2015-04-01

    Although effective community falls prevention programmes for the older persons have been described, challenges remain in translating proven interventions into daily practice. To evaluate the efficacy, feasibility and acceptability of a falls prevention programme that can be integrated into daily activities in a group of community-dwelling older adults with risk of falling. A cohort study with intervention and comparison groups was designed to evaluate a 36-week group-based falls prevention exercise programme (FaME) in the community setting. Participants were aged 60 years or older, had fallen in the past 12 months, had fear of falling with avoidance of activities or had deficits in balance control. Primary outcome measures included assessment of balance control and mobility; secondary outcome measures included level of physical activity, assessment of fear of falling and health-related quality of life. There were 48 and 51 participants in the intervention and comparison groups, respectively. There were improvements in measurements of balance, walking speed and self-efficacy. The drop out rate was low (14.6% and 3.9% from the intervention and comparison groups, respectively). Overall compliance in the intervention group was 79%. Factors that motivated continued participation include the regular and long-term nature of the programme helping to reinforce their exercise habits, the simplicity of movements and friendliness of the group. The FaME programme improves balance, walking speed and reduces fear of falling. It could be widely promoted and integrated into regular health and social activities in community settings.

  19. Forest carbon response to management scenarios intended to mitigate GHG emissions and reduce fire impacts in the US West Coast region

    NASA Astrophysics Data System (ADS)

    Hudiburg, T. W.; Law, B. E.; Thornton, P. E.; Luyssaert, S.

    2012-12-01

    US West coast forests are among the most carbon dense biomes in the world and the potential for biomass accumulation in mesic coastal forests is the highest recorded (Waring and Franklin 1979, Hudiburg et al. 2009). Greenhouse gas (GHG) mitigation strategies have recently expanded to include forest woody biomass as bioenergy, with the expectation that this will also reduce forest mortality. We examined forest carbon response and life cycle assessment (LCA) of net carbon emissions following varying combinations of bioenergy management scenarios in Pacific Northwest forests for the period from 2010-2100. We use the NCAR CLM4 model combined with a regional atmospheric forcing dataset and account for future environmental change using the IPCC RCP4.5 and RCP 8.5 scenarios. Bioenergy management strategies include a repeated thinning harvest, a repeated clearcut harvest, and a single salvage harvest in areas with projected insect-related mortality. None of the bioenergy management scenarios reduce net emissions to the atmosphere compared to continued business-as-usual harvest (BAU) by the end of the 21st century. Forest regrowth and reduced fire emissions are not large enough to balance the wood removals from harvest. Moreover, the substitution of wood for fossil fuel energy and products is not large enough to offset the wood losses through decomposition and combustion. However, in some ecoregions (Blue Mountains and East Cascades), emissions from the thinning harvests begin to improve over BAU at the end of the century and could lead to net reductions in those ecoregions over a longer time period (> 100 years). For salvage logging, there is no change compared to BAU emissions by the end of the 21st century because the treatment area is minimal compared to the other treatments and only performed once. These results suggest that managing forests for carbon sequestration will need to include a variety of approaches accounting for forest baseline conditions and in some

  20. Organic matter and water management strategies to reduce methane and nitrous oxide emissions from rice fields in Vietnam

    NASA Astrophysics Data System (ADS)

    Pandey, A.

    2014-12-01

    The reduction of CH4 and N2O emissions from rice paddies is of utmost importance in minimizing the impact of rice production on global warming. A field experiment was therefore conducted in farmers' field in Hanoi, Vietnam to examine whether the use of straw compost or straw biochar, in combination with the safe alternate wetting and drying (AWD) has the potential to suppress both CH4 and N2O emissions from rice paddies while maintaining the rice yield. The study compared the proposed strategies with local farmers' practice of permanent flooding (PF) and farmyard manure (FYM) incorporation, respectively. A control treatment without organic matter incorporation in both AWD and PF water regimes was also included in the study; all treatments received equal amounts of mineral fertilizer. Gas emissions were monitored using the closed chamber method at seven-day intervals during the first 50 days and at 15-day intervals thereafter. Addition of FYM, straw compost and biochar increased CH4 emissions by 230 %, 150 % and 38 %, respectively, when compared with the control treatments in both the AWD and PF water regimes. Within AWD, FYM increased N2O emissions by 30 %, straw compost and biochar displayed similar amount of N2O emissions as the control treatment. Within PF, N2O emissions under FYM and straw compost were 40 % and 35 % higher than the control treatment, respectively, and biochar once again displayed similar amount of N2O emissions as the control treatment. Yield difference was not significant (P > 0.05) between any of the treatments. These results indicated that the straw compost incorporation might not reduce the global warming potential (GWP) and yield-scaled GWP of rice production, whereas biochar in combination with AWD has the potential to maintain the GWP and yield-scaled GWP of rice production at lower level than the farmers' practice.

  1. Bivalirudin dosing adjustments for reduced renal function with or without hemodialysis in the management of heparin-induced thrombocytopenia.

    PubMed

    Tsu, Laura V; Dager, William E

    2011-10-01

    While not approved by the Food and Drug Administration for treatment of heparin-induced thrombocytopenia (HIT), except in patients undergoing percutaneous interventions, the direct thrombin inhibitor bivalirudin is a treatment option that is gaining use. An initial dose of bivalirudin 0.15-0.2 mg/kg/h, adjusted to an activated partial thromboplastin time (aPTT) of 1.5-2.5 times the baseline value, has been suggested. Initial dosing in patients with renal dysfunction, including those on hemodialysis, is unclear. To evaluate initial bivalirudin dosing requirements in patients with and without renal dysfunction, including patients on different forms of dialysis. A retrospective analysis of 135 patients treated with bivalirudin for HIT between June 2004 and October 2009 was conducted at a tertiary care medical center. The patients were divided into groups, based on renal function. Patients receiving dialysis were divided into 3 subgroups based on the mode of hemodialysis: intermittent hemodialysis (IHD, n = 24), sustained low-efficiency daily diafiltration (SLEDD, n = 12), or continuous renal replacement therapy (CRRT, n = 5). Patients not receiving dialysis were separated into 3 subgroups based on calculated creatinine clearance (CrCl): CrCl >60 mL/min (n = 52), CrCl 30-60 mL/min (n = 26), and CrCl <30 mL/min (n = 16). Compared with patients with normal renal function (CrCl >60 mL/min), patients with differing degrees of renal dysfunction (CrCl 30-60 and <30 mL/min) required lower doses of bivalirudin to achieve aPTT goal (0.13 vs 0.08 vs 0.05 mg/kg/h, respectively; p < 0.001). Patients on dialysis (IHD, SLEDD, CRRT) also required dose reductions (0.07, 0.09, and 0.07 mg/kg/h) compared with patients with normal renal function, but higher dosing requirements than patients not receiving dialysis with CrCl <30 mL/min. Patients with renal dysfunction require a reduced dose of bivalirudin to reach a therapeutic aPTT goal. Slightly higher doses may be observed in patients

  2. Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial.

    PubMed

    Stewart, Simon; Ball, Jocasta; Horowitz, John D; Marwick, Thomas H; Mahadevan, Gnanadevan; Wong, Chiew; Abhayaratna, Walter P; Chan, Yih K; Esterman, Adrian; Thompson, David R; Scuffham, Paul A; Carrington, Melinda J

    2015-02-28

    Patients are increasingly being admitted with chronic atrial fibrillation, and disease-specific management might reduce recurrent admissions and prolong survival. However, evidence is scant to support the application of this therapeutic approach. We aimed to assess SAFETY--a management strategy that is specific to atrial fibrillation. We did a pragmatic, multicentre, randomised controlled trial in patients admitted with chronic, non-valvular atrial fibrillation (but not heart failure). Patients were recruited from three tertiary referral hospitals in Australia. 335 participants were randomly assigned by computer-generated schedule (stratified for rhythm or rate control) to either standard management (n=167) or the SAFETY intervention (n=168). Standard management consisted of routine primary care and hospital outpatient follow-up. The SAFETY intervention comprised a home visit and Holter monitoring 7-14 days after discharge by a cardiac nurse with prolonged follow-up and multidisciplinary support as needed. Clinical reviews were undertaken at 12 and 24 months (minimum follow-up). Coprimary outcomes were death or unplanned readmission (both all-cause), measured as event-free survival and the proportion of actual versus maximum days alive and out of hospital. Analyses were done on an intention-to-treat basis. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTRN 12610000221055). During median follow-up of 905 days (IQR 773-1050), 49 people died and 987 unplanned admissions were recorded (totalling 5530 days in hospital). 127 (76%) patients assigned to the SAFETY intervention died or had an unplanned readmission (median event-free survival 183 days [IQR 116-409]) and 137 (82%) people allocated standard management achieved a coprimary outcome (199 days [116-249]; hazard ratio 0·97, 95% CI 0·76-1·23; p=0·851). Patients assigned to the SAFETY intervention had 99·5% maximum event-free days (95% CI 99·3-99·7), equating to a median

  3. Referral management centres as a means of reducing outpatients attendances: how do they work and what influences successful implementation and perceived effectiveness?

