Feasibility testing of a web-based symptom self-management system for persons living with HIV.

PubMed

Schnall, Rebecca; Wantland, Dean; Velez, Olivia; Cato, Kenrick; Jia, Haomiao

2014-01-01

The purpose of this study was to explore the feasibility of using a Web-based tool to provide tailored symptom management strategies for persons living with HIV (PLWH) and to estimate the effect size of the tool for future studies. Testing the components of the Web-based system was done by incorporating a repeated-measures design measuring the outcomes of symptom frequency and intensity, use of symptom management strategies, and engagement with health care providers. We recruited 42 PLWH; participants were enrolled in the study for 12 weeks and were asked to use the system and complete the questionnaires every 2 weeks. Our results showed that participants who used the strategies were more likely to have a decrease in symptom frequency and intensity. Findings from this feasibility study provide preliminary evidence for the use of a Web-based HIV symptom management tool with self-management strategies for individuals living with HIV infection. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

The Use of Public Enlightenment Campaign Strategy and School Disciplinary Measures in the Management of Cultism in Tertiary Institutions in Nigeria

ERIC Educational Resources Information Center

Omemu, Felix

2015-01-01

The study investigated the perceptions of staff and students on the use of school disciplinary measures and public awareness campaign strategy in the management of cultism in tertiary institutions in Nigeria. The study is guided by two hypotheses tested using the t-test statistics. An instrument containing 10 items properly validated was used in…

An Integrated Approach Is Needed for Ecosystem Based Fisheries Management: Insights from Ecosystem-Level Management Strategy Evaluation

PubMed Central

Fulton, Elizabeth A.; Smith, Anthony D. M.; Smith, David C.; Johnson, Penelope

2014-01-01

An ecosystem approach is widely seen as a desirable goal for fisheries management but there is little consensus on what strategies or measures are needed to achieve it. Management strategy evaluation (MSE) is a tool that has been widely used to develop and test single species fisheries management strategies and is now being extended to support ecosystem based fisheries management (EBFM). We describe the application of MSE to investigate alternative strategies for achieving EBFM goals for a complex multispecies fishery in southeastern Australia. The study was undertaken as part of a stakeholder driven process to review and improve the ecological, economic and social performance of the fishery. An integrated management strategy, involving combinations of measures including quotas, gear controls and spatial management, performed best against a wide range of objectives and this strategy was subsequently adopted in the fishery, leading to marked improvements in performance. Although particular to one fishery, the conclusion that an integrated package of measures outperforms single focus measures we argue is likely to apply widely in fisheries that aim to achieve EBFM goals. PMID:24454722

A test-based strategy is more cost effective than empiric dose escalation for patients with Crohn's disease who lose responsiveness to infliximab.

PubMed

Velayos, Fernando S; Kahn, James G; Sandborn, William J; Feagan, Brian G

2013-06-01

Patients with Crohn's disease who become unresponsive to therapy with tumor necrosis factor antagonists are managed initially with either empiric dose escalation or testing-based strategies. The comparative cost effectiveness of these 2 strategies is unknown. We investigated whether a testing-based strategy is more cost effective than an empiric dose-escalation strategy. A decision analytic model that simulated 2 cohorts of patients with Crohn's disease compared outcomes for the 2 strategies over a 1-year time period. The incremental cost-effectiveness ratio of the empiric strategy was expressed as cost per quality-adjusted life-year (QALY) gained, compared with the testing-based strategy. We performed 1-way, probabilistic, and prespecified secondary analyses. The testing strategy yielded similar QALYs compared with the empiric strategy (0.801 vs 0.800, respectively) but was less expensive ($31,870 vs $37,266, respectively). In sensitivity analyses, the incremental cost-effectiveness ratio of the empiric strategy ranged from $500,000 to more than $5 million per QALY gained. Similar rates of remission (63% vs 66%) and response (28% vs 26%) were achieved through differential use of available interventions. The testing-based strategy resulted in a higher percentage of surgeries (48% vs 34%) and lower percentage use of high-dose biological therapy (41% vs 54%). A testing-based strategy is a cost-effective alternative to the current strategy of empiric dose escalation for managing patients with Crohn's disease who have lost responsiveness to infliximab. The basis for this difference is lower cost at similar outcomes. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

Teaching Strategies to Increase Nursing Student Acceptance and Management of Unconscious Bias.

PubMed

Schultz, Paula L; Baker, Janet

2017-11-01

Medical providers' unconscious biases may contribute to health disparities. Awareness and self-reflection strategies commonly used to teach cultural competence in academic settings are generally ineffective in reducing unconscious bias or motivating change. This article describes the innovative teaching strategies implemented in a graduate setting (N = 75) to increase nursing learners' acceptance and management of unconscious bias. Strategies used guided the debriefing and feedback that incorporated implicit association testing, interactive audience polling, categorized management strategies, and perspective taking. Strategies resulted in positive learner feedback, including a high likelihood to learn more about unconscious bias, acceptance of unconscious bias influence on health disparities, and importance of using management strategies to address personal bias. Increasingly diverse patient populations require nurses who have the skills to understand, assess, and correct unconscious biases. To accomplish this goal, consistent exposure to unconscious bias curricula that includes focused debriefing, feedback, and management strategies is needed at all levels of nursing education. [J Nurs Educ. 2017;56(11):692-696.]. Copyright 2017, SLACK Incorporated.

INTEGRATING MESO-AND MICRO-SIMULATION MODELS TO EVALUATE TRAFFIC MANAGEMENT STRATEGIES, YEAR 2

DOT National Transportation Integrated Search

2017-07-04

In the Year 1 Report, the Arizona State University (ASU) Project Team described the development of a hierarchical multi-resolution simulation platform to test proactive traffic management strategies. The scope was to integrate an easily available mic...

Sleep Management Strategy and Performance in an Extreme Mountain Ultra-marathon.

PubMed

Poussel, Mathias; Laroppe, Julien; Hurdiel, Rémy; Girard, Julien; Poletti, Laurence; Thil, Catherine; Didelot, Antoine; Chenuel, Bruno

2015-01-01

We intended to assess the relationship between sleep strategies and performance during the North-Face Ultra-Trail du Mont-Blanc 2013, to test the hypothesis that sleep management can influence athletic performance. Almost all runners specifically adopted sleep management strategies before the race. Among the finishers 72% didn't sleep at all during the race and 28% took a least one break for sleep. Non-sleepers completed the race faster than the sleepers (P = 0.0008). Race time was positively correlated with drowsiness (P < 0.0001) and negatively correlated with the number participations in this race (P = 0.0039). Runners who adopted a sleep management strategy based on increased sleep time before the race completed the race faster (P = 0.0258). Most finishers seemed to be aware of the importance of developing sleep management strategies and increasing sleep time some nights before the race appeared to be the most relevant strategy to improve performance.

Livestock Disease Management for Trading Across Different Regulatory Regimes.

PubMed

Bate, Andrew M; Jones, Glyn; Kleczkowski, Adam; Naylor, Rebecca; Timmis, Jon; White, Piran C L; Touza, Julia

2018-02-12

The maintenance of livestock health depends on the combined actions of many different actors, both within and across different regulatory frameworks. Prior work recognised that private risk management choices have the ability to reduce the spread of infection to trading partners. We evaluate the efficiency of farmers' alternative biosecurity choices in terms of their own-benefits from unilateral strategies and quantify the impact they may have in filtering the disease externality of trade. We use bovine viral diarrhoea (BVD) in England and Scotland as a case study, since this provides an example of a situation where contrasting strategies for BVD management occur between selling and purchasing farms. We use an agent-based bioeconomic model to assess the payoff dependence of farmers connected by trade but using different BVD management strategies. We compare three disease management actions: test-cull, test-cull with vaccination and vaccination alone. For a two-farm trading situation, all actions carried out by the selling farm provide substantial benefits to the purchasing farm in terms of disease avoided, with the greatest benefit resulting from test-culling with vaccination on the selling farm. Likewise, unilateral disease strategies by purchasers can be effective in reducing disease risks created through trade. We conclude that regulation needs to balance the trade-off between private gains from those bearing the disease management costs and the positive spillover effects on others.

Development, implementation, and evaluation of a mental rehearsal strategy to improve clinical performance and reduce stress: A mixed methods study.

PubMed

Ignacio, Jeanette; Dolmans, Diana; Scherpbier, Albert; Rethans, Jan-Joost; Lopez, Violeta; Liaw, Sok Ying

2016-02-01

Mental rehearsal is a form of mental training that has been used by physicians and nurses to improve performance of clinical skills, and as a vital component of stress management training. To help novice nurses deal with often stressful clinical events that require the processing of information essential to patient management, a mental rehearsal strategy was developed and implemented in a Year 3 nursing simulation program. Inherent to mental rehearsal is imagery, which facilitates cognitive and affective modification, and reduction of extraneous cognitive load. As such, it was expected that the mental rehearsal strategy would improve students' performance and reduce stress in managing deteriorating patients. The study used a mixed methods design. Eighteen Year 3 nursing students participated in the pre- and post-design study, which consisted of the development and implementation of a mental rehearsal strategy. The Rescuing A Patient In Deteriorating Situations (RAPIDS) tool was used to assess performance. Heart rates and systolic blood pressures were used to measure stress. The State-Trait Anxiety Inventory (STAI) was used as a psychological measure of stress/anxiety. Five participants were involved in a focus group discussion that evaluated the usefulness of the mental rehearsal strategy. There was a significant improvement in performance (P<0.05). However, post-test heart rate and systolic blood pressure were not significantly different from pre-test measures. A comparison of STAI results did not show significant differences between pre- and post-test state anxiety and pre- and post-test trait anxiety. Three themes emerged from the focus group interview: managing stress, using a mental framework, and integrating realistic simulations with the mental rehearsal strategy. The mental rehearsal strategy for deteriorating patient management can be valuable based on the findings on performance and based on the participants' feedback. Its role in reducing stress, however, needs further evaluation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Energy management strategy based on fuzzy logic for a fuel cell hybrid bus

NASA Astrophysics Data System (ADS)

Gao, Dawei; Jin, Zhenhua; Lu, Qingchun

Fuel cell vehicles, as a substitute for internal-combustion-engine vehicles, have become a research hotspot for most automobile manufacturers all over the world. Fuel cell systems have disadvantages, such as high cost, slow response and no regenerative energy recovery during braking; hybridization can be a solution to these drawbacks. This paper presents a fuel cell hybrid bus which is equipped with a fuel cell system and two energy storage devices, i.e., a battery and an ultracapacitor. An energy management strategy based on fuzzy logic, which is employed to control the power flow of the vehicular power train, is described. This strategy is capable of determining the desired output power of the fuel cell system, battery and ultracapacitor according to the propulsion power and recuperated braking power. Some tests to verify the strategy were developed, and the results of the tests show the effectiveness of the proposed energy management strategy and the good performance of the fuel cell hybrid bus.

Electric vehicle energy management system

NASA Astrophysics Data System (ADS)

Alaoui, Chakib

This thesis investigates and analyzes novel strategies for the optimum energy management of electric vehicles (EVs). These are aimed to maximize the useful life of the EV batteries and make the EV more practical in order to increase its acceptability to market. The first strategy concerns the right choice of the batteries for the EV according to the user's driving habits, which may vary. Tests conducted at the University of Massachusetts Lowell battery lab show that the batteries perform differently from one manufacturer to the other. The second strategy was to investigate the fast chargeability of different batteries, which leads to reduce the time needed to recharge the EV battery pack. Tests were conducted again to prove that only few battery types could be fast charged. Test data were used to design a fast battery charger that could be installed in an EV charging station. The third strategy was the design, fabrication and application of an Electric Vehicle Diagnostic and Rejuvenation System (EVDRS). This system is based on Mosfet Controlled Thyristors (MCTs). It is capable of quickly identifying any failing battery(s) within the EV pack and rejuvenating the whole battery pack without dismantling them and unloading them. A novel algorithm to rejuvenate Electric Vehicle Sealed Lead Acid Batteries is described. This rejuvenation extends the useful life of the batteries and makes the EV more competitive. The fourth strategy was to design a thermal management system for EV, which is crucial to the safe operation, and the achievement of normal/optimal performance of, electric vehicle (EV) batteries. A novel approach for EV thermal management, based on Pettier-Effect heat pumps, was designed, fabricated and tested in EV. It shows the application of this type of technology for thermal management of EVs.

Cost-effectiveness of molecular testing for thyroid nodules with atypia of undetermined significance cytology.

PubMed

Lee, Lawrence; How, Jacques; Tabah, Roger J; Mitmaker, Elliot J

2014-08-01

Novel molecular diagnostics, such as the gene expression classifier (GEC) and gene mutation panel (GMP) testing, may improve the management for thyroid nodules with atypia of undetermined significance (AUS) cytology. The cost-effectiveness of an approach combining both tests in different practice settings in North America is unknown. The aim of the study was to determine the cost-effectiveness of two diagnostic molecular tests, singly or in combination, for AUS thyroid nodules. We constructed a microsimulation model to investigate cost-effectiveness from US (Medicare) and Canadian healthcare system perspectives. Low-risk patients with AUS thyroid nodules were simulated. We examined five management strategies: 1) routine GEC; 2) routine GEC + selective GMP; 3) routine GMP; 4) routine GMP + selective GEC; and 5) standard management. Lifetime costs and quality-adjusted life-years were measured. From the US perspective, the routine GEC + selective GMP strategy was the dominant strategy. From the Canadian perspective, routine GEC + selective GMP cost and additional CAN$24 030 per quality-adjusted life-year gained over standard management, and was dominant over the other strategies. Sensitivity analyses reported that the decisions from both perspectives were sensitive to variations in the probability of malignancy in the nodule and the costs of the GEC and GMP. The probability of cost-effectiveness for routine GEC + selective GMP was low. In the US setting, the most cost-effective strategy was routine GEC + selective GMP. In the Canadian setting, standard management was most likely to be cost effective. The cost of these molecular diagnostics will need to be reduced to increase their cost-effectiveness for practice settings outside the United States.

Costs and health consequences of chlamydia management strategies among pregnant women in sub-Saharan Africa.

PubMed

Romoren, M; Hussein, F; Steen, T W; Velauthapillai, M; Sundby, J; Hjortdahl, P; Kristiansen, I S

2007-12-01

Chlamydia is the most common bacterial sexually transmitted infection worldwide and a major cause of morbidity-particularly among women and neonates. We compared costs and health consequences of using point-of-care (POC) tests with current syndromic management among antenatal care attendees in sub-Saharan Africa. We also compared erythromycin with azithromycin treatment and universal with age-based chlamydia management. A decision analytical model was developed to compare diagnostic and treatment strategies, using Botswana as a case. Model input was based upon (1) a study of pregnant women in Botswana, (2) literature reviews and (3) expert opinion. We expressed the study outcome in terms of costs (US$), cases cured, magnitude of overtreatment and successful partner treatment. Azithromycin was less costly and more effective than erythromycin. Compared with syndromic management, testing all attendees on their first visit with a 75% sensitive POC test increased the number of cases cured from 1500 to 3500 in a population of 100,000 women, at a cost of US$38 per additional case cured. This cost was lower in high-prevalence populations or if testing was restricted to teenagers. The specific POC tests provided the advantage of substantial reductions in overtreatment with antibiotics and improved partner management. Using POC tests to diagnose chlamydia during antenatal care in sub-Saharan Africa entails greater health benefits than syndromic management does-and at acceptable costs-especially when restricted to younger women. Changes in diagnostic strategy and treatment regimens may improve people's health and even reduce healthcare budgets.

An educational strategy for treating chronic, noncancer pain with opioids: a pilot test.

PubMed

Elhwairis, Huda; Reznich, Christopher B

2010-12-01

Chronic pain is common and can be devastating to the patient and challenging to the health care provider. Despite the importance of the topic, pain management curricula are incomplete in health professionals' training. We developed a longitudinal curriculum to teach therapy for chronic noncancer pain over four units and pilot-tested the teaching of one unit (opioids) to internal medicine residents. The educational strategies we used included didactic sessions, write-up of a management plan following a model, case discussions, and role-play group activities. We pilot-tested one unit (opioid therapy) in March 2008. We performed learner evaluations, using a pretest and posttest, a write-up plan following a model, and a learner knowledge questionnaire. Results showed significant improvement in knowledge. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain. This article demonstrates that multiple teaching modalities-including didactic lectures, case discussions, write-up of a management plan following a model, and role-play group activities-are effective methods of teaching internal medicine residents how to use opioids to manage chronic noncancer pain. Copyright © 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

Integrated corridor management analysis, modeling, and simulation results for the test corridor.

DOT National Transportation Integrated Search

2008-06-01

This report documents the Integrated Corridor Management (ICM) Analysis Modeling and Simulation (AMS) tools and strategies used on a Test Corridor, presents results and lessons-learned, and documents the relative capability of AMS to support benefit-...

Parents' knowledge, attitudes, use of pain relief methods and satisfaction related to their children's postoperative pain management: a descriptive correlational study.

PubMed

Chng, Hui Yi; He, Hong-Gu; Chan, Sally Wai-Chi; Liam, Joanne Li Wee; Zhu, Lixia; Cheng, Karis Kin Fong

2015-06-01

To examine parents' knowledge about and attitudes towards pain management, use of pain relief strategies and satisfaction with their children's postoperative pain management, as well as the relationships among these variables. Children's postoperative pain is inadequately managed worldwide. Despite increasing emphasis on parental involvement in children's postoperative pain management, few studies have examined parents' management of their child's postoperative pain in Singapore. A descriptive correlational study. A convenience sample of 60 parents having 6- to 14-year-old children undergoing inpatient elective surgery in a public hospital in Singapore was recruited. Data were collected one day after each child's surgery using the Pain Management Knowledge and Attitudes questionnaire and the Parents' Use of Pain Relief Strategies questionnaire. Descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests and Spearman's rank correlation coefficient were used for data analyses. Parents displayed moderate levels of knowledge, attitudes and use of pain relief methods in relation to their children's postoperative pain and pain management. They were generally satisfied with the management of their child's postoperative pain. There was significant difference in Parents' Use of Pain Relief Strategies scores between parents with and without previous experience of caring for their hospitalised child. Statistically significant positive correlations were found between parents' knowledge and attitude, knowledge and satisfaction, attitude and satisfaction, knowledge and pain relief strategies, as well as attitude and pain relief strategies. This study indicates the need to provide parents with more information regarding their children's postoperative pain management. Future studies are needed to develop educational interventions for parents to improve their knowledge and attitudes, which will eventually improve their use of pain relief strategies for their children. Health professionals need to provide more information to equip parents with knowledge and skills regarding paediatric postoperative pain management. © 2015 John Wiley & Sons Ltd.

Command and Control Rapid Prototyping Continuum (C2RPC): The Framework for Achieving a New C2 Strategy

DTIC Science & Technology

2011-06-01

Sync Matrix Assessing J/ADOCS (Fires) TBMCS (ATO) Executing Monitoring (SA) C2 Strategy Objectives • Provide Expanded Mission Management...Computers, and Intelligence T&E Test and Evaluation PMW150 Program Warfare Office Command and Control TBMCS Theater Battle Management Core System POR

Evaluating Management Strategies for Automated Test Systems/Equipment (ATS/E): An F-15 Case Study

DTIC Science & Technology

2005-03-01

ethnography , grounded theory , case study , phenomenological research , and narrative research (also known as bibliography from...Creswell, 2003:183). Example inquiry strategies identified by Creswell are: narrative , phenomenology , ethnography , case study , and grounded theory ...other managed systems. Methodology The researcher chose a qualitative research methodology and

Multi-mode energy management strategy for fuel cell electric vehicles based on driving pattern identification using learning vector quantization neural network algorithm

NASA Astrophysics Data System (ADS)

Song, Ke; Li, Feiqiang; Hu, Xiao; He, Lin; Niu, Wenxu; Lu, Sihao; Zhang, Tong

2018-06-01

The development of fuel cell electric vehicles can to a certain extent alleviate worldwide energy and environmental issues. While a single energy management strategy cannot meet the complex road conditions of an actual vehicle, this article proposes a multi-mode energy management strategy for electric vehicles with a fuel cell range extender based on driving condition recognition technology, which contains a patterns recognizer and a multi-mode energy management controller. This paper introduces a learning vector quantization (LVQ) neural network to design the driving patterns recognizer according to a vehicle's driving information. This multi-mode strategy can automatically switch to the genetic algorithm optimized thermostat strategy under specific driving conditions in the light of the differences in condition recognition results. Simulation experiments were carried out based on the model's validity verification using a dynamometer test bench. Simulation results show that the proposed strategy can obtain better economic performance than the single-mode thermostat strategy under dynamic driving conditions.

Testing the tenets of minority stress theory in workplace contexts.

PubMed

Velez, Brandon L; Moradi, Bonnie; Brewster, Melanie E

2013-10-01

The links of minority stressors (workplace discrimination, expectations of stigma, internalized heterosexism, and identity management strategies) with psychological distress and job satisfaction were examined in a sample of 326 sexual minority employees. Drawing from minority stress theory and the literature on the vocational experiences of sexual minority people, patterns of mediation and moderation were tested. Minority stressors were associated with greater distress and lower job satisfaction. A mediation model was supported in which the links of discrimination and internalized heterosexism with psychological distress were mediated by a concealment-focused identity management strategy (i.e., avoiding), and the links of discrimination, expectations of stigma, and internalized heterosexism with job satisfaction were mediated by a disclosure-focused identity management strategy (i.e., integrating). Tests of moderation indicated that for sexual minority women (but not men), the positive association of discrimination with distress was stronger at higher levels of internalized heterosexism than at lower levels. In addition, lower levels of internalized heterosexism and concealment strategies (i.e., counterfeiting and avoiding) and higher levels of a disclosure strategy (i.e., integrating) were associated with higher job satisfaction in the context of low discrimination, but this buffering effect disappeared as level of discrimination increased. The implications of these findings for minority stress research are discussed, and clinical recommendations are made.

Acceptance- versus Change-Based Pain Management: The Role of Psychological Acceptance

ERIC Educational Resources Information Center

Blacker, Kara J.; Herbert, James D.; Forman, Evan M.; Kounios, John

2012-01-01

This study compared two theoretically opposed strategies for acute pain management: an acceptance-based and a change-based approach. These two strategies were compared in a within-subjects design using the cold pressor test as an acute pain induction method. Participants completed a baseline pain tolerance assessment followed by one of the two…

Behavior Management Strategies for Teachers: Achieving Instructional Effectiveness, Student Success, and Student Motivation--Every Teacher and Any Student Can! 2nd Edition.

ERIC Educational Resources Information Center

Harlan, Joan C.; Rowland, Sidney T.

This book provides tested methods for teachers to use in their behavior management and instructional efforts, offering strategies for maintaining and increasing appropriate behaviors as well as preventing and remediating inappropriate behaviors. Section 1, "Understanding Behavior and Selected Models," includes (1) "Understanding…

Putting Climate Adaptation on the Map: Developing Spatial Management Strategies for Whitebark Pine in the Greater Yellowstone Ecosystem.

PubMed

Ireland, Kathryn B; Hansen, Andrew J; Keane, Robert E; Legg, Kristin; Gump, Robert L

2018-06-01

Natural resource managers face the need to develop strategies to adapt to projected future climates. Few existing climate adaptation frameworks prescribe where to place management actions to be most effective under anticipated future climate conditions. We developed an approach to spatially allocate climate adaptation actions and applied the method to whitebark pine (WBP; Pinus albicaulis) in the Greater Yellowstone Ecosystem (GYE). WBP is expected to be vulnerable to climate-mediated shifts in suitable habitat, pests, pathogens, and fire. We spatially prioritized management actions aimed at mitigating climate impacts to WBP under two management strategies: (1) current management and (2) climate-informed management. The current strategy reflected management actions permissible under existing policy and access constraints. Our goal was to understand how consideration of climate might alter the placement of management actions, so the climate-informed strategies did not include these constraints. The spatial distribution of actions differed among the current and climate-informed management strategies, with 33-60% more wilderness area prioritized for action under climate-informed management. High priority areas for implementing management actions include the 1-8% of the GYE where current and climate-informed management agreed, since this is where actions are most likely to be successful in the long-term and where current management permits implementation. Areas where climate-informed strategies agreed with one another but not with current management (6-22% of the GYE) are potential locations for experimental testing of management actions. Our method for spatial climate adaptation planning is applicable to any species for which information regarding climate vulnerability and climate-mediated risk factors is available.

Putting Climate Adaptation on the Map: Developing Spatial Management Strategies for Whitebark Pine in the Greater Yellowstone Ecosystem

NASA Astrophysics Data System (ADS)

Ireland, Kathryn B.; Hansen, Andrew J.; Keane, Robert E.; Legg, Kristin; Gump, Robert L.

2018-06-01

Natural resource managers face the need to develop strategies to adapt to projected future climates. Few existing climate adaptation frameworks prescribe where to place management actions to be most effective under anticipated future climate conditions. We developed an approach to spatially allocate climate adaptation actions and applied the method to whitebark pine (WBP; Pinus albicaulis) in the Greater Yellowstone Ecosystem (GYE). WBP is expected to be vulnerable to climate-mediated shifts in suitable habitat, pests, pathogens, and fire. We spatially prioritized management actions aimed at mitigating climate impacts to WBP under two management strategies: (1) current management and (2) climate-informed management. The current strategy reflected management actions permissible under existing policy and access constraints. Our goal was to understand how consideration of climate might alter the placement of management actions, so the climate-informed strategies did not include these constraints. The spatial distribution of actions differed among the current and climate-informed management strategies, with 33-60% more wilderness area prioritized for action under climate-informed management. High priority areas for implementing management actions include the 1-8% of the GYE where current and climate-informed management agreed, since this is where actions are most likely to be successful in the long-term and where current management permits implementation. Areas where climate-informed strategies agreed with one another but not with current management (6-22% of the GYE) are potential locations for experimental testing of management actions. Our method for spatial climate adaptation planning is applicable to any species for which information regarding climate vulnerability and climate-mediated risk factors is available.

Diagnosis and management of adults with pharyngitis. A cost-effectiveness analysis.

PubMed

Neuner, Joan M; Hamel, Mary Beth; Phillips, Russell S; Bona, Kira; Aronson, Mark D

2003-07-15

Rheumatic fever has become uncommon in the United States while rapid diagnostic test technology for streptococcal antigens has improved. However, little is known about the effectiveness or cost-effectiveness of various strategies for managing pharyngitis caused by group A beta-hemolytic streptococcus (GAS) in U.S. adults. To examine the cost-effectiveness of several diagnostic and management strategies for patients with suspected GAS pharyngitis. Cost-effectiveness analysis. Published literature, including systematic reviews where possible. When costs were not available in the literature, we estimated them from our institution and Medicare charges. Adults in the general U.S. population. 1 year. Societal. Five strategies for the management of adult patients with pharyngitis: 1) observation without testing or treatment, 2) empirical treatment with penicillin, 3) throat culture using a two-plate selective culture technique, 4) optical immunoassay (OIA) followed by culture to confirm negative OIA test results, or 5) OIA alone. Cost per lost quality-adjusted life-days (converted to life-years where appropriate) and incremental cost-effectiveness. Empirical treatment was the least effective strategy at a GAS pharyngitis prevalence of 10% (resulting in 0.41 lost quality-adjusted life-day). Although the other four strategies had similar effectiveness (all resulted in about 0.27 lost quality-adjusted life-day), culture was the least expensive strategy. Results were sensitive to the prevalence of GAS pharyngitis: OIA followed by culture was most effective when GAS pharyngitis prevalence was greater than 20%. Observation was least expensive when prevalence was less than 6%, and empirical treatment was least expensive when prevalence was greater than 71%. The effectiveness of strategies was also very sensitive to the probability of anaphylaxis: When the probability of anaphylaxis was about half the baseline probability, OIA/culture was most effective; when the probability was 1.6 times that of baseline, observation was most effective. Only at an OIA cost less than half of baseline did the OIA alone strategy become less expensive than culture. Results were not sensitive to other variations in probabilities or costs of diagnosis or treatment of GAS pharyngitis. Observation, culture, and two rapid antigen test strategies for diagnostic testing and treatment of suspected GAS pharyngitis in adults have very similar effectiveness and costs, although culture is the least expensive and most effective strategy when the GAS pharyngitis prevalence is 10%. Empirical treatment was not the most effective or least expensive strategy at any prevalence of GAS pharyngitis in adults, although it may be reasonable for individual patients at very high risk for GAS pharyngitis as assessed by a clinical decision rule.

Using nonesterified fatty acids and β-hydroxybutyrate concentrations during the transition period for herd-level monitoring of increased risk of disease and decreased reproductive and milking performance.

PubMed

Ospina, Paula A; McArt, Jessica A; Overton, Thomas R; Stokol, Tracy; Nydam, Daryl V

2013-07-01

Dairy cows visit a state of negative energy balance (NEB) as they transition from late gestation to early lactation. At the individual level, there are several metabolic adaptations to manage NEB, including mobilization of nonesterified fatty acids (NEFA) from body fat reserves and glucose sparing for lactogenesis. Based on current pen-level feeding and management practices, strategies to minimize excessive NEB in both the individual and herd should focus on herd-level testing and management. This article reviews strategies for testing and monitoring of excessive NEB at the herd level through individual testing of 2 energy markers: NEFA and β-hydroxybutyrate. Copyright © 2013 Elsevier Inc. All rights reserved.

A reduced energy supply strategy in active vibration control

NASA Astrophysics Data System (ADS)

Ichchou, M. N.; Loukil, T.; Bareille, O.; Chamberland, G.; Qiu, J.

2011-12-01

In this paper, a control strategy is presented and numerically tested. This strategy aims to achieve the potential performance of fully active systems with a reduced energy supply. These energy needs are expected to be comparable to the power demands of semi-active systems, while system performance is intended to be comparable to that of a fully active configuration. The underlying strategy is called 'global semi-active control'. This control approach results from an energy investigation based on management of the optimal control process. Energy management encompasses storage and convenient restitution. The proposed strategy monitors a given active law without any external energy supply by considering purely dissipative and energy-demanding phases. Such a control law is offered here along with an analysis of its properties. A suboptimal form, well adapted for practical implementation steps, is also given. Moreover, a number of numerical experiments are proposed in order to validate test findings.