    PubMed

    Ball, Sarah L; Greenhalgh, Joanne; Roland, Martin

    2016-03-24

    The rising volume of referrals to secondary care is a continuing concern in the NHS in England, with considerable resource implications. Referral management centres (RMCs) are one of a range of initiatives brought in to curtail this rise, but there is currently limited evidence for their effectiveness, and little is known about their mechanisms of action. This study aimed to gain a better understanding of how RMCs operate and the factors contributing to the achievement of their goals. Drawing on the principles of realist evaluation, we sought to elicit programme theories (the ideas and assumptions about how a programme works) and to identify the key issues to be considered when establishing or evaluating such schemes. Qualitative study with a purposive sample of health professionals and managers involved in the commissioning, set-up and running of four referral management centres in England and with GPs referring through these centres. Semi-structured interviews were conducted with 18 participants. Interviews were audio-recorded and transcribed. Data were analysed thematically. Interview data highlighted the diverse aims and functions of RMCs, reflecting a range of underlying programme theories. These included the overarching theory that RMCs work by ensuring the best use of limited resources and three sub-theories, relating to how this could be achieved, namely, improving the quality of referrals and patient care, reducing referrals, and increasing efficiency in the referral process. The aims of the schemes, however, varied between sites and between stakeholders, and evolved significantly over time. Three themes were identified relating to the context in which RMCs were implemented and managed: the impact of practical and administrative difficulties; the importance and challenge of stakeholder buy-in; and the dependence of perceived effectiveness on the aims and priorities of the scheme. Many RMCs were described as successful by those involved, despite limited

  4. Sexual and injection-related risks in Puerto Rican-born injection drug users living in New York City: A mixed-methods analysis

    PubMed Central

    2011-01-01

    perpetuated in their new setting following an almost natural flow. These norms may have a particular stronghold over risky drug injection practices. These results indicate that culturally appropriate HIV and HCV prevention and education services are needed. In addition, homelessness should be addressed to reduce risky sexual practices. PMID:22004801

  5. Impact of early-season thrips management on reducing the risks of spotted wilt virus and suppressing aphid populations in Flue-cured tobacco.

    PubMed

    McPherson, R M; Stephenson, M G; Lahue, S S; Mullis, S W

    2005-02-01

    The influence of tray drench (TD) treatments, with and without foliar applications of the plant activator acibenzolar-S-methyl (Actigard), was examined in replicated field plots in 2000--2002. TD treatments of Actigard, imidacloprid (Admire), and these two products combined had little effect on seasonal mean thrips populations; however, thrips densities were lower in the Admire-treated plots at 4 and 5 wk after transplanting. Actigard and Admire TD treatments significantly reduced the seasonal incidence of tomato spotted wilt virus (TSWV) symptomatic plants in 2 yr in the study. The combination of both products was better in reducing TSWV than Actigard alone. Three early-season foliar sprays of Actigard had no effect on thrips population densities, but they did reduce TSWV incidence. The tobacco thrips, Frankliniella fusca (Hinds), comprised 92-95% of the thrips complex each year. Other thrips collected on tobacco foliage at very low densities included Haplothrips spp., Chirothrips spp., Limothrips cerealium (Haliday), other Frankliniella spp. and other unidentified species. Using nonstructural TSWV protein enzyme-linked immunosorbent assay, 1.5-2.3% of the F. fusca tested positive for nonstructural TSWV protein. Cured yields were higher in the TD treatments and the Actigard foliar treatments in the years with high TSWV in the untreated plots. The TD treatments and foliar Actigard had little impact on plant height or grade index; however, TD treatments with Admire had low tobacco aphid, Myzus nicotianae Blackman, populations through 10 wk after transplanting. The early-season Actigard and Admire treatment options are management decisions that can effectively reduce the risks of TSWV incidence in flue-cured tobacco.

  6. Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

    PubMed Central

    Huntley, A L; Johnson, R; King, A; Morris, R W; Purdy, S

    2016-01-01

    Objectives The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS). Setting CM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community. Participants Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries. Intervention CM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems. Primary and secondary outcomes Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources. Results 22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference −1.28 days (95% CI −2.04 to −0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions. Conclusions Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission. PMID:27165648

  7. A job safety program for construction workers designed to reduce the potential for occupational injury using tool box training sessions and computer-assisted biofeedback stress management techniques.

    PubMed

    Johnson, Kenneth A; Ruppe, Joan

    2002-01-01

    This project was conducted with a multicultural construction company in Hawaii, USA. The job duties performed included drywall and carpentry work. The following objectives were selected for this project: (a) fire prevention training and inspection of first aid equipment; (b) blood-borne pathogen training and risk evaluation; (c) ergonomic and risk evaluation intervention program; (d) electrical safety training and inspection program; (e) slips, trips, and falls safety training; (f) stress assessment and Personal Profile System; (g) safety and health program survey; (h) improving employee relations and morale by emphasizing spirituality; and (i) computer-assisted biofeedback stress management training. Results of the project indicated that observed safety hazards, reported injuries, and levels of perceived stress. were reduced for the majority of the population.

  8. Improving efficiency and reducing costs: Design of an adaptive, seamless, and enriched pragmatic efficacy trial of an online asthma management program.

    PubMed

    Lu, Mei; Ownby, Dennis R; Zoratti, Edward; Roblin, Douglas; Johnson, Dayna; Johnson, Christine Cole; Joseph, Christine L M

    2014-05-01

    Clinical trials are critical for medical decision-making, however, under the current paradigm, clinical trials are fraught with problems including low enrollment and high cost. Promising alternatives to increase trial efficiency and reduce costs include the use of (1) electronic initiatives that permit electronic remote data capture (EDC) for direct data collection at a site (2), electronic medical records (EMR) for patient identification and data collection, and (3) adaptive, enrichment designs with pragmatic approaches. We describe the design of a seamless, multi-site randomized Phase II/III trial to evaluate an asthma management intervention in urban adolescents with asthma. Patients are randomized, asked to access four online sessions of the intervention or control asthma management program, and are then followed for one year. The primary efficacy endpoint is self-reported asthma control as measured by the Asthma Control Test (ACT). Comparative effectiveness parametric approaches are utilized to conduct the trial in a real world setting with reduced costs. Escalated electronic initiatives are implemented for patient identification, assent, enrollment and tracking. Patient enrollment takes place during primary care visits. A centralized database with EDC is used for CRF data collection with integration of EMR data. This Phase II/III trial plans to have a total sample size of 500 patients with an interim look at the completion of Phase II (n=250), The interim analyses include an assessment of the intervention effect, marker(s) identification and the feasibility study of EMR data as the trial CRF data collection. Patient enrollment has begun and is ongoing.

  9. The role of sustainable agriculture and renewable-resource management in reducing greenhouse-gas emissions and increasing sinks in China and India.

    PubMed

    Pretty, J N; Ball, A S; Xiaoyun, Li; Ravindranath, N H

    2002-08-15

    This paper contains an analysis of the technical options in agriculture for reducing greenhouse-gas emissions and increasing sinks, arising from three distinct mechanisms: (i) increasing carbon sinks in soil organic matter and above-ground biomass; (ii) avoiding carbon emissions from farms by reducing direct and indirect energy use; and (iii) increasing renewable-energy production from biomass that either substitutes for consumption of fossil fuels or replaces inefficient burning of fuelwood or crop residues, and so avoids carbon emissions, together with use of biogas digesters and improved cookstoves. We then review best-practice sustainable agriculture and renewable-resource-management projects and initiatives in China and India, and analyse the annual net sinks being created by these projects, and the potential market value of the carbon sequestered. We conclude with a summary of the policy and institutional conditions and reforms required for adoption of best sustainability practice in the agricultural sector to achieve the desired reductions in emissions and increases in sinks. A review of 40 sustainable agriculture and renewable-resource-management projects in China and India under the three mechanisms estimated a carbon mitigation potential of 64.8 MtC yr(-1) from 5.5 Mha. The potential income for carbon mitigation is $324 million at $5 per tonne of carbon. The potential exists to increase this by orders of magnitude, and so contribute significantly to greenhouse-gas abatement. Most agricultural mitigation options also provide several ancillary benefits. However, there are many technical, financial, policy, legal and institutional barriers to overcome.