Nurses' response to pain communication from patients: a post-test experimental study.

PubMed

McDonald, Deborah Dillon; Laporta, Matthew; Meadows-Oliver, Mikki

2007-01-01

Inadequate communication about pain can result in increased pain for patients. The purpose of the current pilot study was to test how nurses respond when patients use their own words, a pain intensity scale, or both to communicate pain. A post-test only experimental design was used with three pain description conditions, personal and numeric; personal only; numeric only. The setting included six hospitals and one school of nursing located in the northeastern United States. PARTICIPANTS included 122 registered medical surgical nurses. Nurses were randomly assigned to condition, and read a vignette about a trauma patient with moderately severe pain. The vignettes were identical except for the patient's pain description and age. The nurses then wrote how they would respond to the patient's pain. Two blind raters content analyzed the responses, giving nurses one point for including each of six a priori criteria derived from the Acute Pain Management Panel [1992. Acute Pain Management: operative or medical procedures and trauma. Clinical practice guideline (AHCPR Publication No. 92-0032)., Rockville, MD, USA] and the American Pain Society [2003. Principles of analgesic use in the treatment of acute pain and cancer pain, Glenville, IL, USA]. Nurses planned similar numbers of pain management strategies across the three conditions, with a mean of 2.1 (SD=1.14) strategies out of the recommended six. Nurses did not respond with more pain management strategies when patients describe pain in their own words, or in their own words and a pain intensity scale. The relatively small number of pain management strategies planned by the nurses suggests that nurses use few strategies to respond to moderately severe pain problems.

Management practices affect soil nutrients and bacterial populations in backgrounding beef feedlot

USDA-ARS?s Scientific Manuscript database

Contaminants associated with manure in animal production sites are of significant concern. Unless properly managed, high soil nutrient concentrations in feedlots can deteriorate soil and water quality. This three year study tested a nutrient management strategy with three sequentially imposed manage...

Clinical trial: a randomized trial of early endoscopy, Helicobacter pylori testing and empirical therapy for the management of dyspepsia in primary care.

PubMed

Duggan, A E; Elliott, C A; Miller, P; Hawkey, C J; Logan, R F A

2009-01-01

Early endoscopy, Helicobacter pylori eradication and empirical acid suppression are commonly used dyspepsia management strategies in primary care but have not been directly compared in a single trial. To compare endoscopy, H. pylori test and refer, H. pylori test and treat and empirical acid suppression for dyspepsia in primary care. Patients presenting to their general practitioner with dyspepsia were randomized to endoscopy, H. pylori'test and treat', H. pylori test and endoscope positives, or empirical therapy with symptoms, patient satisfaction, healthcare costs and cost effectiveness at 12 months being the outcomes. At 2 months, the proportion of patients reporting no or minimal dyspeptic symptoms ranged from 74% for those having early endoscopy to 55% for those on empirical therapy (P = 0.009), but at 1 year, there was little difference among the four strategies. Early endoscopy was associated with fewer subsequent consultations for dyspepsia (P = 0.003). 'Test and treat' resulted in fewer endoscopies overall and was most cost-effective over a range of cost assumptions. Empirical therapy resulted in the lowest initial costs, but the highest rate of subsequent endoscopy. Gastro-oesophageal cancers were found in four patients randomized to the H. pylori testing strategies. While early endoscopy offered some advantages 'Test and treat' was the most cost-effective strategy. In older patients, early endoscopy may be an appropriate strategy in view of the greater risk of malignant disease. © 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd.

Daily Use of Energy Management Strategies and Occupational Well-being: The Moderating Role of Job Demands.

PubMed

Parker, Stacey L; Zacher, Hannes; de Bloom, Jessica; Verton, Thomas M; Lentink, Corine R

2017-01-01

We examine the relationships among employees' use of energy management strategies and two occupational well-being outcomes: job satisfaction and emotional exhaustion. Based on conservation of resources theory, it was hypothesized that employees with high job demands would benefit more from using energy management strategies (i.e., including prosocial, organizing, and meaning-related strategies), compared to employees with low job demands. We tested this proposition using a quantitative diary study. Fifty-four employees provided data twice daily across one work week (on average, 7 daily entries). Supporting the hypotheses, prosocial energy management was positively related to job satisfaction. Moreover, employees with high job demands were less emotionally exhausted when using prosocial strategies. Contrary to predictions, when using organizing strategies, employees with low job demands had higher job satisfaction and lower emotional exhaustion. Under high job demands, greater use of organizing strategies was associated with lower job satisfaction and higher emotional exhaustion. Finally, use of meaning-related strategies was associated with higher emotional exhaustion when job demands were low. With this research, we position energy management as part of a resource investment process aimed at maintaining and improving occupational well-being. Our findings show that this resource investment will be more or less effective depending on the type of strategy used and the existing drain on resources (i.e., job demands). This is the first study to examine momentary effects of distinct types of work-related energy management strategies on occupational well-being.

Daily Use of Energy Management Strategies and Occupational Well-being: The Moderating Role of Job Demands

PubMed Central

Parker, Stacey L.; Zacher, Hannes; de Bloom, Jessica; Verton, Thomas M.; Lentink, Corine R.

2017-01-01

We examine the relationships among employees’ use of energy management strategies and two occupational well-being outcomes: job satisfaction and emotional exhaustion. Based on conservation of resources theory, it was hypothesized that employees with high job demands would benefit more from using energy management strategies (i.e., including prosocial, organizing, and meaning-related strategies), compared to employees with low job demands. We tested this proposition using a quantitative diary study. Fifty-four employees provided data twice daily across one work week (on average, 7 daily entries). Supporting the hypotheses, prosocial energy management was positively related to job satisfaction. Moreover, employees with high job demands were less emotionally exhausted when using prosocial strategies. Contrary to predictions, when using organizing strategies, employees with low job demands had higher job satisfaction and lower emotional exhaustion. Under high job demands, greater use of organizing strategies was associated with lower job satisfaction and higher emotional exhaustion. Finally, use of meaning-related strategies was associated with higher emotional exhaustion when job demands were low. With this research, we position energy management as part of a resource investment process aimed at maintaining and improving occupational well-being. Our findings show that this resource investment will be more or less effective depending on the type of strategy used and the existing drain on resources (i.e., job demands). This is the first study to examine momentary effects of distinct types of work-related energy management strategies on occupational well-being. PMID:28912741

Strategies for time of culling in control of paratuberculosis in dairy herds.

PubMed

Kudahl, A B; Nielsen, S S; Ostergaard, S

2011-08-01

Effect of time for culling cows infected with Mycobacterium avium ssp. paratuberculosis on prevalence and profitability was identified through simulations. Seven test-and-cull strategies with different culling criteria and no attempts to close infection routes were compared with strategies with (1) no control and (2) closure of infection routes and no culling. The effects on true prevalence and gross margin were evaluated in a herd with typical reproduction management (heat detection rate of 38%). This was repeated in a herd with poor reproduction management (heat detection rate of 28%), because poor reproduction leads to lack of replacement animals, which was hypothesized to affect the economic effects of culling. Effects of varying prices of milk, replacement heifers, and hourly wages were also evaluated. The simulated results predicted that immediate culling after the first positive antibody ELISA test would be the most effective culling strategy to reduce prevalence. However, closing transmission routes was even more effective in reducing the prevalence. In the first 3 to 6 yr, all test-and-cull strategies reduced gross margin by US$5 to 55/stall per year. These losses were fully compensated by increased gross margin in yr 6 to 19. In the short run (7 yr with typical reproduction and 10 yr with poor reproduction), it was most profitable to cull test-positive cows when their milk yield decreased below 85% of that expected according to their parity and lactation stage, especially in herds with poor reproduction management. However, this strategy only stabilized the prevalence and did not reduce it. In the long term (>7 yr from implementation of a strategy), it was most profitable to cull cows immediately or as soon as possible after testing positive the first time. Varying milk prices did not affect the ranking between the different culling strategies. Increased market price (20%) of replacement heifers made all culling strategies less profitable and made culling based on a milk yield criterion the most profitable culling strategy for a longer period (11 to 13 yr). A 20% reduction in heifer price made immediate culling after a positive test the most profitable strategy overall in herds with typical reproduction, and after 9 yr in herd with poor reproduction. To conclude, the ideal culling strategy depends on the aim of intervention, the time horizon, and the reproductive capabilities combined with prices of replacement animals. Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Mastering the management system.

PubMed

Kaplan, Robert S; Norton, David P

2008-01-01

Companies have always found it hard to balance pressing operational concerns with long-term strategic priorities. The tension is critical: World-class processes won't lead to success without the right strategic direction, and the best strategy in the world will get nowhere without strong operations to execute it. In this article, Kaplan, of Harvard Business School, and Norton, founder and director of the Palladium Group, explain how to effectively manage both strategy and operations by linking them tightly in a closed-loop management system. The system comprises five stages, beginning with strategy development, which springs from a company's mission, vision, and value statements, and from an analysis of its strengths, weaknesses, and competitive environment. In the next stage, managers translate the strategy into objectives and initiatives with strategy maps, which organize objectives by themes, and balanced scorecards, which link objectives to performance metrics. Stage three involves creating an operational plan to accomplish the objectives and initiatives; it includes targeting process improvements and preparing sales, resource, and capacity plans and dynamic budgets. Managers then put plans into action, monitoring their effectiveness in stage four. They review operational, environmental, and competitive data; assess progress; and identify barriers to execution. In the final stage, they test the strategy, analyzing cost, profitability, and correlations between strategy and performance. If their underlying assumptions appear faulty, they update the strategy, beginning another loop. The authors present not only a comprehensive blueprint for successful strategy execution but also a managerial tool kit, illustrated with examples from HSBC Rail, Cigna Property and Casualty, and Store 24. The kit incorporates leading management experts' frameworks, outlining where they fit into the management cycle.

Developing an Assessment of Sexual Identity Management for Lesbian and Gay Workers.

ERIC Educational Resources Information Center

Anderson, Mary Z.; Croteau, James M.; DiStefano, Teresa M.; Chung, Y. Barry

2001-01-01

Psychometric properties of the Workplace Sexual Identity Management Measure were tested with 172 professionals. Results suggest it successfully assesses a continuum of lesbian and gay identity management strategies (passing, covering, implicitly out, explicitly out). (Contains 27 references.) (SK)

Software reliability through fault-avoidance and fault-tolerance

NASA Technical Reports Server (NTRS)

Vouk, Mladen A.; Mcallister, David F.

1993-01-01

Strategies and tools for the testing, risk assessment and risk control of dependable software-based systems were developed. Part of this project consists of studies to enable the transfer of technology to industry, for example the risk management techniques for safety-concious systems. Theoretical investigations of Boolean and Relational Operator (BRO) testing strategy were conducted for condition-based testing. The Basic Graph Generation and Analysis tool (BGG) was extended to fully incorporate several variants of the BRO metric. Single- and multi-phase risk, coverage and time-based models are being developed to provide additional theoretical and empirical basis for estimation of the reliability and availability of large, highly dependable software. A model for software process and risk management was developed. The use of cause-effect graphing for software specification and validation was investigated. Lastly, advanced software fault-tolerance models were studied to provide alternatives and improvements in situations where simple software fault-tolerance strategies break down.

Post-Closure Strategy for Use-Restricted Sites on the Nevada National Security Site, Nevada Test and Training Range, and Tonopah Test Range, Nevada

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

Silvas, A. J.

The purpose of this Post-Closure Strategy is to provide a consistent methodology for continual evaluation of post-closure requirements for use-restricted areas on the Nevada National Security Site (NNSS), Nevada Test and Training Range (NTTR), and Tonopah Test Range (TTR) to consolidate, modify, or streamline the program. In addition, this document stipulates the creation of a single consolidated Post-Closure Plan that will detail the current post-closure requirements for all active use restrictions (URs) and outlines its implementation and subsequent revision. This strategy will ensure effective management and control of the post-closure sites. There are currently over 200 URs located on themore » NNSS, NTTR, and TTR. Post-closure requirements were initially established in the Closure Report for each site. In some cases, changes to the post-closure requirements have been implemented through addenda, errata sheets, records of technical change, or letters. Post-closure requirements have been collected from these multiple sources and consolidated into several formats, such as summaries and databases. This structure increases the possibility of inconsistencies and uncertainty. As more URs are established and the post-closure program is expanded, the need for a comprehensive approach for managing the program will increase. Not only should the current requirements be obtainable from a single source that supersedes all previous requirements, but the strategy for modifying the requirements should be standardized. This will enable more effective management of the program into the future. This strategy document and the subsequent comprehensive plan are to be implemented under the assumption that the NNSS and outlying sites will be under the purview of the U.S. Department of Energy, National Nuclear Security Administration for the foreseeable future. This strategy was also developed assuming that regulatory control of the sites remains static. The comprehensive plan is not intended to be a permanent long-term stewardship plan. However, it is intended to clarify requirements and identify components to effectively manage the sites until regulatory requirements are met or management of the site changes. The Environmental Management Program is required to manage these sites until the NNSS Environmental Restoration program is completed, currently planned for 2030. Prior to completion of the Environmental Restoration program, additional planning will be conducted to ensure that long-term stewardship of the sites is maintained. A comprehensive post-closure plan can be transitioned effectively into any future site-wide long-term stewardship program that may be developed. Therefore, the post-closure plan will include current aspects of the post-closure program that are also important aspects of long-term stewardship, including the following: • Management of physical and engineering controls such as fences, signs, and soil covers • Management of institutional and administrative controls such as use restrictions and real estate systems • Management of monitoring and maintenance programs • Management of information related to the sites such as geographic information system data and related documentation The strategy will also allow for periodic review and modification of any aspect of the program to ensure continued effectiveness.« less

Managing emergencies and abnormal situations in air traffic control (part II): teamwork strategies.

PubMed

Malakis, Stathis; Kontogiannis, Tom; Kirwan, Barry

2010-07-01

Team performance has been studied in many safety-critical organizations including aviation, nuclear power plant, offshore oil platforms and health organizations. This study looks into teamwork strategies that air traffic controllers employ to manage emergencies and abnormal situations. Two field studies were carried out in the form of observations of simulator training in emergency and unusual scenarios of novices and experienced controllers. Teamwork strategies covered aspects of team orientation and coordination, information exchange, change management and error handling. Several performance metrics were used to rate the efficiency of teamwork and test the construct validity of a prototype model of teamwork. This is a companion study to an earlier investigation of taskwork strategies in the same field (part I) and contributes to the development of a generic model for Taskwork and Teamwork strategies in Emergencies in Air traffic Management (T(2)EAM). Suggestions are made on how to use T(2)EAM to develop training programs, assess team performance and improve mishap investigations. Copyright 2010 Elsevier Ltd. All rights reserved.

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

PubMed

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

2016-04-01

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

[Revolution of the health care delivery system and its impacts on laboratory testing in the United States].

PubMed

Takemura, Y; Ishibashi, M

2000-02-01

Failure to slow the exponential growth of total health care expenditures in the United States through the government policies resulted in a rapid and progressive penetration of managed care organizations(MCOs) in the early 1990s. Diagnostic testing is viewed as a "commodity" rather than a medical service under the managed care environment. Traditional hospital-based laboratories are placed in a downward spiral with the advent of managed care era. A massive reduction of in-house testing resulted from shorter lengths of patients' hospital stay and a marked decrease in admission under the dominance of managed care urges them to develop strategies for restoring tests deprived by the managed care-associated new businesses: consolidation and networking, participation in the outreach-testing market, and point-of-care/satellite laboratory testing in non-traditional, ambulatory settings are major strategies for survival of hospital laboratories. A number of physicians' office laboratories(POLs) have been closed owing to regulatory restrictions imposed by the Clinical Laboratory Improvement Amendments of 1988(CLIA '88), and to the expanded penetration of MCOs which limit reimbursement to a very few in-house procedures. It seems likely that POLs and hospital laboratories continue to reduce test volumes, while commercial reference laboratories(CRLs) gain more tests through contracting with MCOs. In the current stream of managed care dominance in the United States, clinical laboratories are changing their basic operation focus and mission in response to the aggressively changing landscape. Traditional laboratories which are unwilling to adapt themselves to the new environment will not survive in this country.

Foundational Report Series: Advanced Distribution Management Systems for Grid Modernization, Implementation Strategy for a Distribution Management System

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

Singh, Ravindra; Reilly, James T.; Wang, Jianhui

Electric distribution utilities encounter many challenges to successful deployment of Distribution Management Systems (DMSs). The key challenges are documented in this report, along with suggestions for overcoming them. This report offers a recommended list of activities for implementing a DMS. It takes a strategic approach to implementing DMS from a project management perspective. The project management strategy covers DMS planning, procurement, design, building, testing, Installation, commissioning, and system integration issues and solutions. It identifies the risks that are associated with implementation and suggests strategies for utilities to use to mitigate them or avoid them altogether. Attention is given to commonmore » barriers to successful DMS implementation. This report begins with an overview of the implementation strategy for a DMS and proceeds to put forward a basic approach for procuring hardware and software for a DMS; designing the interfaces with external corporate computing systems such as EMS, GIS, OMS, and AMI; and implementing a complete solution.« less

Simulating timber management in Lake States forests.

Treesearch

Gary J. Brand

1981-01-01

Describes in detail a management subsystem to simulate cutting in Lake States forest types. This subsystem is part of a Stand and Tree Evaluation and Modeling System (STEMS) contained in the Forest Resource Evaluation Program (FREP) for the Lake States. The management subsystem can be used to test the effect of alternate management strategies.

What are the real risks of sport-related concussion, and are they modifiable?

PubMed

Randolph, Christopher; Kirkwood, Michael W

2009-07-01

Over the past two decades, the management of sport-related concussion has been the topic of increased attention in the scientific literature and in the popular media. Despite a proliferation of competing guidelines for concussion management, the widespread use of neuropsychological "baseline" testing designed to monitor postinjury recovery, and several prospective controlled studies of the natural history of concussion, there has been virtually no attempt to quantify the risks associated with sport-related concussion or to determine whether these risks are modifiable via management strategies. Using American football as a model, the short- and long-term risks of sport-related concussion are reviewed. It is concluded that serious short-term consequences of sport-related concussion are extremely rare and unlikely to be significantly modified via management strategies that rely on baseline testing. Other less serious short-term adverse outcomes are also quite rare, transient, and not likely to be altered by specific management guidelines. The long-term consequences of multiple sport-related head trauma remain unclear but are potentially of greater public health concern and should be the focus of increased research. Based on available evidence, there is little rationale for the use of rigid strategies or guidelines in the place of individual clinical decision-making in the management of these injuries.

Incident management under SCAT adaptive control system : FAST-TRAC phase III deliverable. #11, Final report on incident management under SCATS adaptive control system

DOT National Transportation Integrated Search

1998-04-01

The report documents the results of a study designed to test the effectiveness of ATMS and ATIS strategies to reduce delay resulting from an incident. The study had two main sections: a simulation study to test the effectiveness of several control st...

Career Goals in Young Adults: Personal Resources, Goal Appraisals, Attitudes, and Goal Management Strategies

ERIC Educational Resources Information Center

Haratsis, Jessica M.; Hood, Michelle; Creed, Peter A.

2015-01-01

We tested a model based on the dual-process framework that assessed the relationships among personal resources, career goal appraisals, career attitudes, and career goal management, which have not been previously assessed together. The model (tested on a sample of 486 young adults: 74% female, M[subscript]age = 22 years) proposed that personal…

WITHDRAWN: Initial management strategies for dyspepsia.

PubMed

Delaney, Brendan; Ford, Alex C; Forman, David; Moayyedi, Paul; Qume, Michelle

2009-10-07

This review considers management strategies (combinations of initial investigation and empirical treatments) for dyspeptic patients. Dyspepsia was defined to include both epigastric pain and heartburn. To determine the effectiveness, acceptability, and cost effectiveness of the following initial management strategies for patients presenting with dyspepsia (a) Initial pharmacological therapy (including endoscopy for treatment failures). (b) Early endoscopy. (c) Testing for Helicobacter pylori (H. pylori )and endoscope only those positive. (d) H. pylori eradication therapy with or without prior testing. Trials were located through electronic searches and extensive contact with trialists. All randomised controlled trials of dyspeptic patients presenting in primary care. Data were collected on dyspeptic symptoms, quality of life and use of resources. An individual patient data meta-analysis of health economic data was conducted Twenty-five papers reporting 27 comparisons were found. Trials comparing proton pump inhibitors (PPI) with antacids (three trials) and histamine H2-receptor antagonists (H2RAs) (three trials), early endoscopy with initial acid suppression (five trials), H. pylori test and endoscope versus usual management (three trials), H. pylori test and treat versus endoscopy (six trials), and test and treat versus acid suppression alone in H. pylori positive patients (four trials), were pooled. PPIs were significantly more effective than both H2RAs and antacids. Relative risks (RR) and 95% confidence intervals (CI) were; for PPI compared with antacid 0.72 (95% CI 0.64 to 0.80), PPI compared with H2RA 0.63 (95% CI 0.47 to 0.85). Results for other drug comparisons were either absent or inconclusive. Initial endoscopy was associated with a small reduction in the risk of recurrent dyspeptic symptoms compared with H. pylori test and treat (OR 0.75, 95% CI 0.58 to 0.96), but was not cost effective (mean additional cost of endoscopy US$401 (95% CI $328 to 474). Test and treat may be more effective than acid suppression alone (RR 0.59 95% CI 0.42 to 0.83). Proton pump inhibitor drugs (PPIs) are effective in the treatment of dyspepsia in these trials which may not adequately exclude patients with gastro-oesophageal reflux disease (GORD). The relative efficacy of histamine H2-receptor antagonists (H2RAs) and PPIs is uncertain. Early investigation by endoscopy or H. pylori testing may benefit some patients with dyspepsia but is not cost effective as part of an overall management strategy.

Nurse managers' work life quality and their participation in knowledge management: a correlational study.

PubMed

Hashemi Dehaghi, Zahra; Sheikhtaheri, Abbas; Dehnavi, Fariba

2015-01-01

The association between quality of work life and participation in knowledge management is unknown. This study aimed to discover the association between quality of work life of nurse managers and their participation in implementing knowledge management. This was a correlational study. All nurse managers (71 people) from 11 hospitals affiliated with the Social Security Organization in Tehran, Iran, were included. They were asked to rate their participation in knowledge management and their quality of work life. Data was gathered by a researcher-made questionnaire (May-June 2012). The questionnaire was validated by content and construct validity approaches. Cronbach's alpha was used to evaluate reliability. Finally, 50 questionnaires were analyzed. The answers were scored and analyzed using mean of scores, T-test, ANOVA (or nonparametric test, if appropriate), Pearson's correlation coefficient and linear regression. Nurse managers' performance to implement knowledge management strategies was moderate. A significant correlation was found between quality of work life of nurse managers and their participation in implementing knowledge management strategies (r = 0.82; P < 0.001). The strongest correlations were found between implementation of knowledge management and participation of nurse managers in decision making (r = 0.82; P < 0.001). Improvement of nurse managers' work life quality, especially in decision-making, may increase their participation in implementing knowledge management.

The impact of the board's strategy-setting role on board-management relations and hospital performance.

PubMed

Büchner, Vera Antonia; Schreyögg, Jonas; Schultz, Carsten

2014-01-01

The appropriate governance of hospitals largely depends on effective cooperation between governing boards and hospital management. Governing boards play an important role in strategy-setting as part of their support for hospital management. However, in certain situations, this active strategic role may also generate discord within this relationship. The objective of this study is to investigate the impact of the roles, attributes, and processes of governing boards on hospital performance. We examine the impact of the governing board's strategy-setting role on board-management collaboration quality and on financial performance while also analyzing the interaction effects of board diversity and board activity level. The data are derived from a survey that was sent simultaneously to German hospitals and their associated governing board, combined with objective performance information from annual financial statements and quality reports. We use a structural equation modeling approach to test the model. The results indicate that different board characteristics have a significant impact on hospital performance (R = .37). The strategy-setting role and board-management collaboration quality have a positive effect on hospital performance, whereas the impact of strategy-setting on collaboration quality is negative. We find that the positive effect of strategy-setting on performance increases with decreasing board diversity. When board members have more homogeneous backgrounds and exhibit higher board activity levels, the negative effect of the strategy-setting on collaboration quality also increases. Active strategy-setting by a governing board may generally improve hospital performance. Diverse members of governing boards should be involved in strategy-setting for hospitals. However, high board-management collaboration quality may be compromised if managerial autonomy is too highly restricted. Consequently, hospitals should support board-management collaboration about empowered contrasting board roles.

A Systematic Review of Relaxation, Meditation, and Guided Imagery Strategies for Symptom Management in Heart Failure.

PubMed

Kwekkeboom, Kristine L; Bratzke, Lisa C

2016-01-01

Pain, dyspnea, fatigue, and sleep disturbance are prevalent and distressing symptoms in persons with advanced heart failure. Although many lifestyle and self-care interventions have been developed to control heart failure progression, very few studies have explored treatments exclusively for symptom palliation. Cognitive-behavioral strategies may be effective treatment for these symptoms in advanced heart failure. A systemic review was conducted to describe the effect of cognitive-behavioral strategies on pain, dyspnea, fatigue, and sleep disturbance in patients with heart failure. CINAHL, Medline, and PsychINFO were searched from inception through December 2014. Articles were selected for inclusion if they tested a cognitive-behavioral strategy using a quasi-experimental or experimental design, involved a sample of adults with heart failure, and measured pain, dyspnea, fatigue, sleep disturbance, or symptom-related quality of life. The 2 authors evaluated study quality, abstracted data elements from each study, and synthesized findings. Thirteen articles describing 9 unique studies met criteria and were included in the review. Five studies tested relaxation strategies, 3 tested meditation strategies, and 1 tested a guided imagery strategy. Of the 9 studies, 7 demonstrated some improvement in symptom outcomes. Relaxation, meditation, guided imagery, or combinations of these strategies resulted in less dyspnea and better sleep compared with attention control or usual care conditions and reduced pain, dyspnea, fatigue, and sleep disturbance within treatment groups (pretreatment to posttreatment). Symptom-related quality of life was improved with meditation compared with attention control and usual care conditions and improved pre- to post-guided imagery. Studies exploring cognitive-behavioral symptom management strategies in heart failure vary in quality and report mixed findings but indicate potential beneficial effects of relaxation, meditation, and guided imagery on heart failure-related symptoms. Future research should test cognitive-behavioral strategies in rigorously designed efficacy trials, using samples selected for their symptom experience, and measure pain, dyspnea, fatigue, and sleep disturbance outcomes with targeted symptom measures.

A Systematic Review of Relaxation, Meditation, and Guided Imagery Strategies for Symptom Management in Heart Failure

PubMed Central

Kwekkeboom, Kristine L.; Bratzke, Lisa C.

2015-01-01

Background Pain, dyspnea, fatigue, and sleep disturbance are prevalent and distressing symptoms in persons with advanced heart failure. Although many lifestyle and self-care interventions have been developed to control heart failure progression, very few studies have explored treatments exclusively for symptom palliation. Cognitive-behavioral strategies may be effective treatment for these symptoms in advanced heart failure. Objective A systemic review was conducted to describe the effect of cognitive-behavioral strategies on pain, dyspnea, fatigue, and sleep disturbance in patients with heart failure. Methods CINAHL, Medline, and PsychINFO were searched from inception through December 2014. Articles were selected for inclusion if they tested a cognitive-behavioral strategy using a quasi-experimental or experimental design, involved a sample of adults with heart failure, and measured pain, dyspnea, fatigue, sleep disturbance, or symptom-related quality of life (QoL). The two authors evaluated study quality, abstracted data elements from each study, and synthesized findings. Results Thirteen articles describing nine unique studies met criteria and were included in the review. Five studies tested relaxation strategies, three tested meditation strategies, and one tested a guided imagery strategy. Seven of the nine studies demonstrated some improvement in symptom outcomes. Relaxation, meditation, guided imagery, or combinations of these strategies resulted in less dyspnea and better sleep compared to attention control or usual care conditions, and reduced pain, dyspnea, fatigue and sleep disturbance within treatment groups (pre- to post-treatment). Symptom-related QoL was improved with meditation compared to attention control and usual care conditions, and improved pre- to post-guided imagery. Conclusions Studies exploring cognitive-behavioral symptom management strategies in heart failure vary in quality and report mixed findings, but indicate potential beneficial effects of relaxation, meditation, and guided imagery on heart failure-related symptoms. Future research should test cognitive-behavioral strategies in rigorously designed efficacy trials, using samples selected for their symptom experience, and measure pain, dyspnea, fatigue, and sleep disturbance outcomes with targeted symptom measures. PMID:26065388

Connected vehicle enabled freeway merge management - field test.

DOT National Transportation Integrated Search

2016-01-01

Freeway congestion is a major problem of the transportation system, resulting in major economic : loss in terms of traffic delays and fuel costs. With connected vehicle (CV) technologies, more : proactive traffic management strategies are possible. T...

Armored Family of Vehicles (AFV) Automation and Communication. Resource Management Plan (ACRMP). Phase 1. Volume 15.

DTIC Science & Technology

1987-09-01

The AFV ACRMP is the Task Force Director’s (08) tool to manage command, control, communication (C3) automation system life cycle developments for the...responsibilities, development management, acquisition strategy, testing , life cycle support, technology assessment and work group relationships. ACRMP

Weight-loss strategies of South African female university students and comparison of weight management-related characteristics between dieters and non-dieters.

PubMed

Senekal, Marjanne; Lasker, Gabrielle L; van Velden, Lindsay; Laubscher, Ria; Temple, Norman J

2016-09-01

Female university students are at risk for weight gain and use of inappropriate weight-loss strategies. By gaining a greater understanding of the weight-loss strategies used by and weight management related characteristics of these students, effective weight management interventions for this vulnerable group can be developed. Two hundred and fifty female students from South Africa universities, aged 18-25 years, participated in this cross-sectional study; 162 attempted weight loss during the year preceding the study (dieters) and 88 were non-dieters. Weight and height were measured and BMI (kg/m(2)) computed. A self-administered questionnaire was used to record all other variables. Weight loss strategies were described for dieters and compared between BMI groups within the dieters group. Weight management related characteristics were compared between dieters and non-dieters. Statistical tests included Pearson Chi-square test, independent samples t-test or Mann-Whitney U test (depending on distribution of the data). Predictors for a higher BMI and being overweight/obese (BMI ≥25 kg/m(2)) were identified using regression models. Healthy weight-loss strategies included increased exercise and fruit/vegetable intake and decreased intake of sugar and fat containing items; unhealthy methods included eating little food and skipping meals; and extreme weight loss strategies included laxatives and vomiting. The most commonly used weight-loss product was Herbex. Dieters were characterized by a higher BMI, overestimation of their weight (especially normal weight students), dissatisfaction with weight and select body parts, higher intake of breakfast and healthy foods, lower intake of unhealthy foods, higher levels of vigorous physical activity, higher use of select informal weight-loss information sources and experiencing more pressure to lose weight from mothers, siblings and friends. Predictors of higher BMI and/or increased risk for BMI ≥25 included weight-loss attempt during the past year, race, dissatisfaction with waist, perception of currently being "chubby," and higher frequencies of intake of a snack and fatty foods. Attempting weight-loss is common among female students and predicts BMI. Healthy (mainly), unhealthy and extreme weight loss methods are used. Dieters are characterized by a less realistic body image, lower body satisfaction, higher pressure to lose weight, use of informal weight-management information and a healthier life-style.

Using an electronic self-management tool to support patients with chronic kidney disease (CKD): a CKD clinic self-care model.

PubMed

Ong, Stephanie W; Jassal, Sarbjit V; Porter, Eveline; Logan, Alexander G; Miller, Judith A

2013-01-01

New healthcare delivery models are needed to enhance the patient experience and improve quality of care for individuals with chronic conditions such as kidney disease. One potential avenue is to implement self-management strategies. There is growing evidence that self-management interventions help optimize various aspects of chronic disease management. With the increasing use of information technology (IT) in health care, chronic disease management programs are incorporating IT solutions to support patient self-management practices. IT solutions have the ability to promote key principles of self-management, namely education, empowerment, and collaboration. Positive clinical outcomes have been demonstrated for a number of chronic conditions when IT solutions were incorporated into self-management programs. There is a paucity of evidence for self-management in chronic kidney disease (CKD) patients. Furthermore, IT strategies have not been tested in this patient population to the same extent as other chronic conditions (e.g., diabetes, hypertension). Therefore, it is currently unknown if IT strategies will promote self-management behaviors and lead to improvements in overall patient care. We designed and developed an IT solution called My KidneyCare Centre to support self-management strategies for patients with CKD. In this review, we discuss the rationale and vision of incorporating an electronic self-management tool to support the care of patients with CKD. © 2013 Wiley Periodicals, Inc.

Discovering successful strategies for diabetic self-management: a qualitative comparative study

PubMed Central

Baer, Roberta; Nash, Anita; Perez, Noe

2017-01-01

Objective This project explored lifestyles of patients in good and poor control to identify naturally occurring practices and strategies that result in successful diabetes management. Research design and methods Semistructured interviews with adult patients with type 2 diabetes explored diet, food preparation, physical activity, medication use and glucose monitoring. Patients (n=56) were classified into good (A1C <7.0%), fair (7.0%8.0%) control groups and matched across groups on diabetes duration (±5 years) and medication modality (none, oral, insulin±oral) to control for non-lifestyle factors. A qualitative comparative analysis identified practices that distinguished glycemic groups. Results Good control patients were more likely to test their glucose two or more times a day and reduce their sodium intake, as well as increase fruits and vegetables and limit portion sizes, some attaining good control without exercise. Fair control patients discussed several dietary strategies including limiting sweets, drinking non-caloric beverages, reducing carbs, ‘cheating’ (eating only a few sweets/limiting carbs in one meal to have more in another meal) and tested their glucose once a day. Poor control patients were more likely to skip antidiabetic medications and not test their glucose. Conclusions Although clinical trials indicate most self-management practices have limited effectiveness over time, increased glucose monitoring is a valuable component in daily management. Research is needed on effectiveness of dietary strategies that emphasize sodium monitoring and allow some degree of cheating. Reoffering diabetes education classes and providing pill boxes as memory aids may help improve poor control. PMID:28761649

Discovering successful strategies for diabetic self-management: a qualitative comparative study.

PubMed

Weller, Susan C; Baer, Roberta; Nash, Anita; Perez, Noe

2017-01-01

This project explored lifestyles of patients in good and poor control to identify naturally occurring practices and strategies that result in successful diabetes management. Semistructured interviews with adult patients with type 2 diabetes explored diet, food preparation, physical activity, medication use and glucose monitoring. Patients (n=56) were classified into good (A1C <7.0%), fair (7.0%8.0%) control groups and matched across groups on diabetes duration (±5 years) and medication modality (none, oral, insulin±oral) to control for non-lifestyle factors. A qualitative comparative analysis identified practices that distinguished glycemic groups. Good control patients were more likely to test their glucose two or more times a day and reduce their sodium intake, as well as increase fruits and vegetables and limit portion sizes, some attaining good control without exercise. Fair control patients discussed several dietary strategies including limiting sweets, drinking non-caloric beverages, reducing carbs, 'cheating' (eating only a few sweets/limiting carbs in one meal to have more in another meal) and tested their glucose once a day. Poor control patients were more likely to skip antidiabetic medications and not test their glucose. Although clinical trials indicate most self-management practices have limited effectiveness over time, increased glucose monitoring is a valuable component in daily management. Research is needed on effectiveness of dietary strategies that emphasize sodium monitoring and allow some degree of cheating. Reoffering diabetes education classes and providing pill boxes as memory aids may help improve poor control.

Role of Emotional Intelligence in Conflict Management Strategies of Nurses.

PubMed

Başoğul, Ceyda; Özgür, Gönül

2016-09-01

This study analyzes the emotional intelligence levels and conflict management strategies of nurses and the association between them. This cross-sectional, descriptive study was conducted with 277 nurses in a stratified random sample from a university hospital in Turkey. The data were collected from nurses who gave their informed consent to participate using a personal information form, the Rahim Organizational Conflict Inventory-II and Bar-On's Emotional Quotient Inventory (EQ-I). Data were assessed by descriptive statistics, t tests, and Pearson correlation analyses, using SPSS software. The levels of the nurses' strategies were as follows: avoiding (M = 2.98), dominating (M = 2.76), and obliging (M = 2.71) were medium; compromising (M = 1.99) and integration (M = 1.96) were low. The levels of the emotional intelligence of nurses (mean = 2.75) were medium on a 5-point scale. Integration (r = .168), obliging (r = .25), dominating (r = .18), and compromising (r = .33), which are conflict management strategies, were positively correlated with scores of emotional intelligence, and avoiding (r = -.25) was negatively correlated with scores of emotional intelligence (p < .05). The study determined that nurses' emotional intelligence affects conflict management strategies. To use effective strategies in conflict management, nurses must develop emotional intelligence. Training programs on conflict management and emotional intelligence are needed to improve effective conflict management in healthcare facilities. Copyright © 2016. Published by Elsevier B.V.

Responsive Multimodal Transportation Management Strategies And IVHS

DOT National Transportation Integrated Search

1998-09-01

Emergency Notification and Response report summarizes and interprets the results of two Field Operational Tests (FOTs) that included emergency notification and response system components. The tests included in this report are: Colorado Mayday and Pug...

78 FR 77646 - Proposed Information Collection; Comment Request; 2014 Census Site Test

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-24

... pre-notification containing instructions about how to respond to the test online. Some households will... Adaptive Design Strategies portion will test a method of managing data collection by dynamically adapting... methodology. The objectives of this component of the test are to: Design and develop software solutions...

Optimal management of adults with pharyngitis – a multi-criteria decision analysis

PubMed Central

Singh, Sonal; Dolan, James G; Centor, Robert M

2006-01-01

Background Current practice guidelines offer different management recommendations for adults presenting with a sore throat. The key issue is the extent to which the clinical likelihood of a Group A streptococcal infection should affect patient management decisions. To help resolve this issue, we conducted a multi-criteria decision analysis using the Analytic Hierarchy Process. Methods We defined optimal patient management using four criteria: 1) reduce symptom duration; 2) prevent infectious complications, local and systemic; 3) minimize antibiotic side effects, minor and anaphylaxis; and 4) achieve prudent use of antibiotics, avoiding both over-use and under-use. In our baseline analysis we assumed that all criteria and sub-criteria were equally important except minimizing anaphylactic side effects, which was judged very strongly more important than minimizing minor side effects. Management strategies included: a) No test, No treatment; b) Perform a rapid strep test and treat if positive; c) Perform a throat culture and treat if positive; d) Perform a rapid strep test and treat if positive; if negative obtain a throat culture and treat if positive; and e) treat without further tests. We defined four scenarios based on the likelihood of group A streptococcal infection using the Centor score, a well-validated clinical index. Published data were used to estimate the likelihoods of clinical outcomes and the test operating characteristics of the rapid strep test and throat culture for identifying group A streptococcal infections. Results Using the baseline assumptions, no testing and no treatment is preferred for patients with Centor scores of 1; two strategies – culture and treat if positive and rapid strep with culture of negative results – are equally preferable for patients with Centor scores of 2; and rapid strep with culture of negative results is the best management strategy for patients with Centor scores 3 or 4. These results are sensitive to the priorities assigned to the decision criteria, especially avoiding over-use versus under-use of antibiotics, and the population prevalence of Group A streptococcal pharyngitis. Conclusion The optimal clinical management of adults with sore throat depends on both the clinical probability of a group A streptococcal infection and clinical judgments that incorporate individual patient and practice circumstances. PMID:16533386

The office of strategy management.

PubMed

Kaplan, Robert S; Norton, David P

2005-10-01

There is a disconnect in most companies between strategy formulation and strategy execution. On average, 95% of a company's employees are unaware of, or do not understand, its strategy. If employees are unaware of the strategy, they surely cannot help the organization implement it effectively. It doesn't have to be like this. For the past 15 years, the authors have studied companies that achieved performance breakthroughs by adopting the Balanced Scorecard and its associated tools to help them better communicate strategy to their employees and to guide and monitor the execution of that strategy. Some companies, of course, have achieved better, longer-lasting improvements than others. The organizations that have managed to sustain their strategic focus have typically established a new corporate-level unit to oversee all activities related to strategy: an office of strategy management (OS M). The OSM, in effect, acts as the CEO's chief of staff. It coordinates an array of tasks: communicating corporate strategy; ensuring that enterprise-level plans are translated into the plans of the various units and departments; executing strategic initiatives to deliver on the grand design; aligning employees' plans for competency development with strategic objectives; and testing and adapting the strategy to stay abreast of the competition. The OSM does not do all the work, but it facilitates the processes so that strategy is executed in an integrated fashion across the enterprise. Although the companies that Kaplan and Norton studied use the Balanced Scorecard as the framework for their strategy management systems, the authors say the lessons of the OSM are applicable even to companies that do not use it.

Predictive validity of the classroom strategies scale-observer form on statewide testing scores: an initial investigation.

PubMed

Reddy, Linda A; Fabiano, Gregory A; Dudek, Christopher M; Hsu, Louis

2013-12-01

The present study examined the validity of a teacher observation measure, the Classroom Strategies Scale--Observer Form (CSS), as a predictor of student performance on statewide tests of mathematics and English language arts. The CSS is a teacher practice observational measure that assesses evidence-based instructional and behavioral management practices in elementary school. A series of two-level hierarchical generalized linear models were fitted to data of a sample of 662 third- through fifth-grade students to assess whether CSS Part 2 Instructional Strategy and Behavioral Management Strategy scale discrepancy scores (i.e., ∑ |recommended frequency--frequency ratings|) predicted statewide mathematics and English language arts proficiency scores when percentage of minority students in schools was controlled. Results indicated that the Instructional Strategy scale discrepancy scores significantly predicted mathematics and English language arts proficiency scores: Relatively larger discrepancies on observer ratings of what teachers did versus what should have been done were associated with lower proficiency scores. Results offer initial evidence of the predictive validity of the CSS Part 2 Instructional Strategy discrepancy scores on student academic outcomes. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Two Different Maintenance Strategies in the Hospital Environment: Preventive Maintenance for Older Technology Devices and Predictive Maintenance for Newer High-Tech Devices.

PubMed

Sezdi, Mana

2016-01-01

A maintenance program generated through the consideration of characteristics and failures of medical equipment is an important component of technology management. However, older technology devices and newer high-tech devices cannot be efficiently managed using the same strategies because of their different characteristics. This study aimed to generate a maintenance program comprising two different strategies to increase the efficiency of device management: preventive maintenance for older technology devices and predictive maintenance for newer high-tech devices. For preventive maintenance development, 589 older technology devices were subjected to performance verification and safety testing (PVST). For predictive maintenance development, the manufacturers' recommendations were used for 134 high-tech devices. These strategies were evaluated in terms of device reliability. This study recommends the use of two different maintenance strategies for old and new devices at hospitals in developing countries. Thus, older technology devices that applied only corrective maintenance will be included in maintenance like high-tech devices.

Two Different Maintenance Strategies in the Hospital Environment: Preventive Maintenance for Older Technology Devices and Predictive Maintenance for Newer High-Tech Devices

PubMed Central

Sezdi, Mana

2016-01-01

A maintenance program generated through the consideration of characteristics and failures of medical equipment is an important component of technology management. However, older technology devices and newer high-tech devices cannot be efficiently managed using the same strategies because of their different characteristics. This study aimed to generate a maintenance program comprising two different strategies to increase the efficiency of device management: preventive maintenance for older technology devices and predictive maintenance for newer high-tech devices. For preventive maintenance development, 589 older technology devices were subjected to performance verification and safety testing (PVST). For predictive maintenance development, the manufacturers' recommendations were used for 134 high-tech devices. These strategies were evaluated in terms of device reliability. This study recommends the use of two different maintenance strategies for old and new devices at hospitals in developing countries. Thus, older technology devices that applied only corrective maintenance will be included in maintenance like high-tech devices. PMID:27195666

Strict adherence to malaria rapid test results might lead to a neglect of other dangerous diseases: a cost benefit analysis from Burkina Faso.

PubMed

Bisoffi, Zeno; Sirima, Sodiomon B; Meheus, Filip; Lodesani, Claudia; Gobbi, Federico; Angheben, Andrea; Tinto, Halidou; Neya, Bouma; Van den Ende, Klara; Romeo, Annalisa; Van den Ende, Jef

2011-08-04

Malaria rapid diagnostic tests (RDTs) have generally been found reliable and cost-effective. In Burkina Faso, the adherence of prescribers to the negative test result was found to be poor. Moreover, the test accuracy for malaria-attributable fever (MAF) is not the same as for malaria infection. This paper aims at determining the costs and benefits of two competing strategies for the management of MAF: presumptive treatment for all or use of RDTs. A cost benefit analysis was carried out using a decision tree, based on data previously obtained, including a randomized controlled trial (RCT) recruiting 852 febrile patients during the dry season and 1,317 in the rainy season. Cost and benefit were calculated using both the real adherence found by the RCT and assuming an ideal adherence of 90% with the negative result. The main parameters were submitted to sensitivity analysis. At real adherence, the test-based strategy was dominated. Assuming ideal adherence, at the value of 525 € for a death averted, the total cost of managing 1,000 febrile children was 1,747 vs. 1,862 € in the dry season and 1,372 vs. 2,138 in the rainy season for the presumptive vs. the test-based strategy. For adults it was 2,728 vs. 1,983 and 2,604 vs. 2,225, respectively. At the subsidized policy adopted locally, assuming ideal adherence, the RDT would be the winning strategy for adults in both seasons and for children in the dry season.At sensitivity analysis, the factors most influencing the choice of the better strategy were the value assigned to a death averted and the proportion of potentially severe NMFI treated with antibiotics in patients with false positive RDT results. The test-based strategy appears advantageous for adults if a satisfactory adherence could be achieved. For children the presumptive strategy remains the best choice for a wide range of scenarios. For RDTs to be preferred, a positive result should not influence the decision to treat a potentially severe NMFI with antibiotics. In the rainy season the presumptive strategy always remains the better choice for children.

Consumer-oriented health care reform strategies: a review of the evidence on managed competition and consumer-directed health insurance.

PubMed

Buchmueller, Thomas C

2009-12-01

For many years, leading health care reform proposals have been based on market-oriented strategies. In the 1990s, a number of reform proposals were built around the concept of "managed competition," but more recently, "consumer-directed health care" models have received attention. Although price-conscious consumer demand plays a critical role in both the managed competition and consumer-directed health care models, the two strategies are based on different visions of the health care marketplace and the best way to use market forces to achieve greater systemwide efficiencies. This article reviews the research literature that tests the main hypotheses concerning the two policy strategies. Numerous studies provide consistent evidence that consumers' health plan choices are sensitive to out-of-pocket premiums. The elasticity of demand appears to vary with consumers' health risk, with younger, healthier individuals being more price sensitive. This heterogeneity increases the potential for adverse selection. Biased risk selection also is a concern when the menu of health plan options includes consumer-directed health plans. Several studies confirm that such plans tend to attract healthier enrollees. A smaller number of studies test the main hypothesis regarding consumer-directed health plans, which is that they result in lower medical spending than do more generous plans. These studies find little support for this claim. The experiences of employers that have adopted key elements of managed competition are generally consistent with the key hypotheses underlying that strategy. Research in this area, however, has focused on only a narrow range of questions. Because consumer-directed health care is such a recent phenomenon, research on this strategy is even more limited. Additional studies on both topics would be valuable.

Consumer-Oriented Health Care Reform Strategies: A Review of the Evidence on Managed Competition and Consumer-Directed Health Insurance

PubMed Central

Buchmueller, Thomas C

2009-01-01

Context: For many years, leading health care reform proposals have been based on market-oriented strategies. In the 1990s, a number of reform proposals were built around the concept of “managed competition,” but more recently, “consumer-directed health care” models have received attention. Although price-conscious consumer demand plays a critical role in both the managed competition and consumer-directed health care models, the two strategies are based on different visions of the health care marketplace and the best way to use market forces to achieve greater systemwide efficiencies. Methods: This article reviews the research literature that tests the main hypotheses concerning the two policy strategies. Findings: Numerous studies provide consistent evidence that consumers’ health plan choices are sensitive to out-of-pocket premiums. The elasticity of demand appears to vary with consumers’ health risk, with younger, healthier individuals being more price sensitive. This heterogeneity increases the potential for adverse selection. Biased risk selection also is a concern when the menu of health plan options includes consumer-directed health plans. Several studies confirm that such plans tend to attract healthier enrollees. A smaller number of studies test the main hypothesis regarding consumer-directed health plans, which is that they result in lower medical spending than do more generous plans. These studies find little support for this claim. Conclusions: The experiences of employers that have adopted key elements of managed competition are generally consistent with the key hypotheses underlying that strategy. Research in this area, however, has focused on only a narrow range of questions. Because consumer-directed health care is such a recent phenomenon, research on this strategy is even more limited. Additional studies on both topics would be valuable. PMID:20021587

Community case management of malaria using ACT and RDT in two districts in Zambia: achieving high adherence to test results using community health workers

PubMed Central

2011-01-01

Background Access to prompt and effective treatment is a cornerstone of the current malaria control strategy. Delays in starting appropriate treatment is a major contributor to malaria mortality. WHO recommends home management of malaria using artemisininbased combination therapy (ACT) and Rapid Diagnostic tests (RDTs) as one of the strategies for improving access to prompt and efective malaria case management. Methods A prospective evaluation of the effectiveness of using community health workers (CHWs) as delivery points for ACT and RDTs in the home management of malaria in two districts in Zambia. Results CHWs were able to manage malaria fevers by correctly interpreting RDT results and appropriately prescribing antimalarials. All severe malaria cases and febrile non-malaria fevers were referred to a health facility for further management. There were variations in malaria prevalence between the two districts and among the villages in each district. 100% and 99.4% of the patients with a negative RDT result were not prescribed an antimalarial in the two districts respectively. No cases progressed to severe malaria and no deaths were recorded during the study period. Community perceptions were positive. Conclusion CHWs are effective delivery points for prompt and effective malaria case management at community level. Adherence to test results is the best ever reported in Zambia. Further areas of implementation research are discussed. PMID:21651827

75 FR 10210 - Market Development Cooperator Program 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

...; 4. Help U.S. industry to capitalize on effective global supply chain management strategies; 5... in foreign markets by safeguarding non-U.S. elements of the supply chain with an ingredient testing... Management (OPCM), Manufacturing and Services (MAS), International Trade Administration (ITA), Commerce...

Individualizing Educational Strategies: An Apple Computer Managed System for the Diagnosis and Evaluation of Reading, Math and Behavior.

ERIC Educational Resources Information Center

Kern, Richard

1985-01-01

A computer-based interactive system for diagnosing academic and school behavior problems is described. Elements include criterion-referenced testing, an instructional management system, and a behavior evaluation tool developed by the author. (JW)

Building Perinatal Case Manager Capacity Using Quality Improvement.

PubMed

Fitzgerald, Elaine

2015-01-01

Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum.

Adapting livestock management to spatio-temporal heterogeneity in semi-arid rangelands.

PubMed

Jakoby, O; Quaas, M F; Baumgärtner, S; Frank, K

2015-10-01

Management strategies in rotational grazing systems differ in their level of complexity and adaptivity. Different components of such grazing strategies are expected to allow for adaptation to environmental heterogeneities in space and time. However, most models investigating general principles of rangeland management strategies neglect spatio-temporal system properties including seasonality and spatial heterogeneity of environmental variables. We developed an ecological-economic rangeland model that combines a spatially explicit farm structure with intra-annual time steps. This allows investigating different management components in rotational grazing systems (including stocking and rotation rules) and evaluating their effect on the ecological and economic states of semi-arid grazing systems. Our results show that adaptive stocking is less sensitive to overstocking compared to a constant stocking strategy. Furthermore, the rotation rule becomes important only at stocking numbers that maximize expected income. Altogether, the best of the tested strategies is adaptive stocking combined with a rotation that adapts to both spatial forage availability and seasonality. This management strategy maximises mean income and at the same time maintains the rangeland in a viable condition. However, we could also show that inappropriate adaptation that neglects seasonality even leads to deterioration. Rangelands characterised by higher inter-annual climate variability show a higher risk of income losses under a non-adaptive stocking rule, and non-adaptive rotation is least able to buffer increasing climate variability. Overall, all important system properties including seasonality and spatial heterogeneity of available resources need to be considered when designing an appropriate rangeland management system. Resulting adaptive rotational grazing strategies can be valuable for improving management and mitigating income risks. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evolving management of low grade glioma: No consensus amongst treating clinicians.

PubMed

Field, K M; Rosenthal, M A; Khasraw, M; Sawkins, K; Nowak, A K

2016-01-01

Following the widely publicized presentation of the Radiation Therapy Oncology Group (RTOG) 9802 data, we sought to understand how these data had been translated to the management of low grade gliomas (LGG) by Australian neuro-oncology clinicians. The de novo management of LGG is transitioning to include postoperative radiotherapy and chemotherapy after the RTOG 9802 study results demonstrated a survival benefit in this setting. In 2014, neurosurgeons, radiation oncologists and neuro-oncologists who were members of the Australian Cooperative Trials Group for Neuro-oncology (COGNO), as well as additional attendants of the COGNO annual scientific meeting, were surveyed. The survey presented six LGG clinical scenarios and asked respondents to select their preferred management strategy. Some additional questions included the respondents' approach to 1p/19q testing and chemotherapy preferences. The response rate was 30.2% (61/202), with the majority (77%) working in tertiary referral neuro-oncology centers. There was no consensus regarding the management approach for each scenario, with postsurgery observation alone remaining a popular strategy. Only 25% of respondents reported that their institution routinely tests for 1p/19q status in LGG, although 69% were of the opinion that all LGG patients should be tested. The majority (81%) preferred to use temozolomide rather than the procarbazine, lomustine, and vincristine combination as the first line chemotherapy for LGG, but only 44% would actually use it in this setting. Up front chemotherapy, prior to radiotherapy, would be considered by 52% of respondents for certain LGG patients. This survey assessed the management strategies for LGG since the updated RTOG 9802 data were presented. It demonstrates no consensus in the postoperative treatment approaches for LGG. Copyright © 2015 Elsevier Ltd. All rights reserved.

HIV-1 tropism testing and clinical management of CCR5 antagonists: Quebec review and recommendations.

PubMed

Tremblay, Cécile; Hardy, Isabelle; Lalonde, Richard; Trottier, Benoit; Tsarevsky, Irina; Vézina, Louis-Philippe; Roger, Michel; Wainberg, Mark; Baril, Jean-Guy

2013-01-01

HIV-1 tropism assays play a crucial role in determining the response to CCR5 receptor antagonists. Initially, phenotypic tests were used, but limited access to these tests prompted the development of alternative strategies. Recently, genotyping tropism has been validated using a Canadian technology in clinical trials investigating the use of maraviroc in both experienced and treatment-naive patients. The present guidelines review the evidence supporting the use of genotypic assays and provide recommendations regarding tropism testing in daily clinical management.

Development of a Spanish HIV/AIDS Symptom Management Guidebook.

PubMed

Román, Elizabeth; Chou, Fang-Yu

2011-07-01

To provide culturally appropriate HIV/AIDS patient care, it is important to develop symptom management patient education materials for patients with different cultural backgrounds. The purpose of this study was to develop a Spanish version of the Symptom Management Guidebook: Strategies for People Living with HIV/AIDS guidelines and verify its content, perceived feasibility, and usefulness with HIV/AIDS care providers and people living with HIV/AIDS in Puerto Rico. The Symptom Management Guidebook includes self-care strategies to manage 14 common HIV-related symptoms. The Spanish version was developed by adopting and translating through forward and backward translation methods. Seven HIV/AID Shealth care providers from San Juan, Puerto Rico, were invited to review and revise the contents. Ten people living with HIV/AIDS from a community AIDS clinic in San Juan participated in a focus group to review the guidebook and discussed its usefulness and feasibility for managing their symptoms. Participants expressed positive responses and considered an educational guidebook as a helpful tool for self-managing their symptoms. Results suggested that this guidebook may be useful as an intervention strategy for symptom management in HIV/AIDS patients. Future research can include testing self-managing intervention and its outcomes in culturally diverse HIV/AIDS patients.

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

PubMed

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

2017-01-01

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

A Different Approach to the Generation of Patient Management Problems from a Knowledge-Based System

PubMed Central

Barriga, Rosa Maria

1988-01-01

Several strategies are proposed to approach the generation of Patient Management Problems from a Knowledge Base and avoid inconsistencies in the results. These strategies are based on a different Knowledge Base structure and in the use of case introductions that describe the patient attributes which are not disease-dependent. This methodology has proven effective in a recent pilot test and it is on its way to implementation as part of an educational program at CWRU, School of Medicine.

The use of on-site visits to assess compliance and implementation of quality management at hospital level.

PubMed

Wagner, C; Groene, O; Dersarkissian, M; Thompson, C A; Klazinga, N S; Arah, O A; Suñol, R

2014-04-01

Stakeholders of hospitals often lack standardized tools to assess compliance with quality management strategies and the implementation of clinical quality activities in hospitals. Such assessment tools, if easy to use, could be helpful to hospitals, health-care purchasers and health-care inspectorates. The aim of our study was to determine the psychometric properties of two newly developed tools for measuring compliance with process-oriented quality management strategies and the extent of implementation of clinical quality strategies at the hospital level. We developed and tested two measurement instruments that could be used during on-site visits by trained external surveyors to calculate a Quality Management Compliance Index (QMCI) and a Clinical Quality Implementation Index (CQII). We used psychometric methods and the cross-sectional data to explore the factor structure, reliability and validity of each of these instruments. The sample consisted of 74 acute care hospitals selected at random from each of 7 European countries. The psychometric properties of the two indices (QMCI and CQII). Overall, the indices demonstrated favourable psychometric performance based on factor analysis, item correlations, internal consistency and hypothesis testing. Cronbach's alpha was acceptable for the scales of the QMCI (α: 0.74-0.78) and the CQII (α: 0.82-0.93). Inter-scale correlations revealed that the scales were positively correlated, but distinct. All scales added sufficient new information to each main index to be retained. This study has produced two reliable instruments that can be used during on-site visits to assess compliance with quality management strategies and implementation of quality management activities by hospitals in Europe and perhaps other jurisdictions.

Putting Residents First: Strategies Developed by CNAs to Prevent and Manage Resident-to-Resident Violence in Nursing Homes

PubMed Central

Snellgrove, Susan; Beck, Cornelia; Green, Angela; McSweeney, Jean C.