  10. Self-Management Strategies to Reduce Pain and Improve Function among Older Adults in Community Settings: A Review of the Evidence

    PubMed Central

    Reid, M. Carrington; Papaleontiou, Maria; Ong, Anthony; Breckman, Risa; Wethington, Elaine; Pillemer, Karl

    2012-01-01

    Context Self-management strategies for pain hold substantial promise as a means of reducing pain and improving function among older adults with chronic pain, but their use in this age group has not been well defined. Objective To review the evidence regarding self-management interventions for pain due to musculoskeletal disorders among older adults. Design We searched the Medline and Cumulative Index to Nursing and Allied Health Literature databases to identify relevant articles for review and analyzed English-language articles that presented outcome data on pain, function, and/or other relevant endpoints and evaluated programs/strategies that could be feasibly implemented in the community. Abstracted information included study sample characteristics, estimates of treatment effect, and other relevant outcomes when present. Results Retained articles (N = 27) included those that evaluated programs sponsored by the Arthritis Foundation and other programs/strategies including yoga, massage therapy, Tai Chi, and music therapy. Positive outcomes were found in 96% of the studies. Proportionate change in pain scores ranged from an increase of 18% to a reduction of 85% (median = 23% reduction), whereas change in disability scores ranged from an increase of 2% to a reduction of 70% (median = 19% reduction). Generalizability issues identified included limited enrollment of ethnic minority elders, as well as non-ethnic elders aged 80 and above. Conclusions Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time. PMID:18346056

  11. Reduced Single Nucleotide Polymorphism Panels for Assigning Atlantic Albacore and Bay of Biscay Anchovy Individuals to Their Geographic Origin: Toward Sustainable Fishery Management.

    PubMed

    Montes, Iratxe; Laconcha, Urtzi; Iriondo, Mikel; Manzano, Carmen; Arrizabalaga, Haritz; Estonba, Andone

    2017-05-31

    There is an increasing trend upon adding a detailed description of the origin of seafood products driven by a general interest in the implementation of sustainable fishery management plans for the conservation of marine ecosystems. North Atlantic albacore ("Bonito del Norte con Eusko Label") and Bay of Biscay anchovy ("Anchoa del Cantábrico") are two commercially important fish populations with high economical value and vulnerable to commercial fraud. This fact, together with the overexploited situation of these two populations, makes it necessary to develop a tool to identify individual origin and to detect commercial fraud. In the present study, we have developed and validated a traceability tool consisting of reduced panels of gene-associated single nucleotide polymorphisms (SNPs) suitable for assigning individuals of two species to their origin with unprecedented accuracy levels. Only 48 SNPs are necessary to assign 81.1% albacore and 93.4% anchovy individuals with 100% accuracy to their geographic origin. The total accuracy of the results demonstrates how gene-associated SNPs can revolutionize food traceability. Gene-associated SNP panels are not of mere commercial interest, but they also can result in a positive impact on sustainability of marine ecosystems through conservation of fish populations through establishing a more effective and sustainable fishery management framework and contributing to the prevention of falsified labeling.

  12. Role of omega-3 ethyl ester concentrate in reducing sudden cardiac death following myocardial infarction and in management of hypertriglyceridemia: An Indian consensus statement

    PubMed Central

    Dalal, J.J.; Kasliwal, R.R.; Dutta, A.L.; Sawhney, J.P.S.; Iyengar, S.S.; Dani, S.; Desai, N.; Sathyamurthy, I.; Rao, D.; Menon, A.; Dasbiswas, A.; Wander, G.S.; Chadha, M.; Hiremath, M.S.; Roy, D.G.; Gupta, V.; Shivakadaksham, N.

    2012-01-01

    Introduction Sudden cardiac death (SCD) is the most lethal manifestation of heart disease. In an Indian study the SCDs contribute about 10% of the total mortality and SCD post ST elevation myocardial infarction (MI) constitutes for about half of total deaths. Objective Given the limitations of existing therapy there is a need for an effective, easy to use, broadly applicable and affordable intervention to prevent SCD post MI. Leading cardiologists from all over India came together to discuss the potential role of n-3 acid ethyl esters (90%) of eicosapentaenoic acid (EPA) 460 mg & docosahexaenoic acid (DHA) 380 mg in the management of post MI patients and those with hypertriglyceridemia. Recommendations Highly purified & concentrated omega-3 ethyl esters (90%) of EPA (460 mg) & DHA (380 mg) has clinically proven benefits in improving post MI outcomes (significant 15% risk reduction for all-cause mortality, 20% risk reduction for CVD and 45% risk reduction in SCD in GISSI-Prevenzione trial) and in reducing hypertriglyceridemia, and hence, represent an interesting option adding to the treatment armamentarium in the secondary prevention after MI based on its anti-arrhythmogenic effects and also in reducing hypertriglyceridemia. PMID:23102390

  13. Logistical management and private sector involvement in reducing the cost of municipal solid waste collection service in the Tubas area of the West Bank.

    PubMed

    El-Hamouz, Amer M

    2008-01-01

    This paper addresses the problems of the municipal solid waste (MSW) collection system in the Tubas district of Palestine. More specifically, it addresses the often-voiced concerns pertaining to low efficiency as well as environmental problems. This was carried out through a systematic methodological approach. The paper illustrates how a private company applied a logistical management strategy, by rescheduling the MSW collection system, reallocating street solid waste containers and minimizing vehicle routing. The way in which the MSW collection timetable was rescheduled decreased the operating expenses and thus reduced MSW collection costs. All data needed to reschedule the collection timetable and optimize vehicle routing were based on actual field measurements. The new MSW collection timetable introduced by a private company was monitored for a period of a month. The new system resulted in an improvement in the MSW collection system by reducing the collection cost to a level that is socially acceptable (US dollars 3.75/family/month), as well as economically and environmentally sound.

  14. Evaluation of Land Use, Land Management and Soil Conservation Strategies to Reduce Non-Point Source Pollution Loads in the Three Gorges Region, China

    NASA Astrophysics Data System (ADS)

    Strehmel, Alexander; Schmalz, Britta; Fohrer, Nicola

    2016-11-01

    The construction of the Three Gorges Dam in China and the subsequent impoundment of the Yangtze River have induced a major land use change in the Three Gorges Reservoir Region, which fosters increased inputs of sediment and nutrients from diffuse sources into the water bodies. Several government programs have been implemented to mitigate high sediment and nutrient loads to the reservoir. However, institutional weaknesses and a focus on economic development have so far widely counteracted the effectiveness of these programs. In this study, the eco-hydrological model soil and water assessment tool is used to assess the effects of changes in fertilizer amounts and the conditions of bench terraces in the Xiangxi catchment in the Three Gorges Reservoir Region on diffuse matter releases. With this, the study aims at identifying efficient management measures, which should have priority. The results show that a reduction of fertilizer amounts cannot reduce phosphorus loads considerably without inhibiting crop productivity. The condition of terraces in the catchment has a strong impact on soil erosion and phosphorus releases from agricultural areas. Hence, if economically feasible, programmes focusing on the construction and maintenance of terraces in the region should be implemented. Additionally, intercropping on corn fields as well as more efficient fertilization schemes for agricultural land were identified as potential instruments to reduce diffuse matter loads further. While the study was carried out in the Three Gorges Region, its findings may also beneficial for the reduction of water pollution in other mountainous areas with strong agricultural use.

  15. Evaluation of Land Use, Land Management and Soil Conservation Strategies to Reduce Non-Point Source Pollution Loads in the Three Gorges Region, China.

    PubMed

    Strehmel, Alexander; Schmalz, Britta; Fohrer, Nicola

    2016-11-01

    The construction of the Three Gorges Dam in China and the subsequent impoundment of the Yangtze River have induced a major land use change in the Three Gorges Reservoir Region, which fosters increased inputs of sediment and nutrients from diffuse sources into the water bodies. Several government programs have been implemented to mitigate high sediment and nutrient loads to the reservoir. However, institutional weaknesses and a focus on economic development have so far widely counteracted the effectiveness of these programs. In this study, the eco-hydrological model soil and water assessment tool is used to assess the effects of changes in fertilizer amounts and the conditions of bench terraces in the Xiangxi catchment in the Three Gorges Reservoir Region on diffuse matter releases. With this, the study aims at identifying efficient management measures, which should have priority. The results show that a reduction of fertilizer amounts cannot reduce phosphorus loads considerably without inhibiting crop productivity. The condition of terraces in the catchment has a strong impact on soil erosion and phosphorus releases from agricultural areas. Hence, if economically feasible, programmes focusing on the construction and maintenance of terraces in the region should be implemented. Additionally, intercropping on corn fields as well as more efficient fertilization schemes for agricultural land were identified as potential instruments to reduce diffuse matter loads further. While the study was carried out in the Three Gorges Region, its findings may also beneficial for the reduction of water pollution in other mountainous areas with strong agricultural use.

  16. Managing the interactions between sulfate- and perchlorate-reducing bacteria when using hydrogen-fed biofilms to treat a groundwater with a high perchlorate concentration.

    PubMed

    Ontiveros-Valencia, Aura; Tang, Youneng; Krajmalnik-Brown, Rosa; Rittmann, Bruce E

    2014-05-15

    A groundwater containing an unusually high concentration (∼4000 μg/L) of perchlorate (ClO4(-)) and significant (∼60 mg/L) sulfate (SO4(2-)) was treated with hydrogen (H2)-fed biofilms. The objective was to manage the interactions between sulfate-reducing bacteria (SRB) and perchlorate-reducing bacteria (PRB) by controlling the H2-delivery capacity to achieve ClO4(-) reduction to below the detection limit (4 μg/L). Complete ClO4(-) reduction with minimized SO4(2-) reduction was achieved by using two membrane biofilm reactors (MBfRs) in series. The lead MBfR removed >96% ClO4(-), and the lag MBfR further reduced ClO4(-) to below the detection limit. SO4(2-) reduction ranged from 10 to 60%, and lower SO4(2-) reduction corresponded to lower H2 availability (i.e., lower H2 pressure or membranes with lower H2-delivery capacity). Minimizing SO4(2-) reduction improved ClO4(-) removal by increasing the fraction of PRB in the biofilm. High SO4(2-) flux correlated with enrichment of Desulfovibrionales, autotrophic SRB that can compete strongly with denitrifying bacteria (DB) and PRB. Increased SO4(2-) reduction also led to enrichment of: 1) Ignavibacteriales and Thiobacteriales, sulfide-oxidizing bacteria that allow sulfur cycling in the biofilm; 2) Bacteroidales, heterotrophic microorganisms likely using organic sources of carbon (e.g., acetate); and 3) Spirochaetales, which potentially utilize soluble microbial products (SMPs) from autotrophic SRB to produce acetate. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Managing serious clinical deterioration in a tertiary hospital in Hong Kong: from indicators development to multiple measures in reducing the rates.

    PubMed

    Ho, Jasperine Ka Yee; Lee, Quinnie; Lam, Jaden Chun Ho; Tang, Kam Shing

    2017-06-01

    Timely detection and management of acutely deteriorating patients can save lives. Tuen Mun Hospital (TMH), a 1800-bed acute tertiary hospital serving more than 1.06 million populations in Hong Kong, is exploring to quantitatively monitor serious clinical deterioration (SCD) and uses it to guide patient care improvement initiatives. Literature review on definition and measurement of SCD was conducted. Monthly SCD rates of TMH were first calculated according to the published methodology and benchmarked against those of international centres. A refined composite clinical indicator good for local use was compiled. In the second phase, p-control charts of SCD have been plotted based on cumulative data. TMH's performance was comparable with that of international centres. SCD on p-control charts has been plotting since January 2013. There were peaks in all 4 SCD rates during the winter surge period in 2013-2014. In the third phase, multiple measures have been taking to reduce the SCD rates including targeting the 3 main factors of winter surge situation. We are delighted to observe that the pattern did not repeat in the rate of cardiac arrest without do not attempt cardiopulmonary resuscitation (DNACPR) and rate of death without DNACPR in the same period in 2014-2015. SCD becomes a clinical governance tool to monitor the performance of clinical teams in treating acutely deteriorating patients in TMH. Any abnormal patterns or indications of special cause variations in the control charts would alert leaders to look for root causes of special cause variations and manage accordingly. We hope that this project will extend to corporate level and become a sustainable clinical indicator to guide audits, quality improvement initiatives and strategic planning. © 2016 John Wiley & Sons, Ltd.

  18. Bayesian evaluation of budgets for endemic disease control: An example using management changes to reduce milk somatic cell count early in the first lactation of Irish dairy cows.

    PubMed

    Archer, S C; Mc Coy, F; Wapenaar, W; Green, M J

    2014-01-01

    The aim of this research was to determine budgets for specific management interventions to control heifer mastitis in Irish dairy herds as an example of evidence synthesis and 1-step Bayesian micro-simulation in a veterinary context. Budgets were determined for different decision makers based on their willingness to pay. Reducing the prevalence of heifers with a high milk somatic cell count (SCC) early in the first lactation could be achieved through herd level management interventions for pre- and peri-partum heifers, however the cost effectiveness of these interventions is unknown. A synthesis of multiple sources of evidence, accounting for variability and uncertainty in the available data is invaluable to inform decision makers around likely economic outcomes of investing in disease control measures. One analytical approach to this is Bayesian micro-simulation, where the trajectory of different individuals undergoing specific interventions is simulated. The classic micro-simulation framework was extended to encompass synthesis of evidence from 2 separate statistical models and previous research, with the outcome for an individual cow or herd assessed in terms of changes in lifetime milk yield, disposal risk, and likely financial returns conditional on the interventions being simultaneously applied. The 3 interventions tested were storage of bedding inside, decreasing transition yard stocking density, and spreading of bedding evenly in the calving area. Budgets for the interventions were determined based on the minimum expected return on investment, and the probability of the desired outcome. Budgets for interventions to control heifer mastitis were highly dependent on the decision maker's willingness to pay, and hence minimum expected return on investment. Understanding the requirements of decision makers and their rational spending limits would be useful for the development of specific interventions for particular farms to control heifer mastitis, and other

  19. Reducing Nitrous Oxide Emissions from US Row-Crop Agriculture through Nitrogen Fertilizer Management: Development of an Nitrous Oxide Emissions Reduction Protocol

    NASA Astrophysics Data System (ADS)

    Millar, N.; Robertson, G. P.; Grace, P. R.; Gehl, R.; Hoben, J.; Kahmark, K.; Bohm, S.

    2009-12-01

    Nitrous oxide (N2O) is the major greenhouse gas emitted by US agriculture. About 80% of N2O emissions emanate from N fertilizer application and other soil management activities, with cropland emissions alone greater than 1 Tg yr-1. Manipulating fertilizer N inputs is a readily accessible management tool for increasing crop N use efficiency with fertilizer N rate, a crucial parameter for estimating both yield and N2O emissions in row-crop systems. Quantification of the trade-offs between N2O emissions, crop yield and fertilizer N rate is essential for proposing strategies which optimize productivity at economically and environmentally favorable N rates. The relationship between fertilizer N rate and subsequent N2O emissions is typically assumed linear and insensitive to increasing N rate. However, recent field studies at producer sites in Michigan, in winter wheat and corn, using static and automated chamber systems suggest that a non-linear relationship is more applicable. Emissions of N2O were low at fertilizer N rates below or coincident to those, optimizing crop yield but, sharply increased thereafter. This threshold response to increasing fertilizer N rate in row-crop agriculture suggests a substantial decrease in N2O emissions could be achieved with moderate reductions in N rate and little or no yield penalty. Our data, in conjunction with a recently developed approach for determining economically profitable N application rates for optimized crop yield in a number of Midwest states, have potential to be incorporated into agricultural N2O emission reduction protocols and utilized in future projects suitable for inclusion in the burgeoning nutrient cap-and-trade markets. We will present results from our 2007-2009 field seasons and outline a protocol framework for reducing N2O emissions from row-crop agriculture in the US Midwest.

  20. Implementation of a management protocol for massive bleeding reduces mortality in non-trauma patients: Results from a single centre audit.

    PubMed

    Martínez-Calle, N; Hidalgo, F; Alfonso, A; Muñoz, M; Hernández, M; Lecumberri, R; Páramo, J A

    2016-12-01

    To audit the impact upon mortality of a massive bleeding management protocol (MBP) implemented in our center since 2007. A retrospective, single-center study was carried out. Patients transfused after MBP implementation (2007-2012, Group 2) were compared with a historical cohort (2005-2006, Group 1). Massive bleeding is associated to high mortality rates. Available MBPs are designed for trauma patients, whereas specific recommendations in the medical/surgical settings are scarce. After excluding patients who died shortly (<6h) after MBP activation (n=20), a total of 304 were included in the data analysis (68% males, 87% surgical). Our MBP featured goal-directed transfusion with early use of adjuvant hemostatic medications. Primary endpoints were 24-h and 30-day mortality. Fresh frozen plasma-to-red blood cells (FFP:RBC) and platelet-to-RBC (PLT:RBC) transfusion ratios, time to first FFP unit and the proactive MBP triggering rate were secondary endpoints. After MBP implementation (Group 2; n=222), RBC use remained stable, whereas FFP and hemostatic agents increased, when compared with Group 1 (n=82). Increased FFP:RBC ratio (p=0.053) and earlier administration of FFP (p=0.001) were also observed, especially with proactive MBP triggering. Group 2 patients presented lower rates of 24-h (0.5% vs. 7.3%; p=0.002) and 30-day mortality (15.9% vs. 30.2%; p=0.018) - the greatest reduction corresponding to non-surgical patients. Logistic regression showed an independent protective effect of MBP implementation upon 30-day mortality (OR=0.3; 95% CI 0.15-0.61). These data suggest that the implementation of a goal-directed MBP for prompt and aggressive management of non-trauma, massive bleeding patients is associated to reduced 24-h and 30-day mortality rates. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  1. An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice.

    PubMed

    Cresswell, Kathrin M; Sadler, Stacey; Rodgers, Sarah; Avery, Anthony; Cantrill, Judith; Murray, Scott A; Sheikh, Aziz

    2012-06-08

    There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER) intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care. Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway), relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework. We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists' explicitly designated role as a change agent. However, important concerns were identified about the likely

  2. An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice

    PubMed Central

    2012-01-01

    Background There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER) intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care. Methods Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway), relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework. Results We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists’ explicitly designated role as a change agent. However, important concerns were

  3. Management based on exhaled nitric oxide levels adjusted for atopy reduces asthma exacerbations in children: A dual centre randomized controlled trial.