2015-01-01

Purpose of the Study: Resident-to-resident violence (RRV) in nursing homes (NHs) is common and threatens the safety and quality of life of both residents and caregivers. The purpose of this portion of a larger qualitative study was to explore strategies developed by certified nurses’ assistants (CNAs) to prevent and manage RRV in NHs. Design and Methods: Semistructured interviews were used to collect data. Data were analyzed utilizing content analysis and constant comparison. Results: Analysis revealed one overriding theme, “Putting Residents First” which the CNAs described as a conscious effort to put themselves or a beloved family member in the place of the resident while administering care. Within this theme, there were three related subthemes: (a) Knowing the Residents, (b) Keeping Residents Safe, and (c) Spending Quality Time. Implications: Together, these themes suggest that the formulation of strategies for decreasing and managing RRV was influenced significantly by the ability of the CNAs to empathize with the residents for whom they were caring. The results indicate that in the absence of evidence-based interventions, CNAs have developed their own strategies for the management and prevention of RRV. These strategies may provide a foundation for the development and testing of interventions aimed at preventing and managing RRV in NHs. PMID:26055786

Performance comparison of two fuel cell hybrid buses with different powertrain and energy management strategies

NASA Astrophysics Data System (ADS)

Ouyang, Minggao; Xu, Liangfei; Li, Jianqiu; Lu, Languang; Gao, Dawei; Xie, Qicheng

In order to assess the influences of different powertrain structures and energy management strategies on the performance of hybrid fuel cell buses (FCB), two buses (FCB A and FCB B) were constructed with a "energy hybrid structure" and "power hybrid structure", respectively. Different energy management strategies were investigated based on analysis of the two systems. And the two buses were compared with each other in a bus cycle and constant speed testing. The Polymer Electrolyte Membrane Fuel Cell (PEMFC) in FCB A showed an advantage in fuel economy for it worked usually in the high efficient range of the PEMFC engine. The hydrogen consumption rate in the cycle testing was 7.9 kg/100 km and 9.8 kg/100 km for FCB A and FCB B, and in the 40 kmph constant speed testing it was 3.3 kg/100 km and 4.0 kg/100 km, respectively. The fuel economy could be improved when the hydrogen and air supply subsystems are optimized and controlled with an advanced algorithm. It could also benefit from a braking energy regeneration system. Compared with FCB A, the PEMFC in FCB B worked under unfavorable operation conditions because its working range was comparatively wide, and the power changing rate was relatively large from a statistical point of view, which resulted in performance recession of the PEMFC in FCB B. After a mileage of 7000 km, the output power of the PEMFC in FCB B was reduced by 10%, compared with 2.4% in FCB A. An advanced energy management strategy is necessary to split the power between the PEMFC and a battery suitable for long durability of a PEMFC.

Improving cost-effectiveness of and outcomes from drug therapy in patients with atrial fibrillation in managed care: role of the pharmacist.

PubMed

Johnson, Samuel G

2009-08-01

The medical care costs for procedures, medications, and testing associated with atrial fibrillation (AF) in the United States are high and projected to increase markedly in the future as the number of Americans affected grows. The burden on patient quality of life, the health care system, and society are pharmacoeconomic considerations in managing AF. To identify key pharmacoeconomic considerations in managing AF and describe ways in which managed care pharmacists can improve the cost-effectiveness of and outcomes from drug therapy for AF. The high medical care costs of AF are largely the result of the high cost of hospitalization and inpatient procedures. Recurrence of AF dramatically increases costs, especially for hospital care. Managed care pharmacists have many opportunities to provide cost-effective care to and improve outcomes in patients with AF. Policy and process review, population management, and case management are key strategies for improving outcomes in patients with AF. Pharmacist input into policy and process review, including pharmacy benefits design, formulary management, and the use of information technology, can help ensure that the use of drug therapy for AF is cost-effective. Population management strategies, such as development of clinical pathways and patient registries, seek to improve the quality, consistency, and cost-effectiveness of care and the likelihood that desired therapeutic outcomes are achieved through targeted interventions. Case management strategies focus on longitudinal care for individuals in order to improve quality. Pharmacist-managed anticoagulation services and antiarrhythmic drug monitoring are the 2 most widely known case management strategies for patients with AF. Managed care pharmacists can screen patients with AF for the use of anticoagulation, which is needed to prevent embolic stroke but is under-used, even though recommended by evidence-based guidelines. The clinical efficacy and cost-effectiveness of pharmacist-managed anticoagulation services for patients with AF are well documented. Pharmacist-managed antiarrhythmic drug monitoring is a less well-known case management strategy that facilitates early detection and intervention to minimize toxicity. Managed care pharmacists can play an instrumental role in implementing strategies to improve the cost-effectiveness of and outcomes from drug therapy for AF.

Optimizing point-of-care testing in clinical systems management.

PubMed

Kost, G J

1998-01-01

The goal of improving medical and economic outcomes calls for leadership based on fundamental principles. The manager of clinical systems works collaboratively within the acute care center to optimize point-of-care testing through systematic approaches such as integrative strategies, algorithms, and performance maps. These approaches are effective and efficacious for critically ill patients. Optimizing point-of-care testing throughout the entire health-care system is inherently more difficult. There is potential to achieve high-quality testing, integrated disease management, and equitable health-care delivery. Despite rapid change and economic uncertainty, a macro-strategic, information-integrated, feedback-systems, outcomes-oriented approach is timely, challenging, effective, and uplifting to the creative human spirit.

Interpretation and Nonformal Environmental Education in Natural Resources Management.

ERIC Educational Resources Information Center

Olson, E. C.; And Others

1984-01-01

A visitor education strategy was developed, implemented, and tested for its effectiveness in raising levels of knowledge and attitudes toward state nature preserve management. Visitor sociodemographic and site-specific data were also collected and analyzed. Methodology, results, conclusions, and implications are reported. (Author/JN)

Nurse Managers’ Work Life Quality and Their Participation in Knowledge Management: A Correlational Study

PubMed Central

Hashemi Dehaghi, Zahra; Sheikhtaheri, Abbas; Dehnavi, Fariba

2014-01-01

Background: The association between quality of work life and participation in knowledge management is unknown. Objectives: This study aimed to discover the association between quality of work life of nurse managers and their participation in implementing knowledge management. Materials and Methods: This was a correlational study. All nurse managers (71 people) from 11 hospitals affiliated with the Social Security Organization in Tehran, Iran, were included. They were asked to rate their participation in knowledge management and their quality of work life. Data was gathered by a researcher-made questionnaire (May-June 2012). The questionnaire was validated by content and construct validity approaches. Cronbach’s alpha was used to evaluate reliability. Finally, 50 questionnaires were analyzed. The answers were scored and analyzed using mean of scores, T-test, ANOVA (or nonparametric test, if appropriate), Pearson’s correlation coefficient and linear regression. Results: Nurse managers’ performance to implement knowledge management strategies was moderate. A significant correlation was found between quality of work life of nurse managers and their participation in implementing knowledge management strategies (r = 0.82; P < 0.001). The strongest correlations were found between implementation of knowledge management and participation of nurse managers in decision making (r = 0.82; P < 0.001). Conclusions: Improvement of nurse managers’ work life quality, especially in decision-making, may increase their participation in implementing knowledge management. PMID:25763267

Testing strategies for building member loyalty in a managed care organization serving Medicare beneficiaries.

PubMed

Ervin, S L

1999-01-01

Member retention has been a challenge for Medicare HMOs. This article describes how a hybrid Medicare HMO is testing methods of strengthening member loyalty and member retention. Methods include managing member expectations and involving sales representatives and Personal Care Planner in outreach to new members. An early problem detection project yielded information that was used to resolve member difficulties and preempt disenrollment.

Concussion Management Practice Patterns Among Sports Medicine Physicians.

PubMed

Stache, Stephen; Howell, David; Meehan, William P

2016-09-01

The primary purpose of this study was to examine concussion management practice patterns among sports medicine physicians in the United States. Cross-sectional study using a web-based survey. Members of the American Medical Society for Sports Medicine (AMSSM). We distributed a questionnaire to physician members of the AMSSM assessing the current practices for evaluating and managing concussions sustained during sports. Specifically, we asked respondents about their use of management guidelines, medications, balance assessments, neuropsychological tests, and return-to-play strategies. Of the 3591 members emailed, 425 (11.8%) respondents responded. Ninety-seven percent of respondents reported basing current management of sport-related concussion on a published set of criteria, with a majority (91.9%) following the guidelines provided by the Fourth International Conference on Concussion in Sport. Seventy-six percent of respondents reported using medication beyond 48 hours postinjury. Acetaminophen was reported as the most commonly administered medication, although tricyclic antidepressants and amantadine were also commonly administered. Vitamins, minerals, and dietary supplements were also reported as commonly administered. Most respondents reported using a form of neuropsychological testing (87.1%). A majority of respondents (88.6%) reported allowing athletes to return to competition after concussion only once the athlete becomes symptom free and completes a return-to-play protocol. Most sports medicine physicians seem to use recently developed guidelines for concussion management, regularly use medications and neuropsychological testing in management strategies, and follow established return-to-play guidelines. Sports medicine physicians seem to have clinical expertise in the management of sport-related concussion.

Conducting field studies for testing pesticide leaching models

USGS Publications Warehouse

Smith, Charles N.; Parrish, Rudolph S.; Brown, David S.

1990-01-01

A variety of predictive models are being applied to evaluate the transport and transformation of pesticides in the environment. These include well known models such as the Pesticide Root Zone Model (PRZM), the Risk of Unsaturated-Saturated Transport and Transformation Interactions for Chemical Concentrations Model (RUSTIC) and the Groundwater Loading Effects of Agricultural Management Systems Model (GLEAMS). The potentially large impacts of using these models as tools for developing pesticide management strategies and regulatory decisions necessitates development of sound model validation protocols. This paper offers guidance on many of the theoretical and practical problems encountered in the design and implementation of field-scale model validation studies. Recommendations are provided for site selection and characterization, test compound selection, data needs, measurement techniques, statistical design considerations and sampling techniques. A strategy is provided for quantitatively testing models using field measurements.

Interactivity Centered Usability Evaluation (ICUE) for Course Management Systems

ERIC Educational Resources Information Center

Yoon, Sangil

2010-01-01

ICUE (Interactivity Centered Usability Evaluation) is an enhanced usability testing protocol created by the researcher. ICUE augments the facilitator's role for usability testing, and offers strategies in developing and presenting usability tasks during a testing session. ICUE was designed to address weaknesses found in the usability evaluation of…

Self-management improvement program combined with community involvement in Thai hypertensive population: an action research.

PubMed

Srichairattanakull, Jeamjai; Kaewpan, Wonpen; Powattana, Arpaporn; Pichayapinyo, Panan

2014-04-01

To investigate the effectiveness of a program that utilizes community involvement to improve the self-management strategies among people living with hypertension. Forty-four subjects, aged 35 to 59-year-old, with hypertension in Nakhon Pathom Province, Thailand, were randomly allocated to either an experimental group (n = 22) or a control group (n = 20). The experimental group attended a program to improve self-management methods based on social cognitive theory (SCT). The program lasted 12 weeks, consisted of 1 1/2 hours meeting once a week, including group meetings and home visit monitoring. Mann-Whitney U test and Friedman test were employed to analyze the program's effectiveness. After the program, the mean rank of the perceived self-efficacy for the self-management strategies was statistically different between the two groups (p = 0.023). In the experimental group, after the twelve week, the mean rank of perceived self-efficacy and outcome expectancy increased and diastolic blood pressure decreased after the eight week. The program applied social cognitive theory (SCT) to promote self-management techniques, increased the health promoting behavior among hypertensive people.

Lymphoma Therapy and Adverse Events: Nursing Strategies for Thinking Critically and Acting Decisively.

PubMed

Goodrich, Amy; Wagner-Johnston, Nina; Delibovi, Dana

2017-02-01

Multiple treatment options, combined with disease heterogeneity, have created nursing challenges in the management of adverse events (AEs) during antilymphoma therapy. Testing has revealed that less than half of participating nurses correctly graded peripheral neuropathy and neutropenia related to antilymphoma regimens. This article identifies nursing challenges in the management of AEs associated with therapy for lymphomas and describes how strategies in critical thinking can help meet those challenges. A comprehensive literature search in oncology nursing, nursing education, and critical thinking was conducted; participant responses to pre- and post-tests at nursing education programs were evaluated; and a roundtable meeting of authors was convened. Oncology nurses can cultivate critical thinking skills, practice thinking critically in relation to team members and patients, leverage information from the Patient-Reported Outcomes Common Terminology Criteria for Adverse Events, and manage workflow to allow more opportunity for critical thinking.

A study of an arbiter function in the structures of a shared bus

NASA Astrophysics Data System (ADS)

Seck, J.-P.

The results of a comparative study of synchronous and asynchronous arbiters for managing user access to a shared bus is presented. The best available method is determined to be modular arbiter structures attached only to the decision module. Linear and circular arbitration strategies are examined for suitability for automatic decision-making. A multiple strategies arbiter scheme is devised, involving the superposition of various strategies of one sequential machine into another. It is then possible to modify the strategy on-line if the current strategy is ineffective. The utilization of a multiple structure of cascading arbiter devices is noted to be effective if response time is not a critical matter. Finally, attention is given to automatic circuit testing and fault detection. An example is furnished in terms of a management system for a shared memory in a multimicroprocessor structure.

An agent-based model of cattle grazing toxic Geyer's larkspur.

PubMed

Jablonski, Kevin E; Boone, Randall B; Meiman, Paul J

2018-01-01

By killing cattle and otherwise complicating management, the many species of larkspur (Delphinium spp.) present a serious, intractable, and complex challenge to livestock grazing management in the western United States. Among the many obstacles to improving our understanding of cattle-larkspur dynamics has been the difficulty of testing different grazing management strategies in the field, as the risk of dead animals is too great. Agent-based models (ABMs) provide an effective method of testing alternate management strategies without risk to livestock. ABMs are especially useful for modeling complex systems such as livestock grazing management, and allow for realistic bottom-up encoding of cattle behavior. Here, we introduce a spatially-explicit, behavior-based ABM of cattle grazing in a pasture with a dangerous amount of Geyer's larkspur (D. geyeri). This model tests the role of herd cohesion and stocking density in larkspur intake, finds that both are key drivers of larkspur-induced toxicosis, and indicates that alteration of these factors within realistic bounds can mitigate risk. Crucially, the model points to herd cohesion, which has received little attention in the discipline, as playing an important role in lethal acute toxicosis. As the first ABM to model grazing behavior at realistic scales, this study also demonstrates the tremendous potential of ABMs to illuminate grazing management dynamics, including fundamental aspects of livestock behavior amidst ecological heterogeneity.

Managing Your Team's Weakest Link.

PubMed

Hills, Laura

2015-01-01

Do you have a poor-performing employee on your medical practice team? If so, you're not alone. Unfortunately, this is a problem that many medical practice managers face. This article describes the best strategies for managing your team's weakest link. It explores common yet very difficult circumstances that cause low employee performance and that test the patience, heart, and skills of a practice manager. It guides readers through a process of self-discovery to determine whether their negative biases or grudges may be causing employees to perform poorly. It suggests several possible other reasons for weak employee performance, including problems with the job, practice, leadership, communication, and fit between the employee and the job. This article also suggests the best strategy for communicating concerns about performance to the weakest-link employee. It offers guidance to practice managers about protecting their time and energy when handling a poor performer. It provides a simple formula for calculating the cost of a low-performing employee, 10 possible personal reasons for the employee's poor work performance, specific questions to ask to uncover the reasons for poor performance, and an eight-rule strategy for confronting poor performance effectively. Finally, this article offers practice managers a practical strategy for handling resistance from their weakest link, illustrated with a sample dialogue.

Investigating Alternatives to the Fish Early Life-Stage Test: A Strategy for Discovering and Annotating Adverse Outcome Pathways for Early Fish Development

EPA Science Inventory

The fish early life-stage (FELS) test (OECD Test Guideline 210) is the primary test used internationally to estimate chronic fish toxicity in support of ecological risk assessments and chemical management programs. As part of an on-going effort to develop efficient and cost-effec...

Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study.

PubMed

Majumdar, S R; Johnson, J A; Bellerose, D; McAlister, F A; Russell, A S; Hanley, D A; Garg, S; Lier, D A; Maksymowych, W P; Morrish, D W; Rowe, B H

2011-01-01

Few outpatients with fractures are treated for osteoporosis in the years following fracture. In a randomized pilot study, we found a nurse case-manager could double rates of osteoporosis testing and treatment compared with a proven efficacious quality improvement strategy directed at patients and physicians (57% vs 28% rates of appropriate care). Few patients with fractures are treated for osteoporosis. An intervention directed at wrist fracture patients (education) and physicians (guidelines, reminders) tripled osteoporosis treatment rates compared to controls (22% vs 7% within 6 months of fracture). More effective strategies are needed. We undertook a pilot study that compared a nurse case-manager to the multifaceted intervention using a randomized trial design. The case-manager counseled patients, arranged bone mineral density (BMD) tests, and prescribed treatments. We included controls from our first trial who remained untreated for osteoporosis 1-year post-fracture. Primary outcome was bisphosphonate treatment and secondary outcomes were BMD testing, appropriate care (BMD test-treatment if bone mass low), and costs. Forty six patients untreated 1-year after wrist fracture were randomized to case-manager (n = 21) or multifaceted intervention (n = 25). Median age was 60 years and 68% were female. Six months post-randomization, 9 (43%) case-managed patients were treated with bisphosphonates compared with 3 (12%) multifaceted intervention patients (relative risk [RR] 3.6, 95% confidence intervals [CI] 1.1-11.5, p = 0.019). Case-managed patients were more likely than multifaceted intervention patients to undergo BMD tests (81% vs 52%, RR 1.6, 95%CI 1.1-2.4, p = 0.042) and receive appropriate care (57% vs 28%, RR 2.0, 95%CI 1.0-4.2, p = 0.048). Case-management cost was $44 (CDN) per patient vs $12 for the multifaceted intervention. A nurse case-manager substantially increased rates of appropriate testing and treatment for osteoporosis in patients at high-risk of future fracture when compared with a multifaceted quality improvement intervention aimed at patients and physicians. Even with case-management, nearly half of patients did not receive appropriate care. clinicaltrials.gov identifier: NCT00152321.

A Landscape Approach to Invasive Species Management.

PubMed

Lurgi, Miguel; Wells, Konstans; Kennedy, Malcolm; Campbell, Susan; Fordham, Damien A

2016-01-01

Biological invasions are not only a major threat to biodiversity, they also have major impacts on local economies and agricultural production systems. Once established, the connection of local populations into metapopulation networks facilitates dispersal at landscape scales, generating spatial dynamics that can impact the outcome of pest-management actions. Much planning goes into landscape-scale invasive species management. However, effective management requires knowledge on the interplay between metapopulation network topology and management actions. We address this knowledge gap using simulation models to explore the effectiveness of two common management strategies, applied across different extents and according to different rules for selecting target localities in metapopulations with different network topologies. These management actions are: (i) general population reduction, and (ii) reduction of an obligate resource. The reduction of an obligate resource was generally more efficient than population reduction for depleting populations at landscape scales. However, the way in which local populations are selected for management is important when the topology of the metapopulation is heterogeneous in terms of the distribution of connections among local populations. We tested these broad findings using real-world scenarios of European rabbits (Oryctolagus cuniculus) infesting agricultural landscapes in Western Australia. Although management strategies targeting central populations were more effective in simulated heterogeneous metapopulation structures, no difference was observed in real-world metapopulation structures that are highly homogeneous. In large metapopulations with high proximity and connectivity of neighbouring populations, different spatial management strategies yield similar outcomes. Directly considering spatial attributes in pest-management actions will be most important for metapopulation networks with heterogeneously distributed links. Our modelling framework provides a simple approach for identifying the best possible management strategy for invasive species based on metapopulation structure and control capacity. This information can be used by managers trying to devise efficient landscape-oriented management strategies for invasive species and can also generate insights for conservation purposes.

Building Perinatal Case Manager Capacity Using Quality Improvement

PubMed Central

Fitzgerald, Elaine

2015-01-01

ABSTRACT Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum. PMID:26937160

Habitat Demonstration Unit Project Leadership and Management Strategies

NASA Technical Reports Server (NTRS)

Kennedy, Kriss J.

2011-01-01

This paper gives an overview of the National Aeronautics and Space Administration (NASA) led multi-center Habitat Demonstration Unit (HDU) project leadership and management strategies. The HDU project team constructed and tested an analog prototype lunar surface habitat/laboratory called the Pressurized Excursion Module (PEM) during 2010. The prototype unit subsystems were integrated in a short amount of time, utilizing a tiger team approach that brought together over 20 habitation-related technologies and innovations from a variety of NASA centers. This paper describes the leadership and management strategies as well as lessons learned pertaining to leading and managing a multi-center diverse team in a rapid prototype environment. The PEM configuration went from a paper design to an operational surface habitat demonstration unit in less than 12 months. The HDU project is part of the strategic plan from the Exploration Systems Mission Directorate (ESMD) Directorate Integration Office (DIO) and the Exploration Mission Systems Office (EMSO) to test destination elements in analog environments. The 2011 HDU-Deep Space Habitat (DSH) configuration will build upon the PEM work, and emphasize validity of crew operations (remote working and living), EVA operations, mission operations, logistics operations, and science operations that might be required in a deep space context for Near Earth Object (NEO) exploration mission architectures. The 2011 HDU-DSH will be field-tested during the 2011 Desert Research and Technologies Studies (DRaTS) field tests. The HDU project is a "technology-pull" project that integrates technologies and innovations from multiple NASA centers. This project will repurpose the HDU 2010 demo unit that was field tested in the 2010 DRaTS, adding habitation functionality to the prototype unit. This paper will describe the strategy of establishing a multi-center project management team that put in place the key multi-center leadership skills and disciplines to enable a successful tiger team approach. Advocacy was established with key stakeholders and NASA Headquarters (HQ) by defining a strategic vision, mission, goals and objectives for the project and team. As a technology-pull testbed capability the HDU project was able to collaborate and leverage the Exploration Technology Development Program (ETDP) and individual NASA center investments which capitalized on their respective center core competencies and skills. This approach enable the leveraging of over $7.5m of value to create an operational habitat demonstration unit 2010 PEM configuration.

A train-to-train impact test of crash energy management passenger rail equipment

DOT National Transportation Integrated Search

2006-12-04

This paper gives an overview of the in-line full-scale impact tests conducted by the Federal : Railroad Administration and discusses a strategy for preventing override between colliding : equipment. Override of the impacting equipment during a passen...

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

PubMed Central

Gisbert, Javier P; Calvet, Xavier

2013-01-01

OBJECTIVES: Deciding on whether the Helicobacter pylori test-and-treat strategy is an appropriate diagnostic–therapeutic approach for patients with dyspepsia invites a series of questions. The aim present article addresses the test-and-treat strategy and attempts to provide practical conclusions for the clinician who diagnoses and treats patients with dyspepsia. METHODS: Bibliographical searches were performed in MEDLINE using the keywords Helicobacter pylori, test-and-treat, and dyspepsia. We focused mainly on data from randomized controlled trials (RCTs), systematic reviews, meta-analyses, cost-effectiveness analyses, and decision analyses. RESULTS: Several prospective studies and decision analyses support the use of the test-and-treat strategy, although we must be cautious when extrapolating the results from one geographical area to another. Many factors determine whether this strategy is appropriate in each particular area. The test-and-treat strategy will cure most cases of underlying peptic ulcer disease, prevent most potential cases of gastroduodenal disease, and yield symptomatic benefit in a minority of patients with functional dyspepsia. Future studies should be able to stratify dyspeptic patients according to their likelihood of improving after treatment of infection by H. pylori. CONCLUSIONS: The test-and-treat strategy will cure most cases of underlying peptic ulcer disease and prevent most potential cases of gastroduodenal disease. In addition, a minority of infected patients with functional dyspepsia will gain symptomatic benefit. Several prospective studies and decision analyses support the use of the test-and-treat strategy. The test-and-treat strategy is being reinforced by the accumulating data that support the increasingly accepted idea that “the only good H. pylori is a dead H. pylori”. PMID:23535826

Development of practice and consensus-based strategies including a treat-to-target approach for the management of moderate and severe juvenile dermatomyositis in Germany and Austria.

PubMed

Hinze, Claas H; Oommen, Prasad T; Dressler, Frank; Urban, Andreas; Weller-Heinemann, Frank; Speth, Fabian; Lainka, Elke; Brunner, Jürgen; Fesq, Heike; Foell, Dirk; Müller-Felber, Wolfgang; Neudorf, Ulrich; Rietschel, Christoph; Schwarz, Tobias; Schara, Ulrike; Haas, Johannes-Peter

2018-06-25

Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy in childhood and a major cause of morbidity among children with pediatric rheumatic diseases. The management of JDM is very heterogeneous. The JDM working group of the Society for Pediatric Rheumatology (GKJR) aims to define consensus- and practice-based strategies in order to harmonize diagnosis, treatment and monitoring of JDM. The JDM working group was established in 2015 consisting of 23 pediatric rheumatologists, pediatric neurologists and dermatologists with expertise in the management of JDM. Current practice patterns of management in JDM had previously been identified via an online survey among pediatric rheumatologists and neurologists. Using a consensus process consisting of online surveys and a face-to-face consensus conference statements were defined regarding the diagnosis, treatment and monitoring of JDM. During the conference consensus was achieved via nominal group technique. Voting took place using an electronic audience response system, and at least 80% consensus was required for individual statements. Overall 10 individual statements were developed, finally reaching a consensus of 92 to 100% regarding (1) establishing a diagnosis, (2) case definitions for the application of the strategies (moderate and severe JDM), (3) initial diagnostic testing, (4) monitoring and documentation, (5) treatment targets within the context of a treat-to-target strategy, (6) supportive therapies, (7) explicit definition of a treat-to-target strategy, (8) various glucocorticoid regimens, including intermittent intravenous methylprednisolone pulse and high-dose oral glucocorticoid therapies with tapering, (9) initial glucocorticoid-sparing therapy and (10) management of refractory disease. Using a consensus process among JDM experts, statements regarding the management of JDM were defined. These statements and the strategies aid in the management of patients with moderate and severe JDM.

Investigating alternative strategies for managing bacterial angular leaf spot in strawberry nursery production

USDA-ARS?s Scientific Manuscript database

The focus of this article is to discuss some of the approaches we have tested for managing the bacterial pathogen Xanthomonas fragariae in infected strawberry nursery stock. X. fragariae causes angular leaf spot (ALS) in strawberry. The pathogen is transmitted to production fields almost exclusively...

Variable rate application of nematicides on cotton fields: A promising site-specific management strategy.

USDA-ARS?s Scientific Manuscript database

Field tests were conducted to determine if differences in response to nematicide application (i.e., root-knot nematode (RKN) population levels, cotton yield, and profitability) occurred among RKN management zones (MZ). The MZ were delineated using variables related to soil texture, including appare...

Costs, effectiveness, and workload impact of management strategies for women with an adnexal mass.

PubMed

Havrilesky, Laura J; Dinan, Michaela; Sfakianos, Gregory P; Curtis, Lesley H; Barnett, Jason C; Van Gorp, Toon; Myers, Evan R

2015-01-01

We compared the estimated clinical outcomes, costs, and physician workload resulting from available strategies for deciding which women with an adnexal mass should be referred to a gynecologic oncologist. We used a microsimulation model to compare five referral strategies: 1) American Congress of Obstetricians and Gynecologists (ACOG) guidelines, 2) Multivariate Index Assay (MIA) algorithm, 3) Risk of Malignancy Algorithm (ROMA), 4) CA125 alone with lowered cutoff values to prioritize test sensitivity over specificity, 5) referral of all women (Refer All). Test characteristics and relative survival were obtained from the literature and data from a biomarker validation study. Medical costs were estimated using Medicare reimbursements. Travel costs were estimated using discharge data from Surveillance, Epidemiology and End Results-Medicare and State Inpatient Databases. Analyses were performed separately for pre- and postmenopausal women (60 000 "subjects" in each), repeated 10 000 times. Refer All was cost-effective compared with less expensive strategies in both postmenopausal (incremental cost-effectiveness ratio [ICER] $9423/year of life saved (LYS) compared with CA125) and premenopausal women (ICER $10 644/YLS compared with CA125), but would result in an additional 73 cases/year/subspecialist. MIA was more expensive and less effective than Refer All in pre- and postmenopausal women. If Refer All is not a viable option, CA125 is an optimal strategy in postmenopausal women. Referral of all women to a subspecialist is an efficient strategy for managing women with adnexal masses requiring surgery, assuming sufficient capacity for additional surgical volume. If a test-based triage strategy is needed, CA125 with lowered cutoff values is a cost-effective strategy. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Enterprise Education: The Frustration of a Pure Contest

ERIC Educational Resources Information Center

Jones, Colin

2007-01-01

Purpose: This paper seeks to discuss the development of a strategy game for enterprise education. It is argued that requiring students to initially struggle with the game's rules and strategies results in a worthwhile test of their persistence and ability to manage ambiguity. Further, that in the absence of uncertainty, students will not benefit…

Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice

PubMed Central

Stam, Hanneke; Harting, Thomas; van der Sluijs, Marjolijn; van Marum, Rob; van der Horst, Henriëtte; van der Wouden, Johannes C.; Maarsingh, Otto R.

2016-01-01

Objective For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP’s management of dizziness in older patients, including FRID evaluation and adjustment. Design Data were derived from electronic medical records, obtained over a 12-month period in 2013. Setting Forty-six Dutch general practices. Patients The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Main outcome measures Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Results Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. Conclusion This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key PointsIt is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement.This study revealed a wide variety in management strategies for dizziness in older patients.There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment.The referral rate for dizziness was high compared with previous research. PMID:27049170

Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice.

PubMed

Stam, Hanneke; Harting, Thomas; Sluijs, Marjolijn van der; Marum, Rob van; Horst, Henriëtte van der; Wouden, Johannes C van der; Maarsingh, Otto R

2016-06-01

For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP's management of dizziness in older patients, including FRID evaluation and adjustment. Data were derived from electronic medical records, obtained over a 12-month period in 2013. Forty-six Dutch general practices. The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key Points It is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement. This study revealed a wide variety in management strategies for dizziness in older patients. There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment. The referral rate for dizziness was high compared with previous research.

Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance.

PubMed

Martineau, Tim; Raven, Joanna; Aikins, Moses; Alonso-Garbayo, Alvaro; Baine, Sebastian; Huss, Reinhard; Maluka, Stephen; Wyss, Kaspar

2018-01-01

To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick's evaluation framework to identify effects at different levels. The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. The MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required.

Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance

PubMed Central

Martineau, Tim; Raven, Joanna; Aikins, Moses; Alonso-Garbayo, Alvaro; Baine, Sebastian; Huss, Reinhard; Maluka, Stephen; Wyss, Kaspar

2018-01-01

Background To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. Methods Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick’s evaluation framework to identify effects at different levels. Findings The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. Conclusions The MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required. PMID:29662692

Risk management strategies in the Physicians' Desk Reference product labels for pregnancy category X drugs.