    PubMed

    Petsky, Helen L; Li, Albert M; Au, Chun T; Kynaston, Jennifer A; Turner, Catherine; Chang, Anne B

    2015-06-01

    While several randomized control trials (RCTs) have evaluated the use of fractional exhaled nitric oxide (FeNO) to improve asthma outcomes, none used FeNO cut-offs adjusted for atopy, a determinant of FeNO levels. In a dual center RCT, we assessed whether a treatment strategy based on FeNO levels, adjusted for atopy, reduces asthma exacerbations compared with the symptoms-based management (controls). Children with asthma from hospital clinics of two hospitals were randomly allocated to receive an a-priori determined treatment hierarchy based on symptoms or FeNO levels. There was a 2-week run-in period and they were then reviewed 10 times over 12-months. The primary outcome was the number of children with exacerbations over 12-months. Sixty-three children were randomized (FeNO = 31, controls = 32); 55 (86%) completed the study. Although we did achieve our planned sample size, significantly fewer children in the FeNO group (6 of 27) had an asthma exacerbation compared to controls (15 of 28), P = 0.021; number to treat for benefit = 4 (95% CI 3-24). There was no difference between groups for any secondary outcomes (quality of life, symptoms, FEV1 ). The final daily inhaled corticosteroids (ICS) dose was significantly (P = 0.037) higher in the FeNO group (median 400 µg, IQR 250-600) compared to the controls (200, IQR100-400). Taking atopy into account when using FeNO to tailor asthma medications is likely beneficial in reducing the number of children with severe exacerbations at the expense of increased ICS use. However, the strategy is unlikely beneficial for improving asthma control. A larger study is required to confirm or refute our findings. © 2014 Wiley Periodicals, Inc.

  4. Implementation of ‘matrix support’ (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study

    PubMed Central

    Martins, Sonia Maria; Salibe-Filho, William; Tonioli, Luís Paulo; Pfingesten, Luís Eduardo; Braz, Patrícia Dias; McDonnell, Juliet; Williams, Siân; do Carmo, Débora; de Sousa, Jaime Correia; Pinnock, Hilary; Stelmach, Rafael

    2016-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented ‘matrix support’: a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157–87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (P<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (P=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (P<0.05). Knowledge scores showed a significant improvement (P<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems. PMID:27536853

  5. Exploring the Effectiveness of an Internet-Based Program for Reducing Caregiver Distress Using the iCare Stress Management e-Training Program

    PubMed Central

    Kajiyama, Bruno; Thompson, Larry W.; Eto-Iwase, Tamiko; Yamashita, Mio; Di Mario, John; Tzuang, Yuan Marian; Gallagher-Thompson, Dolores

    2013-01-01

    OBJECTIVE Determine if the online iCare Stress Management e-Training Program reduces stress, bother depression and poor life quality for dementia family caregivers (CGs). METHOD CGs (N=150) were randomly assigned to the iCare Condition (ICC) or to the Education/Information-Only Condition (EOC) for a 3-month periodChange in self-report measures of stress (PSS) (primary outcome), caregiver bother(RMBPC), depression (CES-D) and quality of life (PQOL) (secondary outcomes) was determined, along with usage of new information in one’s own caregiving. RESULTS A mixed ANOVA revealed that change in perceived stress was significant for the ICC but not the EOC (p = .017). Changes in the other measures were not significant. More caregivers in the ICC used the materials in their own caregiving situation than those in the EOC. Roughly one-third of the caregivers enrolled in the study dropped prior to completion. CONCLUSION Results are promising, but the high dropout is a concern. Future efforts to improve dropout rate and increase participant engagement are warranted. To our knowledge this is the first attempt to present an evidence-based intervention for CGs via the Internet. PMID:23461355

  6. Exploring the effectiveness of an internet-based program for reducing caregiver distress using the iCare Stress Management e-Training Program.

    PubMed

    Kajiyama, Bruno; Thompson, Larry W; Eto-Iwase, Tamiko; Yamashita, Mio; Di Mario, John; Marian Tzuang, Yuan; Gallagher-Thompson, Dolores

    2013-01-01

    Determine if the online iCare Stress Management e-Training Program reduces stress, bother, depression, and poor life quality for dementia family caregivers (CGs). CGs (N = 150) were randomly assigned to the iCare Condition (ICC) or to the Education/Information-Only Condition (EOC) for a 3-month period. Change in self-report measures of stress (PSS) (primary outcome), caregiver bother(RMBPC), depression (CES-D), and quality of life (PQOL) (secondary outcomes) was determined, along with usage of new information in one's own caregiving. A mixed ANOVA revealed that change in perceived stress was significant for the ICC but not the EOC (p = .017). Changes in the other measures were not significant. More caregivers in the ICC used the materials in their own caregiving situation than those in the EOC. Roughly one-third of the caregivers enrolled in the study dropped prior to completion. Results are promising, but the high dropout is a concern. Future efforts to improve dropout rate and increase participant engagement are warranted. To our knowledge, this is the first attempt to present an evidence-based intervention for CGs via the Internet.

  7. Implementation of Home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso

    PubMed Central

    Tiono, Alfred B; Kaboré, Youssouf; Traoré, Abdoulaye; Convelbo, Nathalie; Pagnoni, Franco; Sirima, Sodiomon B

    2008-01-01

    Background Home Management of Malaria (HMM) is one of the key strategies to reduce the burden of malaria for vulnerable population in endemic countries. It is based on the evidence that well-trained communities health workers can provide prompt and adequate care to patients close to their homes. The strategy has been shown to reduce malaria mortality and severe morbidity and has been adopted by the World Health Organization as a cornerstone of malaria control in Africa. However, the potential fall-out of this community-based strategy on the work burden at the peripheral health facilities level has never been investigated. Methods A two-arm interventional study was conducted in a rural health district of Burkina Faso. The HMM strategy has been implemented in seven community clinics catchment's area (intervention arm). For the other seven community clinics in the control arm, no HMM intervention was implemented. In each of the study arms, presumptive treatment was provided for episodes of fevers/malaria (defined operationally as malaria). The study drug was artemether-lumefantrine, which was sold at a subsidized price by community health workers/Key opinion leaders at the community level and by the pharmacists at the health facility level. The outcome measured was the proportion of malaria cases among all health facility attendance (all causes diseases) in both arms throughout the high transmission season. Results A total of 7,621 children were enrolled in the intervention arm and 7,605 in the control arm. During the study period, the proportions of malaria cases among all health facility attendance (all causes diseases) were 21.0%, (445/2,111, 95% CI [19.3%–22.7%]) and 70.7% (2,595/3,671, 95% CI 68.5%–71.5%), respectively in the intervention and control arms (p << 0.0001). The relative risk ratio for a fever/malaria episode to be treated at the HF level was 30% (0.30 < RR < 0.32). The number of malaria episodes treated in the intervention arm was much higher

  8. The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports.

    PubMed

    Gonseth, Jonás; Guallar-Castillón, Pilar; Banegas, José R; Rodríguez-Artalejo, Fernando

    2004-09-01

    To systematically evaluate the published evidence regarding the effectiveness of disease management programmes (DMPs) reducing hospital re-admissions among elderly patients with heart failure (HF). Computerised search of MEDLINE (1966 to 31 August 2003) and EMBASE (1966 to 31 August 2003). The Cochrane Library was also searched, and reference lists of review articles on the topic, and of all relevant studies identified, were scanned. Search and selection of studies, data-extraction using standardised forms, and assessment of study quality was performed by two reviewers. The end-point was the proportion of persons who underwent hospital re-admission, and pooled relative risks (RR) were used to summarise the effectiveness of DMPs. The meta-analysis included 54 articles, comprising 27 randomised and 27 non-randomised controlled studies. Randomised studies consistently suggested that, in comparison with usual care, DMP reduced the frequency of re-admission for HF or cardiovascular disease by 30% (pooled RR 0.70; confidence interval (CI) 95% 0.62-0.79), all-cause re-admission by 12% (pooled RR 0.88, 95% CI: 0.79-0.97), and the combined event of re-admission or death by 18% (pooled RR 0.82, 95% CI: 0.72-0.94). The results displayed no substantial variation when only DMPs with home visits, out-patient visits to a clinic, or patient follow-up longer than 6 months were included. For DMPs with out-patient clinical visits, however, the reduction in re-admission for HF or cardiovascular disease, and for all causes, did not attain statistical significance. The magnitude of DMP benefits reported by non-randomised studies was more than double that reported by randomised studies. Practically all the non-randomised studies failed to control for confounding factors, such as severity, co-morbidity and drug therapy. DMPs are effective at reducing re-admissions among elderly patients with HF. Their effectiveness is close to that observed in clinical trials evaluating drugs for HF, such

  9. Sleep Restriction Therapy for Insomnia is Associated with Reduced Objective Total Sleep Time, Increased Daytime Somnolence, and Objectively Impaired Vigilance: Implications for the Clinical Management of Insomnia Disorder

    PubMed Central

    Kyle, Simon D.; Miller, Christopher B.; Rogers, Zoe; Siriwardena, A. Niroshan; MacMahon, Kenneth M.; Espie, Colin A.