PubMed

Uhl, Kathleen; Kennedy, Dianne L; Kweder, Sandra L

2002-01-01

Drugs that carry a concern for teratogenicity are often classified as pregnancy category X in the drug label and contraindicated for use during pregnancy. Many drug labels can be found in the Physicians' Desk Reference (PDR), a widely used source of drug information by American clinicians and patients. To review product labelling in the electronic PDR for the pregnancy category X products for pregnancy prevention risk management components in labelling. The electronic version of the 2001 and 2002 PDR was searched for 'pregnancy category X' products using the full text search feature. All product labels identified were retrieved and reviewed for trade name, generic name, manufacturer and indication. Product labels were manually searched for any pregnancy prevention risk management strategies included in labelling. Those labels that had specific pregnancy prevention risk management strategies were further evaluated. One hundred and seventeen pregnancy category X products were obtained from 2249 products searched in the 2001 PDR database and 124 pregnancy category X products were obtained from the 2150 products in the 2002 PDR database. All pregnancy category X products identified were drug products. The label/package insert for each drug was reviewed to identify risk management strategies for pregnancy prevention. The majority of the labels include as the sole risk management strategy either a black box warning and/or a contraindication for use in women who are or may become pregnant. Only 13 drugs contained specific pregnancy prevention risk management strategies in the label directing the clinician and/or patient, e.g. frequency of pregnancy testing, number and type of contraception methods. Two drugs, bexarotene capsules and gel, were only included in the 2001 PDR. Three drugs, isotretinoin, acitretin, and thalidomide, have formal pregnancy prevention risk management programmes. This study demonstrates the varied risk management approaches in labelling for pregnancy prevention for pregnancy category X drugs. There is a need for consistency in the classification of pregnancy category X products and the pregnancy prevention risk management strategies utilised in the labelling for them.

Disclosure of medical injury to patients: an improbable risk management strategy.

PubMed

Studdert, David M; Mello, Michelle M; Gawande, Atul A; Brennan, Troyen A; Wang, Y Claire

2007-01-01

Pressure mounts on physicians and hospitals to disclose adverse outcomes of care to patients. Although such transparency diverges from traditional risk management strategy, recent commentary has suggested that disclosure will actually reduce providers' liability exposure. We tested this theory by modeling the litigation consequences of disclosure. We found that forecasts of reduced litigation volume or cost do not withstand close scrutiny. A policy question more pressing than whether moving toward routine disclosure will expand litigation is the question of how large such an expansion might be.

EVALUATION OF A TEST AND CULL STRATEGY FOR REDUCING PREVALENCE OF CHRONIC WASTING DISEASE IN MULE DEER ( ODOCOILEUS HEMIONUS).

PubMed

Wolfe, Lisa L; Watry, Mary Kay; Sirochman, Michael A; Sirochman, Tracey M; Miller, Michael W

2018-04-18

  We evaluated a test and cull strategy for lowering chronic wasting disease (CWD) prevalence in a naturally-infected, free-ranging mule deer ( Odocoileus hemionus) herd wintering in the town of Estes Park, Colorado, USA and in nearby Rocky Mountain National Park. We tested 48-68% of the estimated number of adult (≥1 yr old) deer annually for 5 yr via tonsil biopsy immunohistochemistry (IHC), collecting 1,251 samples from >700 individuals and removing IHC-positive deer. Among males, CWD prevalence during the last 3 yr of selective culling was lower (one-sided Fisher's exact test P=0.014) than in the period prior. In contrast, CWD prevalence among females before culling and after culling were equivalent ( P=0.77). Relatively higher annual testing of males (mean 77%) compared to females (mean 51%) might have contributed to differences seen in responses to management. A more intensive and sustained effort or modified spatial approach might have reduced prevalence more consistently in both sexes. Limitations of this technique in wider management application include cost and labor as well as property access and animal tolerance to repeated capture. However, elements of this approach could potentially be used to augment harvest-based disease management.

Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area.

PubMed

Willcox, M L; Sanogo, F; Graz, B; Forster, M; Dakouo, F; Sidibe, O; Falquet, J; Giani, S; Diakite, C; Diallo, D

2009-01-01

Rapid diagnostic tests (RDT) are sometimes recommended to improve the home-based management of malaria. The accuracy of an RDT for the detection of clinical malaria and the presence of malarial parasites has recently been evaluated in a high-transmission area of southern Mali. During the same study, the cost-effectiveness of a 'test-and-treat' strategy for the home-based management of malaria (based on an artemisinin-combination therapy) was compared with that of a 'treat-all' strategy. Overall, 301 patients, of all ages, each of whom had been considered a presumptive case of uncomplicated malaria by a village healthworker, were checked with a commercial RDT (Paracheck-Pf). The sensitivity, specificity, and positive and negative predictive values of this test, compared with the results of microscopy and two different definitions of clinical malaria, were then determined. The RDT was found to be 82.9% sensitive (with a 95% confidence interval of 78.0%-87.1%) and 78.9% (63.9%-89.7%) specific compared with the detection of parasites by microscopy. In the detection of clinical malaria, it was 95.2% (91.3%-97.6%) sensitive and 57.4% (48.2%-66.2%) specific compared with a general practitioner's diagnosis of the disease, and 100.0% (94.5%-100.0%) sensitive but only 30.2% (24.8%-36.2%) specific when compared against the fulfillment of the World Health Organization's (2003) research criteria for uncomplicated malaria. Among children aged 0-5 years, the cost of the 'test-and-treat' strategy, per episode, was about twice that of the 'treat-all' (U.S.$1.0. v. U.S.$0.5). In older subjects, however, the two strategies were equally costly (approximately U.S.$2/episode). In conclusion, for children aged 0-5 years in a high-transmission area of sub-Saharan Africa, use of the RDT was not cost-effective compared with the presumptive treatment of malaria with an ACT. In older patients, use of the RDT did not reduce costs. The question remains whether either of the strategies investigated can be made affordable for the affected population.

Alternatives to the Fish Early Life-Stage Test: A Research Strategy for Discovering and Annotating Adverse Outcome Pathways During Fish Development

EPA Science Inventory

The OECD 210 fish early life]stage (FELS) test is the primary guideline test used to estimate chronic fish toxicity, as well as support ecological risk assessments and chemical management programs around the world. As a step toward developing alternatives to the FELS test, a HES...

Conceptual PHES-system models of the Aysén watershed and fjord (Southern Chile): testing a brainstorming strategy.

PubMed

Marín, Víctor H; Delgado, Luisa E; Bachmann, Pamela

2008-09-01

The use of brainstorming techniques for the generation of conceptual models, as the basis for the integrated management of physical-ecological-social systems (PHES-systems) is tested and discussed. The methodology is applied in the analysis of the Aysén fjord and watershed (Southern Chilean Coast). Results show that the proposed methods can be adequately used in management scenarios characterized by highly hierarchical, experts/non-experts membership.

A Study of Interpersonal Conflict Among Operating Room Nurses.

PubMed

Chang, Tsui-Fen; Chen, Chung-Kuang; Chen, Ming-Jia

2017-12-01

Team collaboration is an important factor that affects the performance of the operating room (OR). Therefore, the ability of OR nurses to adapt to and manage interpersonal conflict incidents properly is very important. The aims of this study were to investigate the interpersonal conflict management capabilities of OR nursing staffs and to find the relationships among the demographics of OR nurses and the following: work-related variables, interpersonal conflict management style, and target of interpersonal conflict. This study investigated 201 OR nurses who had worked for more than 6 months at the target hospitals, which were located in the three counties of Changhua, Yunlin, and Chiayi. The questionnaire that was used to collect data included three components: a demographic and work-related variables survey, interpersonal conflict management factor analysis scale, and interpersonal conflict parties and frequency scale. Data were analyzed using independent t test, analysis of variance, Scheffe's test, and Pearson's correlation coefficient. The main findings were as follows: (a) Integration and arbitration were the major interpersonal conflict management strategies adopted by the participants; (b) medical doctor, OR nurses, and anesthetists were the primary targets of conflict for the participants; (c) the factors of educational background, job position, experience in other departments, seniority, attending courses in conflict management, and level of hospital significantly affected the strategies that participants used to manage interpersonal conflict; and (d) license level, experience in other departments, seniority, and inclination toward serving in the OR were each found to relate significantly to the target of interpersonal conflict and the frequency of interpersonal conflict incidents. The main implications of this study are as follows: (a) The environment for communication in the OR should be made more friendly to encourage junior OR nurses to adopt constructive interpersonal conflict management strategies; (b) prior experience in other departments should be one of the most important factors of consideration when recruiting new nurses for the OR; and (c) hospitals should provide more interpersonal conflict management training courses to support the capability of OR nursing staffs in terms of adopting cooperativeness strategies and coping effectively with all types of interpersonal conflicts.

[Traditional Chinese Medicine data management policy in big data environment].

PubMed

Liang, Yang; Ding, Chang-Song; Huang, Xin-di; Deng, Le

2018-02-01

As traditional data management model cannot effectively manage the massive data in traditional Chinese medicine(TCM) due to the uncertainty of data object attributes as well as the diversity and abstraction of data representation, a management strategy for TCM data based on big data technology is proposed. Based on true characteristics of TCM data, this strategy could solve the problems of the uncertainty of data object attributes in TCM information and the non-uniformity of the data representation by using modeless properties of stored objects in big data technology. Hybrid indexing mode was also used to solve the conflicts brought by different storage modes in indexing process, with powerful capabilities in query processing of massive data through efficient parallel MapReduce process. The theoretical analysis provided the management framework and its key technology, while its performance was tested on Hadoop by using several common traditional Chinese medicines and prescriptions from practical TCM data source. Result showed that this strategy can effectively solve the storage problem of TCM information, with good performance in query efficiency, completeness and robustness. Copyright© by the Chinese Pharmaceutical Association.

Approaches to quality management and accreditation in a genetic testing laboratory

PubMed Central

Berwouts, Sarah; Morris, Michael A; Dequeker, Elisabeth

2010-01-01

Medical laboratories, and specifically genetic testing laboratories, provide vital medical services to different clients: clinicians requesting a test, patients from whom the sample was collected, public health and medical-legal instances, referral laboratories and authoritative bodies. All expect results that are accurate and obtained in an efficient and effective manner, within a suitable time frame and at acceptable cost. There are different ways of achieving the end results, but compliance with International Organization for Standardization (ISO) 15189, the international standard for the accreditation of medical laboratories, is becoming progressively accepted as the optimal approach to assuring quality in medical testing. We present recommendations and strategies designed to aid genetic testing laboratories with the implementation of a quality management system, including key aspects such as document control, external quality assessment, internal quality control, internal audit, management review, validation, as well as managing the human side of change. The focus is on pragmatic approaches to attain the levels of quality management and quality assurance required for accreditation according to ISO 15189, within the context of genetic testing. Attention is also given to implementing efficient and effective quality improvement. PMID:20720559

Net-aware bitstreams that upgrade FPGA hardware remotely over the Internet: creating intelligent bitstreams that know where to go, what to do when they get there, and can report back when they're done

NASA Astrophysics Data System (ADS)

Casselman, Steve; Schewel, John

2002-07-01

Success in the marketplace may well depend upon the ability to upgrade and test hardware designs instantly around the world. An upgrade management strategy requires more than just the bitstream file, email or a JTAG cable. A well-managed methodology, capable of transmitting bitstreams directly into targeted FPGAs over the network or internet is an essential element for a successful FPGA based product strategy. Virtual Computer Corporation"s HOTMan, Bitstream Management Environment combines a feature rich cross-platform API with an Object Oriented Bitstream technique for Remote Upgrading of Hardware over the Internet.

The withholding of test results as a means of assessing the effectiveness of treatment in test-positive persons.

PubMed

Weiss, Noel S

2013-04-01

In recent years, a number of studies have achieved randomization of patients to alternative management strategies by blinding some patients (and their providers of medical care) to the results of tests that guide such strategies. Although this research approach has the potential to be a powerful means of measuring treatment effectiveness, the interpretation of the results may not be straightforward if the treatment received by test-positive persons is variable or not well documented, or if the analysis is not restricted to outcomes in test-positive persons. Studies in which the test results are withheld at random may face ethical issues that, to date, have received little discussion. Copyright © 2013 Elsevier Inc. All rights reserved.

Mourning dove hunting regulation strategy based on annual harvest statistics and banding data

USGS Publications Warehouse

Otis, D.L.

2006-01-01

Although managers should strive to base game bird harvest management strategies on mechanistic population models, monitoring programs required to build and continuously update these models may not be in place. Alternatively, If estimates of total harvest and harvest rates are available, then population estimates derived from these harvest data can serve as the basis for making hunting regulation decisions based on population growth rates derived from these estimates. I present a statistically rigorous approach for regulation decision-making using a hypothesis-testing framework and an assumed framework of 3 hunting regulation alternatives. I illustrate and evaluate the technique with historical data on the mid-continent mallard (Anas platyrhynchos) population. I evaluate the statistical properties of the hypothesis-testing framework using the best available data on mourning doves (Zenaida macroura). I use these results to discuss practical implementation of the technique as an interim harvest strategy for mourning doves until reliable mechanistic population models and associated monitoring programs are developed.

Farmers' Attitude towards a Participatory Research Method Used to Evaluate Weed Management Strategies in Bananas

ERIC Educational Resources Information Center

Ganpat, Wayne G.; Isaac, Wendy-Ann P.; Brathwaite, Richard A. I.; Bekele, Isaac

2009-01-01

In this study, farmers were engaged in a participatory research project and their attitudes evaluated. The purpose was to identify the characteristics of farmers who are favourably predisposed towards meaningful participation in the process. Several cover crops were tested for possible use in the management of watergrass ("Commelina…

HotTips for Speakers: 25 Surefire Ways To Engage and Captivate Any Group or Audience.

ERIC Educational Resources Information Center

Abernathy, Rob; Reardon, Mark

From managing stage fright to keeping the audience hanging on their every word, experienced public speakers have the techniques to make every presentation memorable. This book contains a collection of 25 strategies for public speaking that have already worked for many people. Each "HotTip" (strategy) has been tested and used with…

Strategies for Science Student Achievement & Productive School Management

ERIC Educational Resources Information Center

Johnson, William L.

2010-01-01

There is an increasing literature pertaining to student achievement and school productivity. This session will present school and classroom strategies used in high school science classes at Robert E. Lee High School (5A) in Tyler, Texas. This year, 84% of the students at Lee passed the science TAKS test. Lee is also ranked in the top 1500 high…

A medium-term, stochastic forecast model to support sustainable, mixed fisheries management in the Mediterranean Sea.

PubMed

Rätz, H-J; Charef, A; Abella, A J; Colloca, F; Ligas, A; Mannini, A; Lloret, J

2013-10-01

A medium-term (10 year) stochastic forecast model is developed and presented for mixed fisheries that can provide estimations of age-specific parameters for a maximum of 10 stocks and 10 fisheries. Designed to support fishery managers dealing with complex, multi-annual management plans, the model can be used to quantitatively test the consequences of various stock-specific and fishery-specific decisions, using non-equilibrium stock dynamics. Such decisions include fishing restrictions and other strategies aimed at achieving sustainable mixed fisheries consistent with the concept of maximum sustainable yield (MSY). In order to test the model, recently gathered data on seven stocks and four fisheries operating in the Ligurian and North Tyrrhenian Seas are used to generate quantitative, 10 year predictions of biomass and catch trends under four different management scenarios. The results show that using the fishing mortality at MSY as the biological reference point for the management of all stocks would be a strong incentive to reduce the technical interactions among concurrent fishing strategies. This would optimize the stock-specific exploitation and be consistent with sustainability criteria. © 2013 The Fisheries Society of the British Isles.

Applying the cell-based coagulation model in the management of critical bleeding.

PubMed

Ho, K M; Pavey, W

2017-03-01

The cell-based coagulation model was proposed 15 years ago, yet has not been applied commonly in the management of critical bleeding. Nevertheless, this alternative model may better explain the physiological basis of current coagulation management during critical bleeding. In this article we describe the limitations of the traditional coagulation protein cascade and standard coagulation tests, and explain the potential advantages of applying the cell-based model in current coagulation management strategies. The cell-based coagulation model builds on the traditional coagulation model and explains many recent clinical observations and research findings related to critical bleeding unexplained by the traditional model, including the encouraging results of using empirical 1:1:1 fresh frozen plasma:platelets:red blood cells transfusion strategy, and the use of viscoelastic and platelet function tests in patients with critical bleeding. From a practical perspective, applying the cell-based coagulation model also explains why new direct oral anticoagulants are effective systemic anticoagulants even without affecting activated partial thromboplastin time or the International Normalized Ratio in a dose-related fashion. The cell-based coagulation model represents the most cohesive scientific framework on which we can understand and manage coagulation during critical bleeding.

Interactive effects of environmental change and management strategies on regional forest carbon emissions.

PubMed

Hudiburg, Tara W; Luyssaert, Sebastiaan; Thornton, Peter E; Law, Beverly E

2013-11-19

Climate mitigation activities in forests need to be quantified in terms of the long-term effects on forest carbon stocks, accumulation, and emissions. The impacts of future environmental change and bioenergy harvests on regional forest carbon storage have not been quantified. We conducted a comprehensive modeling study and life-cycle assessment of the impacts of projected changes in climate, CO2 concentration, and N deposition, and region-wide forest management policies on regional forest carbon fluxes. By 2100, if current management strategies continue, then the warming and CO2 fertilization effect in the given projections result in a 32-68% increase in net carbon uptake, overshadowing increased carbon emissions from projected increases in fire activity and other forest disturbance factors. To test the response to new harvesting strategies, repeated thinnings were applied in areas susceptible to fire to reduce mortality, and two clear-cut rotations were applied in productive forests to provide biomass for wood products and bioenergy. The management strategies examined here lead to long-term increased carbon emissions over current harvesting practices, although semiarid regions contribute little to the increase. The harvest rates were unsustainable. This comprehensive approach could serve as a foundation for regional place-based assessments of management effects on future carbon sequestration by forests in other locations.

Time to incorporate germline multigene panel testing into breast and ovarian cancer patient care.

PubMed

Graffeo, Rossella; Livraghi, Luca; Pagani, Olivia; Goldhirsch, Aron; Partridge, Ann H; Garber, Judy E

2016-12-01

Genetic evaluation is increasingly becoming an integral part of the management of women with newly diagnosed breast and ovarian cancer (OC), and of individuals at high risk for these diseases. Genetic counseling and testing have been incorporated into oncological care to help and complete management and treatment strategies. Risk assessment and early detection strategies in individuals with BRCA1/2 mutations and with Lynch syndrome have been quite extensively studied, whereas much less is known about the management of mutation carriers with less common high-penetrance cancer susceptibility genes (PTEN, TP53, STK11, CDH1), and particularly those who carry mutations in moderate-penetrance genes (e.g., PALB2, CHEK2, ATM, NF1, RAD51C, RAD51D, BRIP1). The latter patient groups represent important ongoing research opportunities to enable informed counseling about appropriate clinical management. We summarize the current guidelines for the management of high and moderate-penetrance mutations for breast and OC susceptibility. Continuous updating of guidelines for proper clinical management of these individuals is ongoing because of rapid advances in technology and knowledge in this field. Thus, we exhort the use of multigene panels for the assessment of cancer risk beyond the classic predisposition syndromes as a new standard of care in cancer genetics. We further support an increase of genetic counselors in Europe and use of their expertise to support genetic testing in specialist multidisciplinary teams.

Assessment of learning and study strategies of university students in Qatar using an Arabic translation of the Learning and Study Strategies Inventory.

PubMed

Alkhateeb, Haitham M; Nasser, Ramzi

2014-06-01

413 (119 men, 294 women) undergraduate university students in Qatar completed an Arabic version of the Learning and Study Strategies Inventory (LASSI) measuring Anxiety, Attitude, Concentration, Information Processing, Motivation, Self-testing, Selecting Main Ideas, Study Aids, Time Management, and Test Strategies. The students' learning and study strategies scores were similar to those reported in the literature. Factor analysis indicated the same general factors as in the original study. Internal consistency estimates ranged from .62 to .88. Nine of the 10 scales (i.e., all with the exception of the Study Aids) significantly correlated with students' GPAs. Scores obtained from these scales provide valid assessments of Qatar University students' use of learning and study strategies related to skill, will, and self-regulation components of strategic learning and also academic achievement. There also were statistically significant differences between higher and lower achieving students in their learning and study strategies. This study also explored the use of the LASSI as a predictive measure of academic achievement. Anxiety and test strategies were significant predictors of academic achievement as measured by students' GPA.

Rising Company’s Performance through Leadership Role: Culture, Strategies, and Management System as a Marine State

NASA Astrophysics Data System (ADS)

Wardi, Jeni; Yandra, Alexsander

2018-05-01

This research aims to learn the direct influence of transformational and transactional leaderships on Indonesian company’s performance through company’s culture, strategy, management accounting and control system as a marine state. This research involves descriptive and inferential designs in solving the research problem. To test the model and the hypothesis, SEM analysis is used. The populations of this research are companies registered in Indonesian stock exchange in 2012. The sampling technique uses purposive sampling. The data of the research are obtained from questionnaires distributed to respondents. The respondents are companies’ managers represented by accounting and finance managers with the positions 1 and 2 levels below top management team who have direct communication with the top management. The results of the research show that transformational leadership influences company’s performance directly, but not the transactional leadership. The company’s culture is not the mediation variable in indirect influence on the company’s performance, either in transformational or transactional leadership. On the other hand, management control system proves to be the mediation in transactional leadership on the performance but not for transformational leadership. Meanwhile, management accounting system proves to be the mediation variable in the influence of transformational and transactional leaderships. Except the variables of company’s culture, strategy, management accounting system and management control system, each directly influences the performance.

Designing and evaluating a web-based self-management site for patients with type 2 diabetes--systematic website development and study protocol.

PubMed

Yu, Catherine H; Parsons, Janet; Mamdani, Muhammad; Lebovic, Gerald; Shah, Baiju R; Bhattacharyya, Onil; Laupacis, Andreas; Straus, Sharon E

2012-06-24

Given that patients provide the majority of their own diabetes care, patient self-management training has increasingly become recognized as an important strategy with which to improve quality of care. However, participation in self management programs is low. In addition, the efficacy of current behavioural interventions wanes over time, reducing the impact of self-management interventions on patient health. Web-based interventions have the potential to bridge the gaps in diabetes care and self-management. Our objective is to improve self-efficacy, quality of life, self-care, blood pressure, cholesterol and glycemic control and promote exercise in people with type 2 diabetes through the rigorous development and use of a web-based patient self-management intervention. This study consists of five phases: (1) intervention development; (2) feasibility testing; (3) usability testing; (4) intervention refinement; and (5) intervention evaluation using mixed methods. We will employ evidence-based strategies and tools, using a theoretical framework of self-efficacy, then elicit user feedback through focus groups and individual user testing sessions. Using iterative redesign the intervention will be refined. Once finalized, the impact of the website on patient self-efficacy, quality of life, self-care, HbA1c, LDL-cholesterol, blood pressure and weight will be assessed through a non-randomized observational cohort study using repeated measures modeling and individual interviews. Increasing use of the World Wide Web by consumers for health information and ongoing revolutions in social media are strong indicators that users are primed to welcome a new era of technology in health care. However, their full potential is hindered by limited knowledge regarding their effectiveness, poor usability, and high attrition rates. Our development and research agenda aims to address these limitations by improving usability, identifying characteristics associated with website use and attrition, and developing strategies to sustain patient use in order to maximize clinical outcomes.

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

PubMed Central

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

2017-01-01

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

Clinical Effectiveness Research in Managed-care Systems: Lessons from the Pediatric Asthma Care PORT

PubMed Central

Finkelstein, Jonathan A; Lozano, Paula; Streiff, Kachen A; Arduino, Kelly E; Sisk, Cynthia A; Wagner, Edward H; Weiss, Kevin B; Inui, Thomas S

2002-01-01

Objective To highlight the unique challenges of evaluative research on practice behavior change in the “real world” settings of contemporary managed-care organizations, using the experience of the Pediatric Asthma Care PORT (Patient Outcomes Research Team). Study Setting The Pediatric Asthma Care PORT is a five-year initiative funded by the Agency for Healthcare Research and Quality to study strategies for asthma care improvement in three managed-care plans in Chicago, Seattle, and Boston. At its core is a randomized trial of two care improvement strategies compared with usual care: (1) a targeted physician education program using practice based Peer Leaders (PL) as change agents, (2) adding to the PL intervention a “Planned Asthma Care Intervention” incorporating joint “asthma check-ups” by nurse-physician teams. During the trial, each of the participating organizations viewed asthma care improvement as an immediate priority and had their own corporate improvement programs underway. Data Collection Investigators at each health plan described the organizational and implementation challenges in conducting the PAC PORT randomized trial. These experiences were reviewed for common themes and “lessons” that might be useful to investigators planning interventional research in similar care-delivery settings. Conclusions Randomized trials in “real world” settings represent the most robust design available to test care improvement strategies. In complex, rapidly changing managed-care organizations, blinding is not feasible, corporate initiatives may complicate implementation, and the assumption that a “usual care” arm will be static is highly likely to be mistaken. Investigators must be prepared to use innovative strategies to maintain the integrity of the study design, including: continuous improvement within the intervention arms, comanagement by researchers and health plan managers of condition-related quality improvement initiatives, procedures for avoiding respondent burden in health plan enrollees, and anticipation and minimization of risks from experimental arm contamination and major organizational change. With attention to these delivery system issues, as well as the usual design features of randomized trials, we believe managed-care organizations can serve as important laboratories to test care improvement strategies. PMID:12132605

Test results management and distributed cognition in electronic health record-enabled primary care.

PubMed

Smith, Michael W; Hughes, Ashley M; Brown, Charnetta; Russo And, Elise; Giardina, Traber D; Mehta, Praveen; Singh, Hardeep

2018-06-01

Managing abnormal test results in primary care involves coordination across various settings. This study identifies how primary care teams manage test results in a large, computerized healthcare system in order to inform health information technology requirements for test results management and other distributed healthcare services. At five US Veterans Health Administration facilities, we interviewed 37 primary care team members, including 16 primary care providers, 12 registered nurses, and 9 licensed practical nurses. We performed content analysis using a distributed cognition approach, identifying patterns of information transmission across people and artifacts (e.g. electronic health records). Results illustrate challenges (e.g. information overload) as well as strategies used to overcome challenges. Various communication paths were used. Some team members served as intermediaries, processing information before relaying it. Artifacts were used as memory aids. Health information technology should address the risks of distributed work by supporting awareness of team and task status for reliable management of results.

Space station power management and distribution

NASA Technical Reports Server (NTRS)

Teren, F.

1985-01-01

The power system architecture is presented by a series of schematics which illustrate the power management and distribution (PMAD) system at the component level, including converters, controllers, switchgear, rotary power transfer devices, power and data cables, remote power controllers, and load converters. Power distribution options, reference power management, and control strategy are also outlined. A summary of advanced development status and plans and an overview of system test plans are presented.

Mitigating amphibian disease: strategies to maintain wild populations and control chytridiomycosis

PubMed Central

2011-01-01

Background Rescuing amphibian diversity is an achievable conservation challenge. Disease mitigation is one essential component of population management. Here we assess existing disease mitigation strategies, some in early experimental stages, which focus on the globally emerging chytrid fungus Batrachochytrium dendrobatidis. We discuss the precedent for each strategy in systems ranging from agriculture to human medicine, and the outlook for each strategy in terms of research needs and long-term potential. Results We find that the effects of exposure to Batrachochytrium dendrobatidis occur on a spectrum from transient commensal to lethal pathogen. Management priorities are divided between (1) halting pathogen spread and developing survival assurance colonies, and (2) prophylactic or remedial disease treatment. Epidemiological models of chytridiomycosis suggest that mitigation strategies can control disease without eliminating the pathogen. Ecological ethics guide wildlife disease research, but several ethical questions remain for managing disease in the field. Conclusions Because sustainable conservation of amphibians in nature is dependent on long-term population persistence and co-evolution with potentially lethal pathogens, we suggest that disease mitigation not focus exclusively on the elimination or containment of the pathogen, or on the captive breeding of amphibian hosts. Rather, successful disease mitigation must be context specific with epidemiologically informed strategies to manage already infected populations by decreasing pathogenicity and host susceptibility. We propose population level treatments based on three steps: first, identify mechanisms of disease suppression; second, parameterize epizootiological models of disease and population dynamics for testing under semi-natural conditions; and third, begin a process of adaptive management in field trials with natural populations. PMID:21496358

Application of GPS and Near-Surface Geophysical Methods to Evaluate Agricultural Test Plot Differences

USDA-ARS?s Scientific Manuscript database

A field research facility with two pairs of replicated agricultural test plots (four total) was established at a location in northwest Ohio during 2005 for the purpose of studying water table management strategies. Initial efforts at this field research facility were devoted to evaluating difference...

A Multigene Test Could Cost-Effectively Help Extend Life Expectancy for Women at Risk of Hereditary Breast Cancer.

PubMed

Li, Yonghong; Arellano, Andre R; Bare, Lance A; Bender, Richard A; Strom, Charles M; Devlin, James J

2017-04-01

The National Comprehensive Cancer Network recommends that women who carry gene variants that confer substantial risk for breast cancer consider risk-reduction strategies, that is, enhanced surveillance (breast magnetic resonance imaging and mammography) or prophylactic surgery. Pathogenic variants can be detected in women with a family history of breast or ovarian cancer syndromes by multigene panel testing. To investigate whether using a seven-gene test to identify women who should consider risk-reduction strategies could cost-effectively increase life expectancy. We estimated effectiveness and lifetime costs from a payer perspective for two strategies in two hypothetical cohorts of women (40-year-old and 50-year-old cohorts) who meet the National Comprehensive Cancer Network-defined family history criteria for multigene testing. The two strategies were the usual test strategy for variants in BRCA1 and BRCA2 and the seven-gene test strategy for variants in BRCA1, BRCA2, TP53, PTEN, CDH1, STK11, and PALB2. Women found to have a pathogenic variant were assumed to undergo either prophylactic surgery or enhanced surveillance. The incremental cost-effectiveness ratio for the seven-gene test strategy compared with the BRCA1/2 test strategy was $42,067 per life-year gained or $69,920 per quality-adjusted life-year gained for the 50-year-old cohort and $23,734 per life-year gained or $48,328 per quality-adjusted life-year gained for the 40-year-old cohort. In probabilistic sensitivity analysis, the seven-gene test strategy cost less than $100,000 per life-year gained in 95.7% of the trials for the 50-year-old cohort. Testing seven breast cancer-associated genes, followed by risk-reduction management, could cost-effectively improve life expectancy for women at risk of hereditary breast cancer. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Operation management of daily economic dispatch using novel hybrid particle swarm optimization and gravitational search algorithm with hybrid mutation strategy

NASA Astrophysics Data System (ADS)

Wang, Yan; Huang, Song; Ji, Zhicheng

2017-07-01

This paper presents a hybrid particle swarm optimization and gravitational search algorithm based on hybrid mutation strategy (HGSAPSO-M) to optimize economic dispatch (ED) including distributed generations (DGs) considering market-based energy pricing. A daily ED model was formulated and a hybrid mutation strategy was adopted in HGSAPSO-M. The hybrid mutation strategy includes two mutation operators, chaotic mutation, Gaussian mutation. The proposed algorithm was tested on IEEE-33 bus and results show that the approach is effective for this problem.

Managing the three-rivers headwater region, china: from ecological engineering to social engineering.

PubMed

Fang, Yiping

2013-09-01

The three-rivers headwater region (THRHR) of Qinghai province, China plays a key role as source of fresh water and ecosystem services for central and eastern China. Global warming and human activities in the THRHR have threatened the ecosystem since the 1980s. Therefore, the Chinese government has included managing of the THRHR in the national strategy since 2003. The State Integrated Test and Demonstration Region of the THRHR highlights the connection with social engineering (focus on improving people's livelihood and well-being) in managing nature reserves. Based on this program, this perspective attempts a holistic analysis of the strategic role of the THRHR, requirements for change, indices of change, and approaches to change. Long-term success of managing nature reserves requires effective combination of ecological conservation, economic development, and social progress. Thus, the philosophy of social engineering should be employed as a strategy to manage the THRHR.

The extension of the thermal-vacuum test optimization program to multiple flights

NASA Technical Reports Server (NTRS)

Williams, R. E.; Byrd, J.

1981-01-01

The thermal vacuum test optimization model developed to provide an approach to the optimization of a test program based on prediction of flight performance with a single flight option in mind is extended to consider reflight as in space shuttle missions. The concept of 'utility', developed under the name of 'availability', is used to follow performance through the various options encountered when the capabilities of reflight and retrievability of space shuttle are available. Also, a 'lost value' model is modified to produce a measure of the probability of a mission's success, achieving a desired utility using a minimal cost test strategy. The resulting matrix of probabilities and their associated costs provides a means for project management to evaluate various test and reflight strategies.

Developing an active implementation model for a chronic disease management program.

PubMed

Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter

2013-04-01

Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council's model for complex interventions and the Chronic Care Model. We used the Medical Research Council's five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council's model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council's model added transparency to the design phase which further facilitated the process of implementing the program. http://www.clinicaltrials.gov/(NCT01228708).

Advisement and Management Strategies as Design Variables in Computer-Assisted Instruction.

ERIC Educational Resources Information Center

Tennyson, Robert D.

This study tested the hypothesis that high school students can effectively manage their learning needs in a computer-assisted instructional system when provided on-task advisement of their learning achievement in relation to a given criterion. One hundred and thirty-nine male and female high school students from a 12th grade course in psychology…

Comprehensive Instructional Management System (CIMS). A Cyclical Mathematics Curriculum. Workbook Part 2. Experimental. Level K.

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn, NY. Div. of Curriculum and Instruction.

This document is part 2 of the workbook for kindergarten pupils in the Comprehensive Instructional Management System, a unified mathematics curriculum for kindergarten through grade 7. Each objective is developed by a variety of strategies, with mastery of objectives diagnosed through a testing component. The activities in the student workbook are…

Are you a strategist or just a manager?

PubMed

Hinterhuber, H H; Popp, W

1992-01-01

Perhaps the greatest strategist of all time was not a business executive but a general. Helmuth von Moltke, chief of the Prussian and German general staffs from 1858 to 1888, issued "directives" to his officers rather than specific commands. These guidelines for autonomous decision making encouraged Moltke's subordinates to show individual initiative. In this article, Hans Hinterhuber and Wolfgang Popp translate Moltke's example into business terms. According to Moltke, strategy is applied common sense and cannot be taught. The authors suggest that good entrepreneurs and managers--along with generals--are born with the qualities that make them successful. But even if managers have the potential to be good strategists, they must develop and hone their natural talents. And CEOs and top management can help by identifying and promoting such talents in their employees. Hinterhuber and Popp have created a questionnaire that helps measure strategic management competence. Managers and entrepreneurs take this test themselves, answering ten questions such as, "Do I have an entrepreneurial vision?", "Do I have a corporate philosophy?", and "Do I have competitive advantages?" Using the questionnaire, company management can evaluate managers being considered for a promotion. At the same time, those who take the test can use it to determine their own performance as strategists. Strategic managers provide subordinates with general guidelines, just as Helmuth von Moltke issued directives to his officers. And outstanding entrepreneurs create a corporate culture in which their vision, philosophy, and business strategies are implemented by employees who think independently.

Habitat Demonstration Unit Project: Leadership and Management Strategies for a Rapid Prototyping Project

NASA Technical Reports Server (NTRS)

Kennedy, Kriss J.; Toup, Larry; Gill, Tracy; Tri, Terry; Howe, Scott; Smitherman, David

2011-01-01

This paper gives an overview of the National Aeronautics and Space Administration (NASA) led multi-center Habitat Demonstration Unit (HDU) project leadership and management strategies being used by the NASA HDU team for a rapid prototyping project. The HDU project team constructed and tested an analog prototype lunar surface habitat/laboratory called the Pressurized Excursion Module (PEM) during 2010. The prototype unit subsystems were integrated in a short amount of time, utilizing a tiger team rapid prototyping approach that brought together over 20 habitation-related technologies and innovations from a variety of NASA centers. This paper describes the leadership and management strategies as well as lessons learned pertaining to leading and managing a multi-center diverse team in a rapid prototype environment. The PEM configuration went from a paper design to an operational surface habitat demonstration unit in less than 12 months. The HDU project is part of the strategic plan from the Exploration Systems Mission Directorate (ESMD) Directorate Integration Office (DIO) and the Exploration Mission Systems Office (EMSO) to test destination elements in analog environments. The 2011 HDU-Deep Space Habitat (DSH) configuration will build upon the PEM work, and emphasize validity of crew operations (remote working and living), EVA operations, mission operations, logistics operations, and science operations that might be required in a deep space context for Near Earth Object (NEO) exploration mission architectures. The 2011 HDU-DSH will be field-tested during the 2011 Desert Research and Technologies Studies (DRaTS) field tests. The HDU project is a "technology-pull" project that integrates technologies and innovations from multiple NASA centers. This project will repurpose the HDU 2010 demo unit that was field tested in the 2010 DRaTS, adding habitation functionality to the prototype unit. This paper will describe the strategy of establishing a multi-center project management team that put in place the key multi-center leadership skills and disciplines to enable a successful tiger team approach. Advocacy was established with key stakeholders and NASA Headquarters (HQ) by defining a strategic vision, mission, goals and objectives for the project and team. As a technology-pull testbed capability the HDU project was able to collaborate and leverage the Exploration Technology Development Program (ETDP) and individual NASA center investments which capitalized on their respective center core competencies and skills. This approach enable the leveraging of over $7.5m of value to create an operational habitat demonstration unit 2010 PEM configuration.

"Shotgun" versus sequential testing. Cost-effectiveness of diagnostic strategies for vaginitis.

PubMed

Carr, Phyllis L; Rothberg, Michael B; Friedman, Robert H; Felsenstein, Donna; Pliskin, Joseph S

2005-09-01

Although vaginitis is a common outpatient problem, only 60% of patients can be diagnosed at the initial office visit of a primary care provider using the office procedures of pH testing, whiff tests, normal saline, and potassium hydroxide preps. To determine the most cost-effective diagnostic and treatment approach for the medical management of vaginitis. Decision and cost-effectiveness analyses. Healthy women with symptoms of vaginitis undiagnosed after an initial pelvic exam, wet mount preparations, pH, and the four criteria to diagnose bacterial vaginosis. General office practice. We evaluated 28 diagnostic strategies comprised of combinations of pH testing, vaginal cultures for yeast and Trichomonas vaginalis, Gram's stain for bacterial vaginosis, and DNA probes for Neisseria gonorrhoeae and Chlamydia. Data sources for the study were confined to English language literature. The outcome measures were symptom-days and costs. The least expensive strategy was to perform yeast culture, gonorrhoeae and Chlamydia probes at the initial visit, and Gram's stain and Trichomonas culture only when the vaginal pH exceeded 4.9 (330 dollars, 7.30 symptom days). Other strategies cost 8 dollars to 76 dollars more and increased duration of symptoms by up to 1.3 days. In probabilistic sensitivity analysis, this strategy was always the most effective strategy and was also least expensive 58% of the time. For patients with vaginitis symptoms undiagnosed by pelvic examination, wet mount preparations and related office tests, a comprehensive, pH-guided testing strategy at the initial office visit is less expensive and more effective than ordering tests sequentially.

Development of tools to study personal weight control strategies: OxFAB taxonomy.

PubMed

Hartmann-Boyce, Jamie; Aveyard, Paul; Koshiaris, Constantinos; Jebb, Susan A

2016-02-01

To describe the development of the Oxford Food and Activity Behaviors (OxFAB) taxonomy and questionnaire to explore the cognitive and behavioral strategies used by individuals during weight management attempts. The taxonomy was constructed through a qualitative analysis of existing resources and a review of existing behavior change taxonomies and theories. The taxonomy was translated into a questionnaire to identify strategies used by individuals. Think-aloud interviews were conducted to test the face/concept validity of the questionnaire, and test-retest reliability was assessed in a sample of 138 participants. The OxFAB taxonomy consists of 117 strategies grouped into 23 domains. Compared to taxonomies used to describe interventions, around half of the domains and strategies identified are unique to the OxFAB taxonomy. The OxFAB questionnaire consists of 117 questions, one for each strategy from the taxonomy. Test-retest resulted in a mean PABAK score of 0.61 (SD 0.15). Questions were revised where appropriate. The OxFAB taxonomy and questionnaire provide a conceptual framework to identify the cognitive and behavioral strategies used by individuals during attempts at weight control. © 2016 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).

Disease management of dairy calves and heifers.

PubMed

McGuirk, Sheila M

2008-03-01

This article focuses on the most important diseases of dairy calves and heifers and presents clinical approaches that can improve detection, diagnosis, and treatment of herd-based problems. A systematic herd investigation strategy is pivotal to define the problems, understand important risk factors, develop a plan, and make recommendations for disease management accurately. A review of records, colostrum and feeding routines, housing and bedding management, routine procedures, vaccination, and treatment protocols begins the investigation and determines which diagnostic procedures and testing strategies are most useful. Disease management is most effective when the problem source is well defined and the exposure can be limited, calf immunity can be enhanced, or a combination of both. Screening examinations performed regularly or done at strategic time points improves detection of disease, can be used to monitor treatment outcomes, and can avoid disease outbreaks.

Turfgrass diagnostics and new, advanced technologies

USDA-ARS?s Scientific Manuscript database

Strategies for sustainable, integrated disease management start with reliable pathogen identification. Conventional identification methods such as disease symptomology, host association, morphology and biochemical tests are still key diagnostic indicators for many phytopathogens; however, nucleic ac...

Is it economical to manage jointly for wood and carbon under the Climate Action Reserve Protocol? In: Standiford, Richard B.; Weller, Theodore J.; Piirto, Douglas D.; Stuart, John D., tech

Treesearch

Richard P. Thompson; Steve R. Auten

2012-01-01

To quantify the benefits and costs of modifying forest management for additional climate benefits, Cal Poly's Swanton Pacific demonstration forest was used to test the Climate Action Reserve's protocol and identify management strategies for both wood and carbon markets. Residing in the Southern Sub-district with its clearcutting restrictions, Swanton offers...

Distractive Auditory Stimuli in the Form of Music in Individuals With COPD: A Systematic Review.

PubMed

Lee, Annemarie L; Desveaux, Laura; Goldstein, Roger S; Brooks, Dina

2015-08-01

Music has been used as a distractive auditory stimulus (DAS) in patients with COPD, but its effects are unclear. This systematic review aimed to establish the effect of DAS on exercise capacity, symptoms, and health-related quality of life (HRQOL) under three conditions: (1) during exercise training, (2) during exercise testing, and (3) for symptom management at rest. Randomized controlled or crossover trials as well as cohort studies of DAS during exercise training, during formal exercise testing, and for symptom management among individuals with COPD were identified from a search of seven databases. Two reviewers independently assessed study quality. Weighted mean differences (WMDs) with 95% CIs were calculated using a random-effects model. Thirteen studies (12 of which were randomized controlled or crossover trials) in 415 participants were included. DAS increased exercise capacity when applied over at least 2 months of exercise training (WMD, 98 m; 95% CI, 47-150 m). HRQOL improved only after a training duration of 3 months. Less dyspnea was noted with DAS during exercise training, but this was not consistently observed in short-term exercise testing or as a symptom management strategy at rest. DAS appears to reduce symptoms of dyspnea and fatigue when used during exercise training, with benefits observed in exercise capacity and HRQOL. When applied during exercise testing, the effects on exercise capacity and symptoms and as a strategy for symptom management at rest are inconsistent.

Sexually transmitted infections: challenges ahead.

PubMed

Unemo, Magnus; Bradshaw, Catriona S; Hocking, Jane S; de Vries, Henry J C; Francis, Suzanna C; Mabey, David; Marrazzo, Jeanne M; Sonder, Gerard J B; Schwebke, Jane R; Hoornenborg, Elske; Peeling, Rosanna W; Philip, Susan S; Low, Nicola; Fairley, Christopher K

2017-08-01

WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk-based management of invading plant disease.

PubMed

Hyatt-Twynam, Samuel R; Parnell, Stephen; Stutt, Richard O J H; Gottwald, Tim R; Gilligan, Christopher A; Cunniffe, Nik J

2017-05-01

Effective control of plant disease remains a key challenge. Eradication attempts often involve removal of host plants within a certain radius of detection, targeting asymptomatic infection. Here we develop and test potentially more effective, epidemiologically motivated, control strategies, using a mathematical model previously fitted to the spread of citrus canker in Florida. We test risk-based control, which preferentially removes hosts expected to cause a high number of infections in the remaining host population. Removals then depend on past patterns of pathogen spread and host removal, which might be nontransparent to affected stakeholders. This motivates a variable radius strategy, which approximates risk-based control via removal radii that vary by location, but which are fixed in advance of any epidemic. Risk-based control outperforms variable radius control, which in turn outperforms constant radius removal. This result is robust to changes in disease spread parameters and initial patterns of susceptible host plants. However, efficiency degrades if epidemiological parameters are incorrectly characterised. Risk-based control including additional epidemiology can be used to improve disease management, but it requires good prior knowledge for optimal performance. This focuses attention on gaining maximal information from past epidemics, on understanding model transferability between locations and on adaptive management strategies that change over time. © 2017 The Authors. New Phytologist © 2017 New Phytologist Trust.

Combating Obesity at Community Health Centers (COACH): A Quality Improvement Collaborative for Weight Management Programs

PubMed Central

Wilkes, Abigail E.; John, Priya M.; Vable, Anusha M.; Campbell, Amanda; Heuer, Loretta; Schaefer, Cynthia; Vinci, Lisa; Drum, Melinda L.; Chin, Marshall H.; Quinn, Michael T.; Burnet, Deborah L.

2013-01-01

Community health centers (CHCs) seek effective strategies to address obesity. MidWest Clinicians’ Network partnered with [an academic medical center] to test feasibility of a weight management quality improvement (QI) collaborative. MidWest Clinicians’ Network members expressed interest in an obesity QI program. This pilot study aimed to determine whether the QI model can be feasibly implemented with limited resources at CHCs to improve weight management programs. Five health centers with weight management programs enrolled with CHC staff as primary study participants; this study did not attempt to measure patient outcomes. Participants attended learning sessions and monthly conference calls to build QI skills and share best practices. Tailored coaching addressed local needs. Topics rated most valuable were patient recruitment/retention strategies, QI techniques, evidence-based weight management, motivational interviewing. Challenges included garnering provider support, high staff turnover, and difficulty tracking patient-level data. This paper reports practical lessons about implementing a weight management QI collaborative in CHCs. PMID:23727964

Application of GPS and Near-Surface Geophysical Methods to Evaluate Differences Between Agricultural Test Plots

USDA-ARS?s Scientific Manuscript database

A field research facility with two pairs of replicated agricultural test plots (four total) was established at a location in northwest Ohio during 2005 for the purpose of studying water table management strategies. Initial efforts at this field research facility were devoted to evaluating difference...

Integrated Propulsion Data System Public Web Site

NASA Technical Reports Server (NTRS)

Hamilton, Kimberly

2001-01-01

The Integrated Propulsion Data System's (IPDS) focus is to provide technologically-advanced philosophies of doing business at SSC that will enhance the existing operations, engineering and management strategies and provide insight and metrics to assess their daily impacts, especially as related to the Propulsion Test Directorate testing scenarios for the 21st Century.

Dredging Operations Technical Support Program. Management Strategy for Disposal of Dredged Material: Contaminant Testing and Controls.

DTIC Science & Technology

1985-08-01

laboratory test using a rainfall simulator has been developed ( Westerdahl and Skogerboe 1981) and is being used to predict surface runoff water quality...Marine Protection, Research, and Sanctuaries Act of 1972)," US Army Engineer Waterways Experiment Station, Vicksburg, Miss. Westerdahl , H. E., and

Using SPMDs To Assess Natural Recovery Of PCB-Contaminated Sediments In Lake Hartwell, SC: I. A Field Test Of New In-Situ Deployment Methods

EPA Science Inventory

Results from the field testing of some innovative sampling methods developed to evaluate risk management strategies for polychlorinated biphenyl (PCB) contaminated sediments are presented. Semipermeable membrane devices (SPMDs) were combined with novel deployment methods to quan...

Information Flow Analysis of Level 4 Payload Processing Operations

NASA Technical Reports Server (NTRS)

Danz, Mary E.

1991-01-01

The Level 4 Mission Sequence Test (MST) was studied to develop strategies and recommendations to facilitate information flow. Recommendations developed as a result of this study include revised format of the Test and Assembly Procedure (TAP) document and a conceptualized software based system to assist in the management of information flow during the MST.

International normalized ratio self-testing and self-management: improving patient outcomes.

PubMed

Pozzi, Matteo; Mitchell, Julia; Henaine, Anna Maria; Hanna, Najib; Safi, Ola; Henaine, Roland

2016-01-01

Long term oral anti-coagulation with vitamin K antagonists is a risk factor of hemorrhagic or thromebomlic complications. Periodic laboratory testing of international normalized ratio (INR) and a subsequent dose adjustment are therefore mandatory. The use of home testing devices to measure INR has been suggested as a potential way to improve the comfort and compliance of the patients and their families, the frequency of monitoring and, finally, the management and safety of long-term oral anticoagulation. In pediatric patients, increased doses to obtain and maintain the therapeutic target INR, more frequent adjustments and INR testing, multiple medication, inconstant nutritional intake, difficult venepunctures, and the need to go to the laboratory for testing (interruption of school and parents' work attendance) highlight those difficulties. After reviewing the most relevant published studies of self-testing and self-management of INR for adult patients and children on oral anticoagulation, it seems that these are valuable and effective strategies of INR control. Despite an unclear relationship between INR control and clinical effects, these self-strategies provide a better control of the anticoagulant effect, improve patients and their family quality of life, and are an appealing solution in term of cost-effectiveness. Structured education and knowledge evaluation by trained health care professionals is required for children, to be able to adjust their dose treatment safely and accurately. However, further data are necessary in order to best define those patients who might better benefit from this multidisciplinary approach.

Food allergy and risk assessment: Current status and future directions

NASA Astrophysics Data System (ADS)

Remington, Benjamin C.

2017-09-01

Risk analysis is a three part, interactive process that consists of a scientific risk assessment, a risk management strategy and an exchange of information through risk communication. Quantitative risk assessment methodologies are now available and widely used for assessing risks regarding the unintentional consumption of major, regulated allergens but new or modified proteins can also pose a risk of de-novo sensitization. The risks due to de-novo sensitization to new food allergies are harder to quantify. There is a need for a systematic, comprehensive battery of tests and assessment strategy to identify and characterise de-novo sensitization to new proteins and the risks associated with them. A risk assessment must be attuned to answer the risk management questions and needs. Consequently, the hazard and risk assessment methods applied and the desired information are determined by the requested outcome for risk management purposes and decisions to be made. The COST Action network (ImpARAS, www.imparas.eu) has recently started to discuss these risk management criteria from first principles and will continue with the broader subject of improving strategies for allergen risk assessment throughout 2016-2018/9.

Contemporary management and surveillance strategy after shunt or endoscopic third ventriculostomy procedures for hydrocephalus.

PubMed

Janjua, M Burhan; Hoffman, Caitlin E; Souweidane, Mark M

2017-11-01

The management of hydrocephalus can be challenging even in expert hands. Due to acute presentation, recurrence, accompanying complications, the need for urgent diagnosis; a robust management plan is an absolute necessity. We devised a novel time efficient surveillance strategy during emergency, and clinic follow up settings which has never been described in the literature. We searched all articles embracing management/surveillance protocol on pediatric hydrocephalus utilizing the terms "hydrocephalus follow up" or "surveillance protocol after hydrocephalus treatment". The authors present their own strategy based on vast experience in the hydrocephalus management at a single institution. The need for the diagnostic laboratory testing, age and presentation based radiological imaging, significance of neuro-opthalmological exam, and when to consider the emergent exploration have been discussed in detail. Moreover, a definitive triaging strategy has been described with the help of flow chart diagrams for clinicians, and the neurosurgeons in practice. The triage starts from detail history, physical exam, necessary labs, radiological imaging depending on the presentation, and the age of the child. A quick head CT scan helps after shunt surgery while, a FAST sequence MRI scan (fsMRI) is important in post ETV patients. The need for neuro-opthalmological exam, and the shunt series stays vital in asymptomatic patients during regular follow up. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries: a realist review protocol.

PubMed

Thapa, Subash; Hannes, Karin; Cargo, Margaret; Buve, Anne; Mathei, Catharina

2015-11-02

Several stigma reduction intervention strategies have been developed and tested for effectiveness in terms of increasing human immunodeficiency virus (HIV) test uptake. These strategies have been more effective in some contexts and less effective in others. Individual factors, such as lack of knowledge and fear of disclosure, and social-contextual factors, such as poverty and illiteracy, might influence the effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries. So far, it is not clearly known how the stigma reduction intervention strategies interact with these contextual factors to increase HIV test uptake. Therefore, we will conduct a review that will synthesize existing studies on stigma reduction intervention strategies to increase HIV test uptake to better understand the mechanisms underlying this process in low- and middle-income countries. A realist review will be conducted to unpack context-mechanism-outcome configurations of the effect of stigma reduction intervention strategies on HIV test uptake. Based on a scoping review, we developed a preliminary theoretical framework outlining a potential mechanism of how the intervention strategies influence HIV test uptake. Our realist synthesis will be used to refine the preliminary theoretical framework to better reflect mechanisms that are supported by existing evidence. Journal articles and grey literature will be searched following a purposeful sampling strategy. Data will be extracted and tested against the preliminary theoretical framework. Data synthesis and analysis will be performed in five steps: organizing extracted data into evidence tables, theming, formulating chains of inference from the identified themes, linking the chains of inference and developing generative mechanisms, and refining the framework. This will be the first realist review that offers both a quantitative and a qualitative exploration of the available evidence to develop and propose a theoretical framework that explains why and how HIV stigma reduction intervention strategies influence HIV test uptake in low- and middle-income countries. Our theoretical framework is meant to provide guidance to program managers on identifying the most effective stigma reduction intervention strategies to increase HIV test uptake. We also include advice on how to effectively implement these strategies to reduce the rate of HIV transmission. PROSPERO CRD42015023687.

Coping with stereotype threat: denial as an impression management strategy.

PubMed

von Hippel, William; von Hippel, Courtney; Conway, Leanne; Preacher, Kristopher J; Schooler, Jonathan W; Radvansky, Gabriel A

2005-07-01

Four experiments tested the hypothesis that people who are concerned with impression management cope with stereotype threat through denial. Consistent with this hypothesis, temporary employees threatened by a stereotype of incompetence (Study 1) and hostel-dwelling older adults (Study 2) were more likely to deny incompetence if they were high in impression management. African Americans (Study 3) showed a similar pattern of denying cognitive incompetence, which emerged primarily when they were interviewed by a White experimenter and had attended a predominantly Black high school. In Study 4, White students who expected to take an IQ test and were threatened by a stereotype of being less intelligent than Asians were more likely to deny that intelligence is important if they were high in impression management.

The FOAM study: is Hysterosalpingo foam sonography (HyFoSy) a cost-effective alternative for hysterosalpingography (HSG) in assessing tubal patency in subfertile women? Study protocol for a randomized controlled trial.

PubMed

van Rijswijk, Joukje; van Welie, Nienke; Dreyer, Kim; van Hooff, Machiel H A; de Bruin, Jan Peter; Verhoeve, Harold R; Mol, Femke; Kleiman-Broeze, Kimiko A; Traas, Maaike A F; Muijsers, Guido J J M; Manger, Arentje P; Gianotten, Judith; de Koning, Cornelia H; Koning, Aafke M H; Bayram, Neriman; van der Ham, David P; Vrouenraets, Francisca P J M; Kalafusova, Michaela; van de Laar, Bob I G; Kaijser, Jeroen; van Oostwaard, Miriam F; Meijer, Wouter J; Broekmans, Frank J M; Valkenburg, Olivier; van der Voet, Lucy F; van Disseldorp, Jeroen; Lambers, Marieke J; Peters, Henrike E; Lier, Marit C I; Lambalk, Cornelis B; van Wely, Madelon; Bossuyt, Patrick M M; Stoker, Jaap; van der Veen, Fulco; Mol, Ben W J; Mijatovic, Velja

2018-05-09

Tubal pathology is a causative factor in 20% of subfertile couples. Traditionally, tubal testing during fertility work-up is performed by hysterosalpingography (HSG). Hysterosalpingo-foam sonography (HyFoSy) is a new technique that is thought to have comparable accuracy as HSG, while it is less expensive and more patient friendly. HyFoSy would be an acceptable alternative for HSG, provided it has similar effectiveness in terms of patient outcomes. We aim to compare the effectiveness and costs of management guided by HyFoSy or by HSG. Consenting women will undergo tubal testing by both HyFoSy and HSG in a randomized order during fertility work-up. The study group will consist of 1163 subfertile women between 18 and 41 years old who are scheduled for tubal patency testing during their fertility work-up. Women with anovulatory cycles not responding to ovulation induction, endometriosis, severe male subfertility or a known contrast (iodine) allergy will be excluded. We anticipate that 7 % (N = 82) of the participants will have discordant test results for HyFoSy and HSG. These participants will be randomly allocated to either a management strategy based on HyFoSy or a management strategy based on HSG, resulting in either a diagnostic laparoscopy with chromopertubation or a strategy that assumes tubal patency (intrauterine insemination or expectant management). The primary outcome is ongoing pregnancy leading to live birth within 12 months after randomization. Secondary outcomes are patient pain scores, time to pregnancy, clinical pregnancy, miscarriage rate, multiple pregnancy rate, preterm birth rate and number of additional treatments. Costs will be estimated by counting resource use and calculating unit prices. This trial will compare the effectiveness and costs of HyFoSy versus HSG in assessing tubal patency in subfertile women. Dutch Trial Register (NTR 4746, http://www.trialregister.nl ). Date of registration: 19 August 2014.

Explaining How to Play Real-Time Strategy Games

NASA Astrophysics Data System (ADS)

Metoyer, Ronald; Stumpf, Simone; Neumann, Christoph; Dodge, Jonathan; Cao, Jill; Schnabel, Aaron

Real-time strategy games share many aspects with real situations in domains such as battle planning, air traffic control, and emergency response team management which makes them appealing test-beds for Artificial Intelligence (AI) and machine learning. End user annotations could help to provide supplemental information for learning algorithms, especially when training data is sparse. This paper presents a formative study to uncover how experienced users explain game play in real-time strategy games. We report the results of our analysis of explanations and discuss their characteristics that could support the design of systems for use by experienced real-time strategy game users in specifying or annotating strategy-oriented behavior.

[The Effectiveness of a Strategy for the Flexible Management of Nursing Human Resources: A Pilot Study].

PubMed

Huang, Chung-I; Lu, Meei-Shiow

2017-12-01

The flexibility of a hospital's nursing-related human resource management policies affects the working willingness and retention of nurses. To explore the effectiveness of a flexible nursing-related human resource management strategy. This quasi-experimental research used a one group pretest-posttest design. Supervisors at participating hospitals attended the "Application of Flexible Nursing Human Resources Management Strategies" workshop, which introduced the related measures and assessed nurses' pretest satisfaction. After these measures were implemented at the participating hospitals, implementation-related problems were investigated and appropriate consultation was provided. The posttest was implemented after the end of the project. Data were collected from nurses at the participating hospitals who had served in their present hospital for more than three months. The participating hospitals were all nationally certified healthcare providers, including 13 medical centers, 17 regional hospitals, and 3 district hospitals. A total of nurses 2,810 nurses took the pretest and 2,437 took the posttest. The research instruments included the "Satisfaction with working conditions and system flexibility" scale and the "Flexible nursing human resource management strategies". The effectiveness of the implemented strategy was assessed using independent samples t-test and variance analysis. The result of implementing the flexible strategies shows that the total mean of pretest satisfaction (Likert 5 scores) was 3.47 (SD = 0.65), and the posttest satisfaction was 3.52 (SD = 0.65), with significant statistical differences in task, numerical, divisional, and leading flexibility. Due to the good implementation effectiveness, the authors strongly suggest that all of the participating hospitals continue to apply this strategic model to move toward a more flexible nursing system and work.