    2014-01-01

    objective performance impairment. Our data have important implications for implementation guidelines around the safe and effective delivery of cognitive behavioral therapy for insomnia. Citation: Kyle SD; Miller CB; Rogers Z; Siriwardena AN; MacMahon KM; Espie CA. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder. SLEEP 2014;37(2):229-237. PMID:24497651

  10. A comparative study of the five-times-sit-to-stand and timed-up-and-go tests as measures of functional mobility in persons with and without injection-related venous ulcers.

    PubMed

    Pieper, Barbara; Templin, Thomas N; Goldberg, Allon

    2014-02-01

    To provide information on the Five-Times-Sit-to-Stand (FTSTS) and Timed-Up-and-Go (TUG) tests in persons with injection-related venous ulcers (VU+) and persons without venous ulcers (VU-). This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to: To examine functional mobility using Five-Times-Sit-to-Stand (FTSTS) and Timed-Up-and-Go (TUG) tests in persons with injection-related venous ulcers (VU+) and compare these findings to persons without venous ulcers (VU-). Cross-sectional, comparative design. Outpatient clinic.PARTICPANTS: Participants (n = 61) were 31 persons VU+ and 30 persons VU-; 57.4% men; mean age, 54 years; 93% African American. Five-Times-Sit-to-Stand, TUG, physical activity, quality of life, comorbidities, falls, and body mass index. Participants VU+ were 36.8% slower on completion of the TUG test (P = .012) and 26.5% slower on completion of the FTSTS test (P = .081). Five-Times-Sit-to-Stand and TUG were strongly correlated with each other, r = 0.93, 0.87, P < .001 for VU- and VU+, respectively. Test-retest reliabilities for the FTSTS and TUG tests were high (intraclass correlation coefficient = 0.89-0.94) for the VU+ and VU-. Within each group, correlations of FTSTS and TUG were similar for each of the variables examined. Across groups, correlations showed that the time to complete FTSTS and TUG increased as a function of comorbidities in the VU+ group; the correlations in the VU- group were not significantly different from zero. The VU+ group exhibited poorer physical performance than the VU- group. The high correlation between FTSTS and TUG and the similarity of correlations with other variables suggest that these physical performance measures may be interchangeable in their ability to predict physical functioning in these clinical groups despite differences in test demands. Clinicians need easy

  11. Effectiveness of heart failure management programmes with nurse-led discharge planning in reducing re-admissions: a systematic review and meta-analysis.

    PubMed

    Lambrinou, Ekaterini; Kalogirou, Fotini; Lamnisos, Demetris; Sourtzi, Panayota

    2012-05-01

    Heart failure (HF) is a clinical condition with major socioeconomic burden. Scientists are trying to find effective solutions to eliminate the effects of the disease and the current innovations in research address the introduction of HF management programmes (HF-MPs). A meta-analysis was undertaken to estimate the effect of HF-MP with a nurse-driven pre-discharge phase on the outcomes of HF and all-cause re-admission. A systematic search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library (reviews and clinical trials) was performed to locate randomised controlled trials (RCTs), published in English language, which implemented any HF-MP with discharge planning carried out by a nurse. Identified articles were further screened for additional studies. Two reviewers independently screened relevant abstracts or titles using a standardised predefined check list. Pilot studies, studies additionally assessing other conditions and studies that evolved technology utilities or included medication management beyond optimisation of therapy, were excluded. Selected articles were thoroughly screened and data of interest (characteristics and outcomes) were obtained. Quality assessment was done by two reviewers separately. Nineteen RCTs were selected for the meta-analysis. The overall pooled effect (relative risk, RR) of the intervention group compared with the control group was estimated by using a random effects analysis (95% confidence interval (CI)) for the outcomes of HF-related re-admission and all-cause re-admission. The overall RR of HF re-admissions was 0.68, 95% CI (0.53, 0.86), p<0.05 and of all-cause re-admission was 0.85, 95% CI (0.76, 0.94), p<0.05 favouring the intervention. Metaregression analysis was performed while trying to explain the observed heterogeneity but none of the factors (environment, duration of follow-up, origin and complexity) were significantly related with the RR. No significant publication bias was

  12. Reducing and managing faecal incontinence in people with advanced dementia who are resident in care homes: protocol for a realist synthesis.

    PubMed

    Goodman, Claire; Rycroft Malone, Jo; Norton, Christine; Harari, Danielle; Harwood, Rowan; Roe, Brenda; Russell, Bridget; Fader, Mandy; Buswell, Marina; Drennan, Vari M; Bunn, Frances

    2015-07-10

    Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high, but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but few studies provide evidence about effective interventions. There is a need to understand how, why, and in what circumstances particular programmes to reduce and manage FI are effective (or not) for people with dementia. The purpose of this review is to identify which (elements of the) interventions could potentially be effective, and examine the barriers and facilitators to the acceptability, uptake and implementation of interventions designed to address FI in people with dementia who are resident in care homes. A realist synthesis approach to review the evidence will be used which will include studies on continence, person-centred care, implementation research in care homes, workforce and research on care home culture. An iterative four-stage approach is planned. Phase 1: development of an initial programme theory or theories that will be 'tested' through a first scoping of the literature and consultation with five stakeholder groups (care home providers, user representatives, academics and practice educators, clinicians with a special interest in FI and continence specialists). Phase 2: a systematic search and analysis of published and unpublished evidence to test and develop the programme theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1. The overall protocol does not require ethical review. The University research ethics committee will review interviews conducted as part of phase 1 and 3. The final fourth phase will synthesise and develop recommendations for practice and develop testable hypotheses for further research. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  13. Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

    PubMed

    Adams, Diane L; Norman, Helen; Burroughs, Valentine J

    2002-06-01

    Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction

  14. Reduced cost and mortality using home telehealth to promote self-management of complex chronic conditions: a retrospective matched cohort study of 4,999 veteran patients.

    PubMed

    Darkins, Adam; Kendall, Stephen; Edmonson, Ellen; Young, Michele; Stressel, Pamela

    2015-01-01

    This retrospective analysis of 2009-2012 Veterans Health Administration (VHA) administrative data assessed the efficacy of care coordination home telehealth (CCHT), a model of care designed to reduce institutional care. Outcomes for 4,999 CCHT-non-institutional care (NIC) patients were compared with usual (non-CCHT) care in a matched cohort group (MCG) of 183,872 Veterans. Both cohorts were comprised of patients with complex chronic conditions with statistically similar baseline (pre-CCHT enrollment) healthcare costs, when adjusted for age, sex, chronic disease, emergency room (ER) visits, hospital admissions, hospital lengths of stay, and pharmacy costs. Subsequent analyses after 12 months of CCHT-NIC enrollment showed mean annual healthcare costs for CCHT-NIC patients fell 4%, from $21,071 to $20,206, whereas the corresponding costs for MCG patients increased 48%, from $20,937 to $31,055. Higher mean annual pharmacy expenditure of 22% ($470 over baseline) for CCHT-NIC patients versus 15% for MCG patients ($326 over baseline) was attributable to the medication compliance effect of better care coordination. Several healthcare cost drivers (e.g., ER visits and admissions) had sizable declines in the CCHT-NIC group. Medicare usage review in both cohorts excluded this as a confounding factor in cost analyses. Prefinal case selection criteria analysis of both cohorts yielded a 9.8% mortality rate in CCHT patients versus 16.58% in non-CCHT patients. This study corroborates previous positive VHA analyses of CCHT but contradicts results from recent non-VHA studies, highlighting the efficacy of the VHA's standardized CCHT model, which incorporates a biopsychosocial approach to care that emphasizes patient self-management.

  15. Feasibility of Adapting Multisystemic Therapy to Improve Illness Management Behaviors and Reduce Asthma Morbidity in High Risk African American Youth: A Case Series

    ERIC Educational Resources Information Center

    Naar-King, Sylvie; Ellis, Deborah; Kolmodin, Karen; Cunningham, Phillippe; Secord, Elizabeth

    2009-01-01

    African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation…

  16. Feasibility of Adapting Multisystemic Therapy to Improve Illness Management Behaviors and Reduce Asthma Morbidity in High Risk African American Youth: A Case Series

    ERIC Educational Resources Information Center

    Naar-King, Sylvie; Ellis, Deborah; Kolmodin, Karen; Cunningham, Phillippe; Secord, Elizabeth

    2009-01-01

    African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation…

  17. The Kinzua Quality Deer Cooperative: can adaptive management and local stakeholder engagement sustain reduced impact of ungulate browsers in forest systems?

    Treesearch

    Susan L. Stout; Alejandro A. Royo; David S. deCalesta; Kevin McAleese; James C. Finley

    2013-01-01

    The Kinzua Quality Deer Cooperative (KQDC) was established in 2000 to test new approaches to stewardship of white-tailed deer and forest habitat on a 30 000 hectare landscape in northwest Pennsylvania, USA. Partners included land managers, scientists, educators, tourism promoters,and hunters. KQDC goals were adaptive management of the deer herd, improved habitat...

  18. Analysis on 3RWB model (Reduce, reuse, recycle, and waste bank) in comprehensive waste management toward community-based zero waste

    NASA Astrophysics Data System (ADS)

    Affandy, Nur Azizah; Isnaini, Enik; Laksono, Arif Budi

    2017-06-01

    Waste management becomes a serious issue in Indonesia. Significantly, waste production in Lamongan Regency is increasing in linear with the growth of population and current people activities, creating a gap between waste production and waste management. It is a critical problem that should be solved immediately. As a reaction to the issue, the Government of Lamongan Regency has enacted a new policy regarding waste management through a program named Lamongan Green and Clean (LGC). From the collected data, it showed that the "wet waste" or "organic waste" was approximately 63% of total domestic waste. With such condition, it can be predicted that the trashes will decompose quite quickly. From the observation, it was discovered that the generated waste was approximately 0.25 kg/person/day. Meanwhile, the number of population in Tumenggungan Village, Lamongan (data obtained from Monograph in Lamongan district, 2012) was 4651 people. Thus, it can be estimated the total waste in Lamongan was approximately 0.25 kg/person/day x 4651 characters = 930 kg/day. Within 3RWB Model, several stages have to be conducted. In the planning stage, the promotion of self-awareness among the communities in selecting and managing waste due to their interest in a potential benefit, is done. It indicated that community's awareness of waste management waste grew significantly. Meanwhile in socialization stage, each village staff, environmental expert, and policymaker should bear significant role in disseminating the awareness among the people. In the implementation phase, waste management with 3RWB model is promoted by applying it among of the community, starting from selection, waste management, until recycled products sale through the waste bank. In evaluation stage, the village managers, environmental expert, and waste managers are expected to regularly supervise and evaluate the whole activity of the waste management.

  19. Towards a no-till no-spray future? Introduction to a symposium on nonchemical weed management for reduced-tillage cropping systems

    USDA-ARS?s Scientific Manuscript database

    Reduced-tillage systems including no-tillage and strip tillage have well-known benefits for conserving and improving soils, protecting vulnerable crops from extreme weather events, and reducing labor and fuel costs associated with full-width inversion tillage. Despite these benefits, reduced-tillage...

  20. Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

    PubMed Central

    Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

    2002-01-01

    Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction

  1. Ebola management centre proximity associated with reduced delays of healthcare of Ebola Virus Disease (EVD) patients, Tonkolili, Sierra Leone, 2014–15

    PubMed Central

    Danis, Kostas; Greig, Jane; Hoffmann, Alexandra; De Valk, Henriette; Jimissa, Augustine; Tejan, Sumaila; Sankoh, Mohammed; Kleijer, Karline; Turner, Will; Achar, Jay; Duncombe, Jennifer; Lokuge, Kamalini; Gayton, Ivan; Broeder, Rob; Kremer, Ronald; Caleo, Grazia

    2017-01-01

    Between August-December 2014, Ebola Virus Disease (EVD) patients from Tonkolili District were referred for care to two Médecins Sans Frontières (MSF) Ebola Management Centres (EMCs) outside the district (distant EMCs). In December 2014, MSF opened an EMC in Tonkolili District (district EMC). We examined the effect of opening a district-based EMC on time to admission and number of suspect cases dead on arrival (DOA), and identified factors associated with fatality in EVD patients, residents in Tonkolili District. Residents of Tonkolili district who presented between 12 September 2014 and 23 February 2015 to the district EMC and the two distant EMCs were identified from EMC line-lists. EVD cases were confirmed by a positive Ebola PCR test. We calculated time to admission since the onset of symptoms, case-fatality and adjusted Risk Ratios (aRR) using Binomial regression. Of 249 confirmed Ebola cases, 206 (83%) were admitted to the distant EMCs and 43 (17%) to the district EMC. Of them 110 (45%) have died. Confirmed cases dead on arrival (n = 10) were observed only in the distant EMCs. The median time from symptom onset to admission was 6 days (IQR 4,8) in distant EMCs and 3 days (IQR 2,7) in the district EMC (p<0.001). Cases were 2.0 (95%CI 1.4–2.9) times more likely to have delayed admission (>3 days after symptom onset) in the distant compared with the district EMC, but were less likely (aRR = 0.8; 95%CI 0.6–1.0) to have a high viral load (cycle threshold ≤22). A fatal outcome was associated with a high viral load (aRR 2.6; 95%CI 1.8–3.6) and vomiting at first presentation (aRR 1.4; 95%CI 1.0–2.0). The opening of a district EMC was associated with earlier admission of cases to appropriate care facilities, an essential component of reducing EVD transmission. High viral load and vomiting at admission predicted fatality. Healthcare providers should consider the location of EMCs to ensure equitable access during Ebola outbreaks. PMID:28459838

  2. Ebola management centre proximity associated with reduced delays of healthcare of Ebola Virus Disease (EVD) patients, Tonkolili, Sierra Leone, 2014-15.

    PubMed

    Theocharopoulos, Georgios; Danis, Kostas; Greig, Jane; Hoffmann, Alexandra; De Valk, Henriette; Jimissa, Augustine; Tejan, Sumaila; Sankoh, Mohammed; Kleijer, Karline; Turner, Will; Achar, Jay; Duncombe, Jennifer; Lokuge, Kamalini; Gayton, Ivan; Broeder, Rob; Kremer, Ronald; Caleo, Grazia

    2017-01-01

    Between August-December 2014, Ebola Virus Disease (EVD) patients from Tonkolili District were referred for care to two Médecins Sans Frontières (MSF) Ebola Management Centres (EMCs) outside the district (distant EMCs). In December 2014, MSF opened an EMC in Tonkolili District (district EMC). We examined the effect of opening a district-based EMC on time to admission and number of suspect cases dead on arrival (DOA), and identified factors associated with fatality in EVD patients, residents in Tonkolili District. Residents of Tonkolili district who presented between 12 September 2014 and 23 February 2015 to the district EMC and the two distant EMCs were identified from EMC line-lists. EVD cases were confirmed by a positive Ebola PCR test. We calculated time to admission since the onset of symptoms, case-fatality and adjusted Risk Ratios (aRR) using Binomial regression. Of 249 confirmed Ebola cases, 206 (83%) were admitted to the distant EMCs and 43 (17%) to the district EMC. Of them 110 (45%) have died. Confirmed cases dead on arrival (n = 10) were observed only in the distant EMCs. The median time from symptom onset to admission was 6 days (IQR 4,8) in distant EMCs and 3 days (IQR 2,7) in the district EMC (p<0.001). Cases were 2.0 (95%CI 1.4-2.9) times more likely to have delayed admission (>3 days after symptom onset) in the distant compared with the district EMC, but were less likely (aRR = 0.8; 95%CI 0.6-1.0) to have a high viral load (cycle threshold ≤22). A fatal outcome was associated with a high viral load (aRR 2.6; 95%CI 1.8-3.6) and vomiting at first presentation (aRR 1.4; 95%CI 1.0-2.0). The opening of a district EMC was associated with earlier admission of cases to appropriate care facilities, an essential component of reducing EVD transmission. High viral load and vomiting at admission predicted fatality. Healthcare providers should consider the location of EMCs to ensure equitable access during Ebola outbreaks.

  3. Sustainable Materials Management (SMM) Web Academy Webinar Series: A Step-by-Step Guide to Conducting a Wasted Food Assessment with the Reducing Wasted Food & Packaging Toolkit

    EPA Pesticide Factsheets

    This is a webinar page for the Sustainable Management of Materials (SMM) Web Academy webinar titled Let’s WRAP (Wrap Recycling Action Program): Best Practices to Boost Plastic Film Recycling in Your Community

  4. Sustainable Materials Management (SMM) Web Academy Webinar: How to Reduce Wasted Food: EPA’s Food Waste Reduction Tools for Food Services & Restaurants

    EPA Pesticide Factsheets

    This is a webinar page for the Sustainable Management of Materials (SMM) Web Academy webinar titled Let’s WRAP (Wrap Recycling Action Program): Best Practices to Boost Plastic Film Recycling in Your Community

  5. Can Chronic Disease Management Programs for Patients with Type 2 Diabetes Reduce Productivity-Related Indirect Costs of the Disease? Evidence from a Randomized Controlled Trial

    PubMed Central

    Bolin, Jane N.; Ohsfeldt, Robert L.; Phillips, Charles D.; Zhao, Hongwei; Ory, Marcia G.; Forjuoh, Samuel N.