Dissociated neural processing for decisions in managers and non-managers.

PubMed

Caspers, Svenja; Heim, Stefan; Lucas, Marc G; Stephan, Egon; Fischer, Lorenz; Amunts, Katrin; Zilles, Karl

2012-01-01

Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated or a slower rational processing system. However, it still remains elusive how personality factors or professional requirements might modulate the decision process and the underlying neural mechanisms. Since decision making is a key task of managers, we hypothesized that managers, facing higher pressure for frequent and rapid decisions than non-managers, prefer the heuristic, automated decision strategy in contrast to non-managers. Such different strategies may, in turn, rely on different neural systems. We tested managers and non-managers in a functional magnetic resonance imaging study using a forced-choice paradigm on word-pairs. Managers showed subcortical activation in the head of the caudate nucleus, and reduced hemodynamic response within the cortex. In contrast, non-managers revealed the opposite pattern. With the head of the caudate nucleus being an initiating component for process automation, these results supported the initial hypothesis, hinting at automation during decisions in managers. More generally, the findings reveal how different professional requirements might modulate cognitive decision processing.

Dissociated Neural Processing for Decisions in Managers and Non-Managers

PubMed Central

Caspers, Svenja; Heim, Stefan; Lucas, Marc G.; Stephan, Egon; Fischer, Lorenz; Amunts, Katrin; Zilles, Karl

2012-01-01

Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated or a slower rational processing system. However, it still remains elusive how personality factors or professional requirements might modulate the decision process and the underlying neural mechanisms. Since decision making is a key task of managers, we hypothesized that managers, facing higher pressure for frequent and rapid decisions than non-managers, prefer the heuristic, automated decision strategy in contrast to non-managers. Such different strategies may, in turn, rely on different neural systems. We tested managers and non-managers in a functional magnetic resonance imaging study using a forced-choice paradigm on word-pairs. Managers showed subcortical activation in the head of the caudate nucleus, and reduced hemodynamic response within the cortex. In contrast, non-managers revealed the opposite pattern. With the head of the caudate nucleus being an initiating component for process automation, these results supported the initial hypothesis, hinting at automation during decisions in managers. More generally, the findings reveal how different professional requirements might modulate cognitive decision processing. PMID:22927984

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

ERIC Educational Resources Information Center

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

2008-01-01

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

A research-based strategy for managing housing adaptations: study protocol for a quasi-experimental trial.

PubMed

Ekstam, Lisa; Carlsson, Gunilla; Chiatti, Carlos; Nilsson, Maria H; Malmgren Fänge, Agneta

2014-11-29

The primary aim of this paper is to describe the design of a project evaluating the effects of using a research-based strategy for managing housing adaptations (HAs). The evaluation targets clients' perspectives in terms of activity, participation, usability, fear of falling, fall incidence, use of mobility devices, and health-related quality of life, and determines the societal effects of HAs in terms of costs. Additional aims of the project are to explore and describe this strategy in relation to experiences and expectations (a) among clients and cohabitants and (b) occupational therapists in ordinary practice. This study is a quasi-experimental trial applying a multiphase design, combining quantitative and qualitative data. At the experimental sites, the occupational therapists (OTs) apply the intervention, i.e. a standardized research-based strategy for HA case management. At the control site, the occupational therapists are following their regular routine in relation to HA. Three municipalities in south Sweden will be included based on their population, their geographical dispersion, and their similar organizational structures for HA administration. Identical data on outcomes is being collected at all the sites at the same four time points: before the HA and then 3, 6, and 12 months after the HA. The data-collection methods are semi-structured qualitative interviews, observations, clinical assessments, and certificates related to each client's HA. The intervention in this study has been developed and tested through many years of research and in collaboration with practitioners. This process includes methodological development and testing research aimed at identifying the most important outcomes and research targeting current HA case-management procedures in Swedish municipalities. When the study is completed, the results will be used for further optimization of the practice strategy for HA, in close collaboration with the data-collecting OTs. No: NCT01960582.

Pricing and Fee Management.

ERIC Educational Resources Information Center

Fischer, Richard B.

1986-01-01

Defines key terms and discusses things to consider when setting fees for a continuing education program. These include (1) the organization's philosophy and mission, (2) certain key variables, (3) pricing strategy options, and (4) the test of reasonableness. (CH)

Electronic freight management (EFM) standards strategy

DOT National Transportation Integrated Search

2006-04-01

The EFM initiative is a U.S. Department of Transportation (DOT)-sponsored research effort aimed at improving the operating efficiency, safety, and security of freight movement. The initiative involves conducting a deployment test using Web services t...

Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report

PubMed Central

Malfertheiner, P; Megraud, F; O'Morain, C; Bazzoli, F; El‐Omar, E; Graham, D; Hunt, R; Rokkas, T; Vakil, N; Kuipers, E J

2007-01-01

Background Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000. Aims To update the guidelines at the European Helicobacter Study Group (EHSG) Third Maastricht Consensus Conference, with emphasis on the potential of H pylori eradication for the prevention of gastric cancer. Results Eradication of H pylori infection is recommended in (a) patients with gastroduodenal diseases such as peptic ulcer disease and low grade gastric, mucosa associated lymphoid tissue (MALT) lymphoma; (b) patients with atrophic gastritis; (c) first degree relatives of patients with gastric cancer; (d) patients with unexplained iron deficiency anaemia; and (e) patients with chronic idiopathic thrombocytopenic purpura. Recurrent abdominal pain in children is not an indication for a “test and treat” strategy if other causes are excluded. Eradication of H pylori infection (a) does not cause gastro‐oesophageal reflux disease (GORD) or exacerbate GORD, and (b) may prevent peptic ulcer in patients who are naïve users of non‐steroidal anti‐inflammatory drugs (NSAIDs). H pylori eradication is less effective than proton pump inhibitor (PPI) treatment in preventing ulcer recurrence in long term NSAID users. In primary care a test and treat strategy using a non‐invasive test is recommended in adult patients with persistent dyspepsia under the age of 45. The urea breath test, stool antigen tests, and serological kits with a high accuracy are non‐invasive tests which should be used for the diagnosis of H pylori infection. Triple therapy using a PPI with clarithromycin and amoxicillin or metronidazole given twice daily remains the recommended first choice treatment. Bismuth‐containing quadruple therapy, if available, is also a first choice treatment option. Rescue treatment should be based on antimicrobial susceptibility. Conclusion The global burden of gastric cancer is considerable but varies geographically. Eradication of H pylori infection has the potential to reduce the risk of gastric cancer development. PMID:17170018

Evaluation of testing strategies to identify infected animals at a single round of testing within dairy herds known to be infected with Mycobacterium avium ssp. paratuberculosis.

PubMed

More, S J; Cameron, A R; Strain, S; Cashman, W; Ezanno, P; Kenny, K; Fourichon, C; Graham, D

2015-08-01

As part of a broader control strategy within herds known to be infected with Mycobacterium avium ssp. paratuberculosis (MAP), individual animal testing is generally conducted to identify infected animals for action, usually culling. Opportunities are now available to quantitatively compare different testing strategies (combinations of tests) in known infected herds. This study evaluates the effectiveness, cost, and cost-effectiveness of different testing strategies to identify infected animals at a single round of testing within dairy herds known to be MAP infected. A model was developed, taking account of both within-herd infection dynamics and test performance, to simulate the use of different tests at a single round of testing in a known infected herd. Model inputs included the number of animals at different stages of infection, the sensitivity and specificity of each test, and the costs of testing and culling. Testing strategies included either milk or serum ELISA alone or with fecal culture in series. Model outputs included effectiveness (detection fraction, the proportion of truly infected animals in the herd that are successfully detected by the testing strategy), cost, and cost-effectiveness (testing cost per true positive detected, total cost per true positive detected). Several assumptions were made: MAP was introduced with a single animal and no management interventions were implemented to limit within-herd transmission of MAP before this test. In medium herds, between 7 and 26% of infected animals are detected at a single round of testing, the former using the milk ELISA and fecal culture in series 5 yr after MAP introduction and the latter using fecal culture alone 15 yr after MAP introduction. The combined costs of testing and culling at a single round of testing increases with time since introduction of MAP infection, with culling costs being much greater than testing costs. The cost-effectiveness of testing varied by testing strategy. It was also greater at 5 yr, compared with 10 or 15 yr, since MAP introduction, highlighting the importance of early detection. Future work is needed to evaluate these testing strategies in subsequent rounds of testing as well as accounting for different herd dynamics and different levels of herd biocontainment. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Developing Internal Structure in Elementary School Students. A System of Classroom Management and Class Control.

ERIC Educational Resources Information Center

Hair, Helen; And Others

A report is given of a three year project in which a system of classroom management designed to develop the ability of elementary school children to function at their maximum capacity in the classroom was implemented and tested. Great emphasis was placed on the use of motivational strategies, reinforcement techniques, involvement of students in…

Public Management Reform and Organizational Performance: An Empirical Assessment of the U.K. Labour Government's Public Service Improvement Strategy

ERIC Educational Resources Information Center

Walker, Richard M.; Boyne, George A.

2006-01-01

We present the first empirical assessment of the U.K. Labour government's program of public management reform. This reform program is based on rational planning, devolution and delegation, flexibility and incentives, and enhanced choice. Measures of these variables are tested against external and internal indicators of organizational performance.…

A Meeting of the Minds: Implementation of an Effective Enrollment Management Strategy at One Private Comprehensive University. ASHE Annual Meeting Paper.

ERIC Educational Resources Information Center

Krotseng, Marsha V.

A case study is presented which tests Hossler's 1984 assertion (that well conceptualized plans to manage enrollment can lead to a better institutional self-understanding and an enhanced institutional health and vitality) and critically examines one private, comprehensive university's effort to improve the quality and quantity of its environmental…

Unraveling the thrombophilia paradox: from hypercoagulability to the prothrombotic state.

PubMed

Baglin, T

2010-02-01

The thrombophilia paradox whereby thrombophilia testing identifies defects associated with an increased risk of a first venous thrombosis but not of a particularly high risk of recurrence is likely the result of limitations imposed by a limited dichotomous testing strategy compounded by test inaccuracy and imprecision. Consequently, the observed intermediate phenotype (defined by limited laboratory test results) is not fully concordant with the heritable genotype. The next generation of thrombophilia tests, which utilize either individual genomic analysis or global measurement of the composite plasma intermediate phenotype, may more accurately quantify the thrombophilic risk. In conjunction with clinical risk assessment a more quantitative measurement of hypercoagulability and definition of the prothrombotic state should facilitate transition of clinical management from a disease-focused to a more patient-focused strategy.

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study.

PubMed

Paciullo, Francesco; Proietti, Marco; Bianconi, Vanessa; Nobili, Alessandro; Pirro, Matteo; Mannucci, Pier Mannuccio; Lip, Gregory Y H; Lupattelli, Graziana

2018-04-01

Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. We performed an ancillary analysis from the 'Registro Politerapie SIMI' study, enrolling elderly inpatients from internal medicine and geriatric wards. We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA 2 DS 2 -VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-1.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26-0.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34-0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively). A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.

Development of a fuel cell plug-in hybrid electric vehicle and vehicle simulator for energy management assessment

NASA Astrophysics Data System (ADS)

Meintz, Andrew Lee

This dissertation offers a description of the development of a fuel cell plug-in hybrid electric vehicle focusing on the propulsion architecture selection, propulsion system control, and high-level energy management. Two energy management techniques have been developed and implemented for real-time control of the vehicle. The first method is a heuristic method that relies on a short-term moving average of the vehicle power requirements. The second method utilizes an affine function of the short-term and long-term moving average vehicle power requirements. The development process of these methods has required the creation of a vehicle simulator capable of estimating the effect of changes to the energy management control techniques on the overall vehicle energy efficiency. Furthermore, the simulator has allowed for the refinement of the energy management methods and for the stability of the method to be analyzed prior to on-road testing. This simulator has been verified through on-road testing of a constructed prototype vehicle under both highway and city driving schedules for each energy management method. The results of the finalized vehicle control strategies are compared with the simulator predictions and an assessment of the effectiveness of both strategies is discussed. The methods have been evaluated for energy consumption in the form of both hydrogen fuel and stored electricity from grid charging.

Comparative Analysis of Cervical Spine Management in a Subset of Severe Traumatic Brain Injury Cases Using Computer Simulation

PubMed Central

Carter, Kimbroe J.; Dunham, C. Michael; Castro, Frank; Erickson, Barbara

2011-01-01

Background No randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI) at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae. The study's goal is to determine cervical spine management strategies that maximize brain injury functional survival while minimizing quadriplegia. Methods/Findings The severity of TBI is categorized as unstable, high risk and stable based on intracranial hypertension, hypoxemia, hypotension, early ventilator associated pneumonia, admission Glasgow Coma Scale (GCS) and age. Complications resulting from cervical spine management are simulated using three decision trees. Each case starts with an amount of primary and secondary brain injury and ends as a functional survivor, severely brain injured, quadriplegic or dead. Cervical spine instability is studied with one-way and two-way sensitivity analyses providing rankings of cervical spine management strategies for probabilities of management complications based on QALYs. Early collar removal received more QALYs than the alternative strategies in most arrangements of these comparisons. A limitation of the model is the absence of testing against an independent data set. Conclusions When clinical logic and components of cervical spine management are systematically altered, changes that improve health outcomes are identified. In the absence of controlled clinical studies, the results of this comparative computer assessment show that early collar removal is preferred over a wide range of realistic inputs for this subset of traumatic brain injury. Future research is needed on identifying factors in projecting awakening from coma and the role of delirium in these cases. PMID:21544239

The Daniel K. Inouye College of Pharmacy Scripts: Updates on Clostridium difficile Infection: Advances in Laboratory Testing to Aid Diagnosis and Treatment.

PubMed

Lteif, Louis

2017-02-01

Clostridium difficile remains a major source of nosocomial infections and associated diarrhea. More recently, community-acquired cases are on the rise creating a concern for a serious public health threat. Appropriate infection control precautions as well as prevention and optimal management may help to avoid detrimental outbreaks. A key step is utilizing laboratory testing for quick and accurate diagnosis of potential cases. This overview article describes Clostridium difficile infection control and prevention methods and updates the most recent management strategies including a focus on the utilization and interpretation of laboratory diagnostic testing and appropriate treatment.

Incentive-compatible demand-side management for smart grids based on review strategies

NASA Astrophysics Data System (ADS)

Xu, Jie; van der Schaar, Mihaela

2015-12-01

Demand-side load management is able to significantly improve the energy efficiency of smart grids. Since the electricity production cost depends on the aggregate energy usage of multiple consumers, an important incentive problem emerges: self-interested consumers want to increase their own utilities by consuming more than the socially optimal amount of energy during peak hours since the increased cost is shared among the entire set of consumers. To incentivize self-interested consumers to take the socially optimal scheduling actions, we design a new class of protocols based on review strategies. These strategies work as follows: first, a review stage takes place in which a statistical test is performed based on the daily prices of the previous billing cycle to determine whether or not the other consumers schedule their electricity loads in a socially optimal way. If the test fails, the consumers trigger a punishment phase in which, for a certain time, they adjust their energy scheduling in such a way that everybody in the consumer set is punished due to an increased price. Using a carefully designed protocol based on such review strategies, consumers then have incentives to take the socially optimal load scheduling to avoid entering this punishment phase. We rigorously characterize the impact of deploying protocols based on review strategies on the system's as well as the users' performance and determine the optimal design (optimal billing cycle, punishment length, etc.) for various smart grid deployment scenarios. Even though this paper considers a simplified smart grid model, our analysis provides important and useful insights for designing incentive-compatible demand-side management schemes based on aggregate energy usage information in a variety of practical scenarios.

Economic evaluation of a randomized controlled trial of pharmacist-supervized patient self-testing of warfarin therapy.

PubMed

Gallagher, J; Mc Carthy, S; Woods, N; Ryan, F; O' Shea, S; Byrne, S

2015-02-01

The increase in numbers of patients requiring oral anti-coagulation testing in outpatient clinics has focused attention on alternative flexible systems of anti-coagulation management. One option is pharmacist led patient self-testing (PST) of international normalised ratio (INR) levels. PST has demonstrated improvements in anti-coagulation control, but its cost-effectiveness is inconclusive. This study reports the first cost-effectiveness evaluation of a randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on oral anti-coagulation therapy. We conducted an economic evaluation alongside a randomised controlled trial investigating a pharmacist led PST method. The primary outcome was to determine the cost effectiveness of PST in comparison with usual care (management in a hospital based anti-coagulation clinic). Long term anti-coagulation patients were recruited to a 6 month cross over study between PST and routine care in an anti-coagulation clinic. Economic evaluation was from the healthcare payer perspective. On a per patient basis over a 6 month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Patients achieved a significantly higher time in therapeutic range (TTR) during the PST arm in comparison with routine care, (72 ± 19.7% vs. 59 ± 13.5%). Overall cost of managing a patient through pharmacist supervised PST for a 6 month period is €226.45. Additional analysis of strategies from a societal perspective indicated that PST was the dominant strategy. Pharmacist led patient self-testing is a viable method of management. It provides significant increases in anti-coagulation control for a minimal increase in cost. © 2014 John Wiley & Sons Ltd.

Modified endoscopic medial maxillectomy for zygomatic implant salvage.

PubMed

Schwartz, Joseph S; Tajudeen, Bobby A; Adappa, Nithin D; Palmer, James N

2016-01-01

Odontogenic chronic rhinosinusitis (CRS) is an epidemiologically important disease process due, in part, to the increasingly commonplace use of dental restorative procedures such as zygomatic implantation. Traditional management of this clinical entity typically entails extraction of the infected hardware via an open or endoscopic approach. We describe a novel management strategy of odontogenic CRS following bilateral zygomatic implantation for oral rehabilitation that we surgically salvaged via a modified endoscopic medial maxillectomy. We describe the presentation and management of a case of metachronous development of bilateral CRS subsequent to zygomatic implantation. The patient's postoperative course was characterized by marked endoscopic, radiologic, and symptomatic improvement as measured by the 22-item Sino-Nasal Outcome Test. We describe a novel treatment strategy for the management of odontogenic sinusitis resulting from erroneous zygomatic implant placement. Modified endoscopic medial maxillectomy in this clinical context facilitates mucosal normalization of the affected sinus, while permitting preservation of oral function through salvage of the displaced implant.

Exploring critical pathways for urban water management to identify robust strategies under deep uncertainties.

PubMed

Urich, Christian; Rauch, Wolfgang

2014-12-01

Long-term projections for key drivers needed in urban water infrastructure planning such as climate change, population growth, and socio-economic changes are deeply uncertain. Traditional planning approaches heavily rely on these projections, which, if a projection stays unfulfilled, can lead to problematic infrastructure decisions causing high operational costs and/or lock-in effects. New approaches based on exploratory modelling take a fundamentally different view. Aim of these is, to identify an adaptation strategy that performs well under many future scenarios, instead of optimising a strategy for a handful. However, a modelling tool to support strategic planning to test the implication of adaptation strategies under deeply uncertain conditions for urban water management does not exist yet. This paper presents a first step towards a new generation of such strategic planning tools, by combing innovative modelling tools, which coevolve the urban environment and urban water infrastructure under many different future scenarios, with robust decision making. The developed approach is applied to the city of Innsbruck, Austria, which is spatially explicitly evolved 20 years into the future under 1000 scenarios to test the robustness of different adaptation strategies. Key findings of this paper show that: (1) Such an approach can be used to successfully identify parameter ranges of key drivers in which a desired performance criterion is not fulfilled, which is an important indicator for the robustness of an adaptation strategy; and (2) Analysis of the rich dataset gives new insights into the adaptive responses of agents to key drivers in the urban system by modifying a strategy. Copyright © 2014 Elsevier Ltd. All rights reserved.

Rule Driven Multi-Objective Management (RDMOM) - An Alternative Form for Describing and Developing Effective Water Resources Management Strategies

NASA Astrophysics Data System (ADS)

Sheer, D. P.

2011-12-01

Economics provides a model for describing human behavior applied to the management of water resources, but that model assumes, among other things, that managers have a way of directly relating immediate actions to long-term economic outcomes. This is rarely the case in water resources problems where uncertainty has significant impacts on the effectiveness of management strategies and where the management objectives are very difficult to commensurate. The difficulty in using economics is even greater in multiparty disputes, where each party has a different relative value for each of the management objectives, and many of the management objectives are shared. A three step approach to collaborative decision making can overcome these difficulties. The first step involves creating science based performance measures and evaluation tools to estimate the effect of alternative management strategies on each of the non-commensurate objectives. The second step involves developing short-term surrogate operating objectives that implicitly deal with all of the aspects of the long term uncertainty. Management that continually "optimizes" the short-term objectives subject to physical and other constraints that change through time can be characterized as Rule Driven Multi-Objective Management (RDMOM). RDMOM strategies are then tested in simulation models to provide the basis for evaluating performance measures. Participants in the collaborative process then engage in multiparty discussions that create new alternatives, and "barter" a deal. RDMOM does not assume that managers fully understand the link between current actions and long term goals. Rather, it assumes that managers operate to achieve short-term surrogate objectives which they believe will achieve an appropriate balance of both short and long-term incommensurable benefits. A reservoir rule curve is a simple, but often not particularly effective, example of the real-world implementation of RDMOM. Water managers find they can easily describe and explain their written and unwritten protocols using the RDMOM, and that the use of short-term surrogates is both intellectually appealing and pragmatic. The identification of operating targets as short-term surrogates leads naturally to a critical discussion of long-term objectives, and to the development of performance measures for the long-term objectives. The transparency and practical feasibility RDMOM based strategies is often crucial to the success of collaborative efforts. Complex disputes in the Delaware and Susquehanna Basins, the Everglades and Lower East Coast South Florida, Southern Nevada, Washington DC and many others have been resolved using RDMOM strategies.

Progress towards implementation of ACT malaria case-management in public health facilities in the Republic of Sudan: a cluster-sample survey

PubMed Central

2012-01-01

Background Effective malaria case-management based on artemisinin-based combination therapy (ACT) and parasitological diagnosis is a major pillar within the 2007-2012 National Malaria Strategic Plan in the Sudan. Three years after the launch of the strategy a health facility survey was undertaken to evaluate case-management practices and readiness of the health facilities and health workers to implement a new malaria case-management strategy. Methods A cross-sectional, cluster sample survey was undertaken at public health facilities in 15 states of Sudan. Data were collected using quality-of-care assessment methods. The main outcomes were the proportions of facilities with ACTs and malaria diagnostics; proportions of health workers exposed to malaria related health systems support activities; and composite and individual indicators of case-management practices for febrile outpatients stratified by age, availability of ACTs and diagnostics, use of malaria diagnostics, and test result. Results We evaluated 244 facilities, 294 health workers and 1,643 consultations for febrile outpatients (425 < 5 years and 1,218 ≥ 5 years). Health facility and health worker readiness was variable: chloroquine was available at only 5% of facilities, 73% stocked recommended artesunate and sulfadoxine/pyrimethamine (AS+SP), 51% had the capacity to perform parasitological diagnosis, 53% of health workers had received in-service training on ACTs, 24% were trained in the use of malaria Rapid Diagnostic Tests, and 19% had received a supervisory visit including malaria case-management. At all health facilities 46% of febrile patients were parasitologically tested and 35% of patients were both, tested and treated according to test result. At facilities where AS+SP and malaria diagnostics were available 66% of febrile patients were tested and 51% were both, tested and treated according to test result. Among test positive patients 64% were treated with AS+SP but 24% were treated with artemether monotherapy. Among test negative patients only 17% of patients were treated for malaria. The majority of ACT dispensing and counseling practices were suboptimal. Conclusions Five years following change of the policy from chloroquine to ACTs and 3 years before the end of the new malaria strategic plan chloroquine was successfully phased out from public facilities in Sudan, however, an important gap remained in the availability of ACTs, diagnostic capacities and coverage with malaria case-management activities. The national scale-up of diagnostics, using the findings of this survey as well as future qualitative research, should present an opportunity not only to expand existing testing capacities but also to implement effective support interventions to bridge the health systems gaps and support corrective case-management measures, including the discontinuation of artemether monotherapy treatment. PMID:22221821

Treatment strategy for a multidrug-resistant Klebsiella UTI.

PubMed

Fleming, Erin; Heil, Emily L; Hynicka, Lauren M

2014-01-01

To describe the management strategy for a multidrug-resistant (MDR) Klebsiella urinary tract infection (UTI). A 69-year-old Caucasian woman with a past medical history of recurrent UTIs and a right-lung transplant presented with fever to 101.4°F, chills, malaise, and cloudy, foul-smelling urine for approximately 1 week. She was found to have a MDR Klebsiella UTI that was sensitive to tigecycline and cefepime. To further evaluate the degree of resistance Etest minimum inhibitory concentrations were requested for cefepime, amikacin, meropenem, and ertapenem. The patient received a 14-day course of amikacin, which resulted in resolution of her symptoms. One month later, the patient's UTI symptoms returned. The urine culture again grew MDR Klebsiella, sensitive only to tigecycline. Fosfomycin was initiated and resulted in limited resolution of her symptoms. Colistin was started, however, therapy was discontinued on day 5 secondary to the development of acute kidney injury. Despite the short course of therapy, the patient's symptoms resolved. The case presented lends itself well to numerous discussion items that are important to consider when determining optimal treatment for MDR Gram-negative bacilli (GNBs). Susceptibility testing is an important tool for optimizing antibiotic therapy, however, automated systems may overestimate the susceptibility profile for a MDR GNB. Treatment strategies evaluated to treat MDR GNB, include combination therapy with a carbepenem and synergy using polymyxin. We have described the management strategy for a MDR Klebsiella UTI, the consequences of the initial management strategy, and potential strategies to manage these types of infections in future patients.

Current limitations of the assessment of haemostasis in adult extracorporeal membrane oxygenation patients and the role of point-of-care testing.

PubMed

Venkatesh, K; Nair, P S; Hoechter, D J; Buscher, H

2016-11-01

Haemostatic perturbations are commonly seen in extracorporeal membrane oxygenation (ECMO) patients and remain a clinical challenge, contributing significantly to morbidity and mortality. The approach to anticoagulation monitoring and the management of bleeding varies considerably across ECMO centres. Routine laboratory tests have their limitations in terms of turnaround time and specificity of information provided. Newer point-of-care testing (POCT) for coagulation may overcome these issues, as it provides information about the entire coagulation pathway from clot initiation to lysis. It is also possible to obtain qualitative information on platelet function from these tests. Furthermore, the ability to incorporate these results into a goal-directed algorithm to manage bleeding with targeted transfusion strategies appears particularly attractive and cost effective. Further studies are required to evaluate the utility of POCT to optimise bleeding and anticoagulation management in these complex patients.

A Randomized Trial of a Web-based Intervention to Improve Migraine Self-Management and Coping

PubMed Central

Bromberg, Jonas; Wood, Mollie E.; Black, Ryan A.; Surette, Daniel A.; Zacharoff, Kevin L.; Chiauzzi, Emil J.

2011-01-01

Objective Test the clinical efficacy of a web-based intervention designed to increase patient self-efficacy to perform headache self-management activities and symptom management strategies; and reduce migraine-related psychological distress. Background In spite of their demonstrated efficacy, behavioral interventions are used infrequently as an adjunct in medical treatment of migraine. Little clinical attention is paid to the behavioral factors that can help manage migraine more effectively, improve the quality of care, and improve quality of life. Access to evidenced-based, tailored, behavioral treatment is limited for many people with migraine. Design The study is a parallel group design with two conditions, (1) an experimental group exposed to the web intervention, and (2) a no-treatment control group that was not exposed to the intervention. Assessments for both groups were conducted at baseline (T1), 1-month (T2), 3-months (T3), and 6-months (T4). Results Compared to controls, participants in the experimental group reported significantly: increased headache self-efficacy, increased use of relaxation, increased use of social support, decreased pain catastrophizing, decreased depression, and decreased stress. The hypothesis that the intervention would reduce pain could not be tested. Conclusions Demonstrated increases in self-efficacy to perform headache self-management, increased use of positive symptom management strategies, and reported decreased migraine-related depression and stress, suggest that the intervention may be a useful behavioral adjunct to a comprehensive medical approach to managing migraine. PMID:22413151

Resolving disagreements in the patient-physician relationship: tools for improving communication in managed care.

PubMed

Levinson, W; Gorawara-Bhat, R; Dueck, R; Egener, B; Kao, A; Kerr, C; Lo, B; Perry, D; Pollitz, K; Reifsteck, S; Stein, T; Santa, J; Kemp-White, M

1999-10-20

Managed care uses financial incentives and restrictions on tests and procedures to attempt to influence physician decision making and limit costs. Increasingly, the public is questioning whether physicians are truly making decisions based on the patient's best interest or are unduly influenced by economic incentives. These circumstances lead to the potential for disagreements and conflict in the patient-physician relationship. We convened a group of individuals in October 1998, including patient representatives, leaders from health care organizations, practicing physicians, communication experts, and medical ethicists, to articulate the types of disagreements emerging in the patient-physician relationship as a result of managed care. We addressed 3 specific scenarios physicians may encounter, including allocation, illustrated by a patient who is referred to a different ophthalmologist based on a new arrangement in the physician's group; access, illustrated by a patient who wishes to see his own physician for a same-day visit rather than a nurse specialist; and financial incentives, illustrated by a patient who expects to have a test performed and a physician who does not believe the test is necessary but is afraid the patient will think the physician is not ordering the test because of financial incentives. Using these scenarios, we suggest communication strategies that physicians can use to decrease the potential for disagreements. In addition, we propose strategies that health plans or physician groups can use to alleviate or resolve these disagreements.