    2014-01-01

    Abstract The objective was to assess the impacts of diabetes self-management programs on productivity-related indirect costs of the disease. Using an employer's perspective, this study estimated the productivity losses associated with: (1) employee absence on the job, (2) diabetes-related disability, (3) employee presence on the job, and (4) early mortality. Data were obtained from electronic medical records and survey responses of 376 adults aged ≥18 years who were enrolled in a randomized controlled trial of type 2 diabetes self-management programs. All study participants had uncontrolled diabetes and were randomized into one of 4 study arms: personal digital assistant (PDA), chronic disease self-management program (CDSMP), combined PDA and CDSMP, and usual care (UC). The human-capital approach was used to estimate lost productivity resulting from 1, 2, 3, and 4 above, which are summed to obtain total productivity loss. Using robust regression, total productivity loss was modeled as a function of the diabetes self-management programs and other identified demographic and clinical characteristics. Compared to subjects in the UC arm, there were no statistically significant differences in productivity losses among persons undergoing any of the 3 diabetes management interventions. Males were associated with higher productivity losses (+$708/year; P<0.001) and persons with greater than high school education were associated with additional productivity losses (+$758/year; P<0.001). Persons with more than 1 comorbid condition were marginally associated with lower productivity losses (-$326/year; P=0.055). No evidence was found that the chronic disease management programs examined in this trial affect indirect productivity losses. (Population Health Management 2014;17:112–120) PMID:24152055

  6. Managing for resilience

    EPA Science Inventory

    Early efforts in wildlife management focused on reducing population variability and maximizing yields of select species. Aldo Leopold proposed the concept of habitat management as superior to population management. More recently, ecosystem management, whereby ecological processes...

  7. Managing for resilience

    EPA Science Inventory

    Early efforts in wildlife management focused on reducing population variability and maximizing yields of select species. Aldo Leopold proposed the concept of habitat management as superior to population management. More recently, ecosystem management, whereby ecological processes...

  8. Can chronic disease management programs for patients with type 2 diabetes reduce productivity-related indirect costs of the disease? Evidence from a randomized controlled trial.

    PubMed

    Adepoju, Omolola E; Bolin, Jane N; Ohsfeldt, Robert L; Phillips, Charles D; Zhao, Hongwei; Ory, Marcia G; Forjuoh, Samuel N

    2014-04-01

    The objective was to assess the impacts of diabetes self-management programs on productivity-related indirect costs of the disease. Using an employer's perspective, this study estimated the productivity losses associated with: (1) employee absence on the job, (2) diabetes-related disability, (3) employee presence on the job, and (4) early mortality. Data were obtained from electronic medical records and survey responses of 376 adults aged ≥18 years who were enrolled in a randomized controlled trial of type 2 diabetes self-management programs. All study participants had uncontrolled diabetes and were randomized into one of 4 study arms: personal digital assistant (PDA), chronic disease self-management program (CDSMP), combined PDA and CDSMP, and usual care (UC). The human-capital approach was used to estimate lost productivity resulting from 1, 2, 3, and 4 above, which are summed to obtain total productivity loss. Using robust regression, total productivity loss was modeled as a function of the diabetes self-management programs and other identified demographic and clinical characteristics. Compared to subjects in the UC arm, there were no statistically significant differences in productivity losses among persons undergoing any of the 3 diabetes management interventions. Males were associated with higher productivity losses (+$708/year; P<0.001) and persons with greater than high school education were associated with additional productivity losses (+$758/year; P<0.001). Persons with more than 1 comorbid condition were marginally associated with lower productivity losses (-$326/year; P=0.055). No evidence was found that the chronic disease management programs examined in this trial affect indirect productivity losses.

  9. Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care.

    PubMed

    van der Plas, Annicka G M; Vissers, Kris C; Francke, Anneke L; Donker, Gé A; Jansen, Wim J J; Deliens, Luc; Onwuteaka-Philipsen, Bregje D

    2015-01-01

    Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. To compare cancer patients with and without additional support from a case manager on: 1) the patients' general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is 'only' advisory and he or she does not provide hands-on care or prescribe medication.

  10. Adaptive management

    USGS Publications Warehouse

    Allen, Craig R.; Garmestani, Ahjond S.

    2015-01-01

    Adaptive management is an approach to natural resource management that emphasizes learning through management where knowledge is incomplete, and when, despite inherent uncertainty, managers and policymakers must act. Unlike a traditional trial and error approach, adaptive management has explicit structure, including a careful elucidation of goals, identification of alternative management objectives and hypotheses of causation, and procedures for the collection of data followed by evaluation and reiteration. The process is iterative, and serves to reduce uncertainty, build knowledge and improve management over time in a goal-oriented and structured process.

  11. WORKSHOP ON MERCURY IN PRODUCTS, PROCESSES, WASTE AND THE ENVIRONMENT: ELIMINATING, REDUCING AND MANAGING RISKS FROM NON-COMBUSTION SOURCES (PROGRAM FLYER)

    EPA Science Inventory

    The Workshop is designed to achieve three goals:
    1. Convey public and private sector perspectives on the management of mercury in products, processes, and wastes;
    2. Present ongoing efforts that address mercury prevention, elimination, noncombustion treatment and disposal; ...

  12. Evaluating the "Healthy Diabetes" Caribbean Food Plate and Website Portal for Diabetes Prevention and Management: Results of an Online Study and Implications for Reducing Health Disparities

    ERIC Educational Resources Information Center

    Thomas, Nigel M.

    2013-01-01

    Given the challenge of cooking traditional Caribbean meals so they are consistent with the goals of diabetes prevention and management, the researcher created and evaluated a new website portal as e-health tailored to be culturally appropriate and teach the following: how to cook and prepare "Healthy Diabetes" Caribbean Plates. A social…

  13. Sensitivity of disease management decision aids to temperature input errors associated with out-of-canopy and reduced time-resolution measurements

    USDA-ARS?s Scientific Manuscript database

    Plant disease management decision aids typically require inputs of weather elements such as air temperature. Whereas many disease models are created based on weather elements at the crop canopy, and with relatively fine time resolution, the decision aids commonly are implemented with hourly weather...

  14. Evaluating the "Healthy Diabetes" Caribbean Food Plate and Website Portal for Diabetes Prevention and Management: Results of an Online Study and Implications for Reducing Health Disparities

    ERIC Educational Resources Information Center

    Thomas, Nigel M.

    2013-01-01

    Given the challenge of cooking traditional Caribbean meals so they are consistent with the goals of diabetes prevention and management, the researcher created and evaluated a new website portal as e-health tailored to be culturally appropriate and teach the following: how to cook and prepare "Healthy Diabetes" Caribbean Plates. A social…

  15. EPA Proposes Rules to Improve Hazardous Waste Management and Better Protect our Waterways / New Rules Also Reduce Regulatory Burden on Businesses

    EPA Pesticide Factsheets

    WASHINGTON -- The U.S. Environmental Protection Agency (EPA) is proposing two new hazardous waste rules to strengthen environmental protection while reducing regulatory burden on businesses. One of the proposed rules will protect waterways, includin

  16. Applying Risk Management to Reduce The Overall Time In Lay-Up While Increasing the Cost Effectiveness of a Nimitz (CVN 68) Class Aircraft Carrier in Dry Dock During the Execution Phase of a Refueling and Complex Overhaul

    DTIC Science & Technology

    2009-03-01

    propulsion into the carrier platform designs. The USS ENTERPRISE (CVN 65), shown in Figure 3, became the world’s first nuclear- powered aircraft ...mission effectiveness of future Navy surface ships. For example, superconducting motors , using special wiring to lower the resistance of electricity flow...MANAGEMENT TO REDUCE THE TIME IN LAY-UP WHILE INCREASING THE COST EFFECTIVENESS OF A NIMITZ (CVN 68) CLASS AIRCRAFT CARRIER IN DRY DOCK DURING THE

  17. Experience with an extended-release opioid formulation designed to reduce abuse liability in a community-based pain management clinic

    PubMed Central

    Rubino, Daniel

    2011-01-01

    Context With the growing public health concern over rising rates of opioid abuse, physicians have a responsibility to incorporate safeguards into their practice to minimize the potential for opioid misuse, abuse, and diversion. Patient-specific treatment regimens should include steps to monitor treatment success with regard to optimal pain management as well as inappropriate use of opioids and other substances. Opioid formulations designed to be less attractive for abuse are also being developed. While future studies are needed to determine the impact of such formulations in addressing the issue of opioid misuse in the community as a whole, the experience of practitioners who have utilized these formulations can highlight the practical steps to incorporate such formulations into the everyday patient-care setting. Purpose The purpose of this report is to describe experience in managing patients with chronic, moderate-to-severe pain using morphine sulfate and naltrexone hydrochloride extended release capsules (MS-sNT) (EMBEDA®, King Pharmaceuticals® Inc, Bristol, TN, which was acquired by Pfizer Inc, New York, NY, in March 2011), a formulation designed with features to deter abuse/misuse, in a community-based pain management clinic. Case presentations Case reports demonstrating a clinical manag