Disease management and medication compliance.

PubMed

Cohen, Joshua; Christensen, Kathyrn; Feldman, Lanna

2012-02-01

Lack of medication compliance is harmful to health care systems from both a clinical and economic perspective. This study examines the methods that disease management organizations employ to identify nonadherent patients and to measure effectiveness of compliance programs for patients with diabetes, hyperlipidemia, and cystic fibrosis. In addition, this study investigates the degree to which disease managers assume risk in their contracts, and whether compliance strategies are being coordinated with payers' use of value-based insurance design, in which patient cost sharing is a function of the relative value of pharmaceuticals. This study's findings suggest that disease management may be falling short in terms of: (a) comprehensive commitment to expert-recommended at-home devices used to self-diagnose and measure health indicators; (b) early adoption of expert-recommended new technologies to measure and improve compliance; (c) intensity of use of standard tests in outpatient clinics; (d) coordination of compliance strategies with payers' use of value-based insurance design; and (e) the proportion of risk assumed in disease management contracts.

Power-balancing instantaneous optimization energy management for a novel series-parallel hybrid electric bus

NASA Astrophysics Data System (ADS)

Sun, Dongye; Lin, Xinyou; Qin, Datong; Deng, Tao

2012-11-01

Energy management(EM) is a core technique of hybrid electric bus(HEB) in order to advance fuel economy performance optimization and is unique for the corresponding configuration. There are existing algorithms of control strategy seldom take battery power management into account with international combustion engine power management. In this paper, a type of power-balancing instantaneous optimization(PBIO) energy management control strategy is proposed for a novel series-parallel hybrid electric bus. According to the characteristic of the novel series-parallel architecture, the switching boundary condition between series and parallel mode as well as the control rules of the power-balancing strategy are developed. The equivalent fuel model of battery is implemented and combined with the fuel of engine to constitute the objective function which is to minimize the fuel consumption at each sampled time and to coordinate the power distribution in real-time between the engine and battery. To validate the proposed strategy effective and reasonable, a forward model is built based on Matlab/Simulink for the simulation and the dSPACE autobox is applied to act as a controller for hardware in-the-loop integrated with bench test. Both the results of simulation and hardware-in-the-loop demonstrate that the proposed strategy not only enable to sustain the battery SOC within its operational range and keep the engine operation point locating the peak efficiency region, but also the fuel economy of series-parallel hybrid electric bus(SPHEB) dramatically advanced up to 30.73% via comparing with the prototype bus and a similar improvement for PBIO strategy relative to rule-based strategy, the reduction of fuel consumption is up to 12.38%. The proposed research ensures the algorithm of PBIO is real-time applicability, improves the efficiency of SPHEB system, as well as suite to complicated configuration perfectly.

Economic evaluation of test-and-treat and empirical treatment strategies in the eradication of Helicobacter pylori infection; A Markov model in an Iranian adult population.

PubMed

Mazdaki, Alireza; Ghiasvand, Hesam; Sarabi Asiabar, Ali; Naghdi, Seyran; Aryankhesal, Aidin

2016-01-01

Helicobacter pylori may cause many gastrointestinal problems in developing countries such as Iran. We aimed to analyze the cost- effectiveness and cost- utility of the test-and-treat and empirical treatment strategies in managing Helicobacter pylori infection. This was a Markov based economic evaluation. Effectiveness was defined as the symptoms free numbers and QALYs in 100,000 hypothetical adults. The sensitivity analysis was based on Monte Carlo approach. In the test- and- treat strategy, if the serology is the first diagnostic test vs. histology, the cost per symptoms free number would be 291,736.1 Rials while the cost per QALYs would be 339,226.1 Rials. The cost per symptoms free number and cost per QALYs when the 13 C-UBT was used as the first diagnostic test vs. serology was 1,283,200 and 1,492,103 Rials, respectively. In the empirical strategy, if histology is used as the first diagnostic test vs. 13 CUBT, the cost per symptoms free numbers and cost per QALYs would be 793,234 and 955,698 Rials, respectively. If serology were used as the first diagnostic test vs. histology, the cost per symptoms free and QALYs would be 793,234 and 368941 Rials, respectively. There was no significant and considerable dominancy between the alternatives and the diagnostic tests.

Porter's generic strategies, discontinuous environments, and performance: a longitudinal study of changing strategies in the hospital industry.

PubMed

Lamont, B T; Marlin, D; Hoffman, J J

1993-12-01

Changes in generic strategies in response to discontinuous environments have been relatively ignored in the management literature. This study reports an examination of the relationships between Porter's (1980) generic strategies, discontinuous environments, and performance. Archival data for 1984 and 1988 were collected for 172 acute care hospitals in Florida in order to test these relationships. To examine fully the performance impact of changes in strategy in a discontinuous environment, a longitudinal research design that identified a firm's strategy at two points in time, 1984 and 1988, was used. Results indicate that firms with a proper strategy environment fit performed the highest, firms that did not change their strategy had no change in performance, and firms that changed their strategy toward a proper strategy environment showed an increase in performance. Findings support the notion that hospitals with appropriate strategy-environment combinations will exhibit higher performance.

Scalable and fail-safe deployment of the ATLAS Distributed Data Management system Rucio

NASA Astrophysics Data System (ADS)

Lassnig, M.; Vigne, R.; Beermann, T.; Barisits, M.; Garonne, V.; Serfon, C.

2015-12-01

This contribution details the deployment of Rucio, the ATLAS Distributed Data Management system. The main complication is that Rucio interacts with a wide variety of external services, and connects globally distributed data centres under different technological and administrative control, at an unprecedented data volume. It is therefore not possible to create a duplicate instance of Rucio for testing or integration. Every software upgrade or configuration change is thus potentially disruptive and requires fail-safe software and automatic error recovery. Rucio uses a three-layer scaling and mitigation strategy based on quasi-realtime monitoring. This strategy mainly employs independent stateless services, automatic failover, and service migration. The technologies used for deployment and mitigation include OpenStack, Puppet, Graphite, HAProxy and Apache. In this contribution, the interplay between these components, their deployment, software mitigation, and the monitoring strategy are discussed.

Lessons learnt from past Flash Floods and Debris Flow events to propose future strategies on risk management

NASA Astrophysics Data System (ADS)

Cabello, Angels; Velasco, Marc; Escaler, Isabel

2010-05-01

Floods, including flash floods and debris flow events, are one of the most important hazards in Europe regarding both economic and life loss. Moreover, changes in precipitation patterns and intensity are very likely to increase due to the observed and predicted global warming, rising the risk in areas that are already vulnerable to floods. Therefore, it is very important to carry out new strategies to improve flood protection, but it is also crucial to take into account historical data to identify high risk areas. The main objective of this paper is to show a comparative analysis of the flood risk management information compiled in four test-bed basins (Llobregat, Guadalhorce, Gardon d'Anduze and Linth basins) from three different European countries (Spain, France and Switzerland) and to identify which are the lessons learnt from their past experiences in order to propose future strategies on risk management. This work is part of the EU 7th FP project IMPRINTS which aims at reducing loss of life and economic damage through the improvement of the preparedness and the operational risk management of flash flood and debris flow (FF & DF) events. The methodology followed includes the following steps: o Specific survey on the effectivity of the implemented emergency plans and risk management procedures sent to the test-bed basin authorities that participate in the project o Analysis of the answers from the questionnaire and further research on their methodologies for risk evaluation o Compilation of available follow-up studies carried out after major flood events in the four test-bed basins analyzed o Collection of the lessons learnt through a comparative analysis of the previous information o Recommendations for future strategies on risk management based on lessons learnt and management gaps detected through the process As the Floods Directive (FD) already states, the flood risks associated to FF & DF events should be assessed through the elaboration of Flood Risk Management Plans (FRMP) with tailored solutions for each basin, evaluating their flood mitigation potential, promoting environmental objectives and increasing the efficiency of the already adopted measures. The FRMP should focus on prevention (and protection), preparedness and response, and these have been the three main risk management phases of a flood crisis that have been assessed when extracting the lessons learnt from past events. Lessons learnt concerning dissemination through the three previously mentioned phases and also related to education initiatives have also been included. A common response to most of the events described in this paper was to upgrade the meteorological and hydrological forecasting systems, making the forecasting lead-time as large as possible. Another common recommendation from the test-beds was the need to implement and accomplish the land use regulations. All the basins also detected that structural measures are necessary to increase the population's protection level, but replacing the traditional safety mentality by a risk culture based on a comprehensive analysis of the flood risk. The four basins studied have also highlighted the importance of collecting information when FF & DF events occur and creating historic databases that will provide extremely useful information in the future.

Impact of Conflict Management Strategies on the Generation Mechanism of Miners' Unsafe Behavior Tendency

ERIC Educational Resources Information Center

Li, Ji-Zu; Zhang, Ya-Ping; Liu, Xiao-Guang; Liu, Yao-Long; Wang, Tian-Ri

2017-01-01

In this paper, we examine the relationship between the generation mechanism of miners' unsafe behavior tendency and conflict management strategies, including cooperative conflict management strategy, competitive conflict management strategy and avoidant conflict management strategy. Miners from 3 collieries in Shanxi province completed a…

Beyond PARR - PMEL's Integrated Data Management Strategy

NASA Astrophysics Data System (ADS)

Burger, E. F.; O'Brien, K.; Manke, A. B.; Schweitzer, R.; Smith, K. M.

2016-12-01

NOAA's Pacific Marine Environmental Laboratory (PMEL) hosts a wide range of scientific projects that span a number of scientific and environmental research disciplines. Each of these 14 research projects have their own data streams that are as diverse as the research. With its requirements for public access to federally funded research results and data, the 2013 White House Office of Science and Technology memo on Public Access to Research Results (PARR) changed the data management landscape for Federal agencies. In 2015, with support from the PMEL Director, Dr. Christopher Sabine, PMEL's Science Data Integration Group (SDIG) initiated a multi-year effort to formulate and implement an integrated data-management strategy for PMEL research efforts. Instead of using external requirements, such as PARR, to define our approach, we focussed on strategies to provide PMEL science projects with a unified framework for data submission, interoperable data access, data storage, and easier data archival to National Data Centers. This improves data access to PMEL scientists, their collaborators, and the public, and also provides a unified lab framework that allows our projects to meet their data management objectives, as well as those required by the PARR. We are implementing this solution in stages that allows us to test technology and architecture choices before comitting to a large scale implementation. SDIG developers have completed the first year of development where our approach is to reuse and leverage existing frameworks and standards. This presentation will describe our data management strategy, explain our phased implementation approach, the software and framework choices, and how these elements help us meet the objectives of this strategy. We will share the lessons learned in dealing with diverse and complex datasets in this first year of implementation and how these outcomes will shape our decisions for this ongoing effort. The data management capabilities now available to scientific projects, and other services being developed to manage and preserve PMEL's scientific data assets for our researchers, their collaborators, and future generations, will be described.

Developing an active implementation model for a chronic disease management program

PubMed Central

Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter

2013-01-01

Background Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council’s model for complex interventions and the Chronic Care Model. Methods We used the Medical Research Council’s five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. Results The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council’s model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). Conclusion The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council’s model added transparency to the design phase which further facilitated the process of implementing the program. Trial registration: http://www.clinicaltrials.gov/(NCT01228708). PMID:23882169

Mobile Apps for Weight Management: A Scoping Review.

PubMed

Rivera, Jordan; McPherson, Amy; Hamilton, Jill; Birken, Catherine; Coons, Michael; Iyer, Sindoora; Agarwal, Arnav; Lalloo, Chitra; Stinson, Jennifer

2016-07-26

Obesity remains a major public health concern. Mobile apps for weight loss/management are found to be effective for improving health outcomes in adults and adolescents, and are pursued as a cost-effective and scalable intervention for combating overweight and obesity. In recent years, the commercial market for 'weight loss apps' has expanded at rapid pace, yet little is known regarding the evidence-based quality of these tools for weight control. To characterize the inclusion of evidence-based strategies, health care expert involvement, and scientific evaluation of commercial mobile apps for weight loss/management. An electronic search was conducted between July 2014 and July 2015 of the official app stores for four major mobile operating systems. Three raters independently identified apps with a stated goal of weight loss/management, as well as weight loss/management apps targeted to pediatric users. All discrepancies regarding selection were resolved through discussion with a fourth rater. Metadata from all included apps were abstracted into a standard assessment criteria form and the evidence-based strategies, health care expert involvement, and scientific evaluation of included apps was assessed. Evidence-based strategies included: self-monitoring, goal-setting, physical activity support, healthy eating support, weight and/or health assessment, personalized feedback, motivational strategies, and social support. A total of 393 apps were included in this review. Self-monitoring was most common (139/393, 35.3%), followed by physical activity support (108/393, 27.5%), weight assessment (100/393, 25.4%), healthy eating support (91/393, 23.2%), goal-setting (84/393, 21.4%), motivational strategies (28/393, 7.1%), social support (21/393, 5.3%), and personalized feedback (7/393, 1.8%). Of apps, 0.8% (3/393) underwent scientific evaluation and 0.3% (1/393) reported health care expert involvement. No apps were comprehensive in the assessment criteria, with the majority of apps meeting less than two criteria. Commercial mobile apps for weight loss/management lack important evidence-based features, do not involve health care experts in their development process, and have not undergone rigorous scientific testing. This calls into question the validity of apps' claims regarding their effectiveness and safety, at a time when the availability and growth in adoption of these tools is rapidly increasing. Collaborative efforts between developers, researchers, clinicians, and patients are needed to develop and test high-quality, evidence-based mobile apps for weight loss/management before they are widely disseminated in commercial markets.

Sustainable improvement of animal health care by systematic quality risk management according to the HACCP concept.

PubMed

Noordhuizen, J P; Welpelo, H J

1996-12-01

This paper addresses the principles of the Hazard Analysis Critical Control Point (HACCP) concept as applied to animal health management strategy. Characteristics of the concept were analysed and compared with those of current animal health care strategies for disease risk identification and herd health management, insurance, and certification. HACCP is a hybrid strategy of quality control at both production process and product level. Animal health is considered a particular quality feature. We show that process control (expressed in terms of controlling both general and specific disease risk factors) and product control (expressed in terms of testing animals or animal products for specific disease agents) could form the basis for improving animal health. We conclude that HACCP provides ample opportunity for preventive health action and risk management at a relatively low cost in terms of labour, finance and documentation expenditure, at both the farm and sector level. Epidemiological field studies are currently needed to identify critical control points and to design HACCP procedures for livestock producers. In the long run, HACCP based animal health care can be further developed into a quality control systems approach to cover all aspects that are related, either directly or indirectly, to animal health.

Dream project: Applications of earth observations to disaster risk management

NASA Astrophysics Data System (ADS)

Dyke, G.; Gill, S.; Davies, R.; Betorz, F.; Andalsvik, Y.; Cackler, J.; Dos Santos, W.; Dunlop, K.; Ferreira, I.; Kebe, F.; Lamboglia, E.; Matsubara, Y.; Nikolaidis, V.; Ostoja-Starzewski, S.; Sakita, M.; Verstappen, N.

2011-01-01

The field of disaster risk management is relatively new and takes a structured approach to managing uncertainty related to the threat of natural and man-made disasters. Disaster risk management consists primarily of risk assessment and the development of strategies to mitigate disaster risk. This paper will discuss how increasing both Earth observation data and information technology capabilities can contribute to disaster risk management, particularly in Belize. The paper presents the results and recommendations of a project conducted by an international and interdisciplinary team of experts at the 2009 session of the International Space University in NASA Ames Research Center (California, USA). The aim is to explore the combination of current, planned and potential space-aided, airborne, and ground-based Earth observation tools, the emergence of powerful new web-based and mobile data management tools, and how this combination can support and improve the emerging field of disaster risk management. The starting point of the project was the World Bank's Comprehensive Approach to Probabilistic Risk Assessment (CAPRA) program, focused in Central America. This program was used as a test bed to analyze current space technologies used in risk management and develop new strategies and tools to be applied in other regions around the world.

Pilot Testing "Okay with Asthma"[TM]: An Online Asthma Intervention for School-Age Children

ERIC Educational Resources Information Center

Wyatt, Tami H.; Hauenstein, Emily J.

2008-01-01

Asthma is the leading cause of missed school days despite advancements in asthma treatment. This may be, in part, due to a lack of understanding about asthma. "Okay With Asthma"[TM], an online story with psychosocial management strategies for school-age children, was pilot tested to measure its effect on asthma knowledge and attitude. The online…

Possibilities and limitations of using historic provenance tests to infer forest species growth responses to climate change

Treesearch

Laura P. Leites; Gerald E. Rehfeldt; Andrew P. Robinson; Nicholas L. Crookston; Barry Jaquish

2012-01-01

Under projected changes in global climate, the growth and survival of existing forests will depend on their ability to adjust physiologically in response to environmental change. Quantifying their capacity to adjust and whether the response is species- or population-specific is important to guide forest management strategies. New analyses of historic provenance tests...

Decision method for optimal selection of warehouse material handling strategies by production companies

NASA Astrophysics Data System (ADS)

Dobos, P.; Tamás, P.; Illés, B.

2016-11-01

Adequate establishment and operation of warehouse logistics determines the companies’ competitiveness significantly because it effects greatly the quality and the selling price of the goods that the production companies produce. In order to implement and manage an adequate warehouse system, adequate warehouse position, stock management model, warehouse technology, motivated work force committed to process improvement and material handling strategy are necessary. In practical life, companies have paid small attantion to select the warehouse strategy properly. Although it has a major influence on the production in the case of material warehouse and on smooth costumer service in the case of finished goods warehouse because this can happen with a huge loss in material handling. Due to the dynamically changing production structure, frequent reorganization of warehouse activities is needed, on what the majority of the companies react basically with no reactions. This work presents a simulation test system frames for eligible warehouse material handling strategy selection and also the decision method for selection.

Environmental scanning as a moderator of strategy-performance relationships: an empirical analysis of physical therapy facilities.

PubMed

Davis, Mark A; Miles, Grant; McDowell, William C

2008-05-01

To date, strategic management research in health care is largely confined to the acute care sector of the industry. This research examines the linkages among environmental scanning, competitive strategy and performance in physical therapy facilities. Nontrivial differences between acute and subacute care firms suggest the role of environmental scanning may change in non-acute care settings. Consistent with previous research, these results indicate that the frequency of internal and external scanning is related to the strategic orientation of physical therapy facilities. Contrary to the expectations, broader scope of scanning is positively related to an increasing market-focused and increasing efficiency strategic orientation. A key objective of the research is to test the impact of strategy/scanning alignment on facility performance. These findings support predictions on the moderating role of scanning activities in the strategy-performance relationship. However, a paradoxical pattern of results has possible implications for clinician managers in subacute care settings as well as the interpretation of scanning activities.

HOME-BASED BLOOD PRESSURE INTERVENTIONS FOR AFRICAN AMERICANS

PubMed Central

Feldman, Penny H.; McDonald, Margaret V.; Mongoven, Jennifer M.; Peng, Timothy R.; Gerber, Linda M.; Pezzin, Liliana E.

2009-01-01

Background Efforts to increase blood pressure (BP) control rates in African Americans, a traditionally underserved, high risk population must address both provider practice and patient adherence issues. The Home-Based BP Intervention for African Americans study is a three-arm randomized controlled trial designed to test two strategies to improve HTN management and outcomes in a decentralized service setting serving a vulnerable and complex home care population. The primary study outcomes are systolic BP, diastolic BP, and BP control; secondary outcomes are nurse adherence to HTN management recommendations, and patient adherence to medication, healthy diet and other self-management strategies. Methods and Results Nurses (N=312) in a nonprofit Medicare-certified home health agency are randomized along with their eligible hypertensive patients (N=845). The two interventions being tested are: (i) a “basic” intervention delivering key evidence-based reminders to home care nurses and patients while the patient is receiving traditional post-acute home health care; and (ii) an “augmented” intervention that includes that same as the basic intervention, plus transition to an ongoing HTN Home Support Program that extends support for 12 months. Outcomes are measured at 3 and 12 months post baseline interview. The interventions will be assessed relative to usual care and to each other. Conclusions Systems change to improve BP management and outcomes in home health will not easily occur without new intervention models and rigorous evaluation of their impact. Results from this trial will provide important information on potential strategies to improve BP control in a low income, chronically ill patient population. PMID:20031844

Design an optimum safety policy for personnel safety management - A system dynamic approach

NASA Astrophysics Data System (ADS)

Balaji, P.

2014-10-01

Personnel safety management (PSM) ensures that employee's work conditions are healthy and safe by various proactive and reactive approaches. Nowadays it is a complex phenomenon because of increasing dynamic nature of organisations which results in an increase of accidents. An important part of accident prevention is to understand the existing system properly and make safety strategies for that system. System dynamics modelling appears to be an appropriate methodology to explore and make strategy for PSM. Many system dynamics models of industrial systems have been built entirely for specific host firms. This thesis illustrates an alternative approach. The generic system dynamics model of Personnel safety management was developed and tested in a host firm. The model was undergone various structural, behavioural and policy tests. The utility and effectiveness of model was further explored through modelling a safety scenario. In order to create effective safety policy under resource constraint, DOE (Design of experiment) was used. DOE uses classic designs, namely, fractional factorials and central composite designs. It used to make second order regression equation which serve as an objective function. That function was optimized under budget constraint and optimum value used for safety policy which shown greatest improvement in overall PSM. The outcome of this research indicates that personnel safety management model has the capability for acting as instruction tool to improve understanding of safety management and also as an aid to policy making.

A systematic review of randomized trials assessing human papillomavirus testing in cervical cancer screening

PubMed Central

Patanwala, Insiyyah Y.; Bauer, Heidi M.; Miyamoto, Justin; Park, Ina U.; Huchko, Megan J.; Smith-McCune, Karen K.

2013-01-01

Our objective was to assess the sensitivity and specificity of human papillomavirus (HPV) testing for cervical cancer screening in randomized trials. We conducted a systematic literature search of the following databases: MEDLINE, CINAHL, EMBASE, and Cochrane. Eligible studies were randomized trials comparing HPV-based to cytology-based screening strategies, with disease status determined by colposcopy/biopsy for participants with positive results. Disease rates (cervical intraepithelial neoplasia [CIN]2 or greater and CIN3 or greater), sensitivity, and positive predictive value were abstracted or calculated from the articles. Six studies met inclusion criteria. Relative sensitivities for detecting CIN3 or greater of HPV testing-based strategies vs cytology ranged from 0.8 to 2.1. The main limitation of our study was that testing methodologies and screening/management protocols were highly variable across studies. Screening strategies in which a single initial HPV-positive test led to colposcopy were more sensitive than cytology but resulted in higher colposcopy rates. These results have implications for cotesting with HPV and cytology as recommended in the United States. PMID:23159693

Targeting of glycine site on NMDA receptor as a possible new strategy for autism treatment.

PubMed

Ghanizadeh, Ahmad

2011-05-01

The exact pathophysiology of the neurodevelopment disorder of autism is not clear and there is not any curative approach for it. There is only one FDA-approved medication for its management. Therefore, providing of novel treatments is highly required. The hypofunction of GABAergic system and glutamate toxicity are generally believed to have a causal role for autism. The antagonist of the N-methyl-D-aspartic acid (NMDA) glutamate receptor improves autism. Glycine is required for the activation of NMDA receptor. The antagonist of glycine site decreases NMDA receptor conductance. It is hypothesis that glycine site antagonists can be tested as a new strategy for the management of autism.

Mitigating amphibian disease: strategies to maintain wild populations and control chytridiomycosis

USGS Publications Warehouse

Woodhams, Douglas C.; Bosch, Jaime; Briggs, Cheryl J.; Cashins, Scott; Davis, Leyla R.; Lauer, Antje; Muths, Erin L.; Puschendorf, Robert; Schmidt, Benedikt R.; Sheafor, Brandon; Voyles, Jamie

2011-01-01

Because sustainable conservation of amphibians in nature is dependent on long-term population persistence and co-evolution with potentially lethal pathogens, we suggest that disease mitigation not focus exclusively on the elimination or containment of the pathogen, or on the captive breeding of amphibian hosts. Rather, successful disease mitigation must be context specific with epidemiologically informed strategies to manage already infected populations by decreasing pathogenicity and host susceptibility. We propose population level treatments based on three steps: first, identify mechanisms of disease suppression; second, parameterize epizootiological models of disease and population dynamics for testing under semi-natural conditions; and third, begin a process of adaptive management in field trials with natural populations.

Seed longevity and dormancy state suggest management strategies for garlic mustard (Alliaria petiolata) and Japanese stiltgrass (Microstegium vimineum) in deciduous forest sites

Treesearch

Mame E. Redwood; Glenn R. Matlack; Cynthia D. Huebner

2018-01-01

An effective management plan for invasive herb populations must consider the potential for regeneration from the soil seedbank. To test chis potential, we examined two species, Japanese scilcgrass and garlic mustard, at deciduous forest sites in southeastern Ohio. Seeds were buried in nylon mesh bags and recovered at regular intervals over 24 mo. Recovered seeds were...

A Boy with Relentless Pruritus: Job's Syndrome.

PubMed

Khan, Kamran; Wozniak, Susan E; Giannone, Anna Lucia; Abdulmassih, Maria Elena

2016-02-21

Job's syndrome (hyper IgE syndrome) is a very rare primary immunodeficiency disease that has an annual approximate incidence of less than 1/1,000,000. This manuscript aims to provide education regarding diagnosis and management strategies of this syndrome worldwide. A 6-year-old boy was seen at the clinic secondary to persistent pruritus interfering with sleep. At the age of 2 months, the patient developed diffuse eczematous and desquamating skin lesions. He was subsequently diagnosed with atopic dermatitis and managed conservatively. From 2 months to 7 years of age, intermittent exacerbations of dermatitis persisted despite an aggressive treatment regimen. The serum IgE level increased exponentially over a period of 7 years, with a peak value of 57,400 IU/ml. Molecular genetic testing revealed a dominant negative mutation within the SH2 domain of the Signal Transducer and Activator of Transcription (STAT3) gene. The patient was subsequently diagnosed with Job's syndrome. Management included proper skin care, prophylactic antibiotics, immunomodulating agents, and psychotherapy. Job's syndrome can often go unrecognized and masquerade as atopic dermatitis. Therefore, genetic testing for this condition should be obtained in all patients with treatment-refractory AD. Additionally, psychotherapy can be a successful management strategy for the grating psychological impact that can be imposed on children with excessive pruritus.

Evidence-based tick acaricide resistance intervention strategy in Uganda: Concept and feedback of farmers and stakeholders.

PubMed

Vudriko, Patrick; Okwee-Acai, James; Byaruhanga, Joseph; Tayebwa, Dickson Stuart; Omara, Robert; Muhindo, Jeanne Bukeka; Lagu, Charles; Umemiya-Shirafuji, Rika; Xuan, Xuenan; Suzuki, Hiroshi

2018-02-01

The emergence of multi-acaricide resistant ticks has led to unprecedented level of acaricide failure in central and western Uganda. In the absence of a national acaricide resistance management strategy, the country's dairy sector is threatened by upsurge of ticks and tick-borne diseases. In this study, we developed a short-to-medium-term intervention approach called Evidence-Based Acaricide Tick Control (EBATIC): Identify, Test, Intervene and Eradicate (IT-IE). Furthermore, the perception of 199 farmers and extension workers, 12 key informants in four districts and 47 stakeholders in the animal industry in Uganda were assessed using semi-structured questionnaires. We report that the establishment of a specialized laboratory is pivotal in identifying and testing (IT) acaricide resistant ticks for prompt intervention and eradication (IE). The laboratory test results and the farm tick control gaps identified are very important in guiding acaricide resistance management strategies such as evidence-based acaricide rotation, development and dissemination of extension materials, training of farmers and extension workers, and stakeholders' engagement towards finding sustainable solutions. All the 47 stakeholders and 91.0% (181/199) of the farmers and extension workers reported that the EBATIC approach will help in solving the tick acaricide resistance crisis in Uganda. Similarly, all the 12 key informants and 92.5% (184/199) of the farmers and extension workers suggested that the EBATIC approach should be sustained and rolled out to other districts. The EBATIC stakeholders' dialogue generated both short-to-medium and long-term strategies for sustainable management of tick acaricide resistance in the country. Overall, the positive feedback from farmers, district veterinarians and stakeholders in the animal industry suggest that the EBATIC approach is a useful proof-of-concept on scalable intervention pathway against tick acaricide resistance in Uganda with possibility of adoption in other African countries. Copyright © 2017 Elsevier GmbH. All rights reserved.

Management of coronary artery disease

NASA Astrophysics Data System (ADS)

Safri, Z.

2018-03-01

Coronary Artery Disease (CAD) is associated with significant morbidity and mortality, therefore it’s important to early and accurate detection and appropriate management. Diagnosis of CAD include clinical examination, noninvasive techniques such as biochemical testing, a resting ECG, possibly ambulatory ECG monitoring, resting echocardiography, chest X-ray in selected patients; and catheterization. Managements of CAD patients include lifestyle modification, control of CAD risk factors, pharmacologic therapy, and patient education. Revascularization consists of percutaneous coronary angioplasty and coronary artery bypass grafting. Cardiac rehabilitation should be considered in all patients with CAD. This comprehensive review highlights strategies of management in patients with CAD.

Flight-management strategies for escape from microburst encounters. M.S. Thesis - George Washington Univ.

NASA Technical Reports Server (NTRS)

Hinton, David A.

1988-01-01

An effort is underway by NASA, FAA, and industry to reduce the threat of convective microburst wind shear phenomena to aircraft. The goal is to develop and test a candidate set of strategies for recovery from inadvertent microburst encounters during takeoff. Candidate strategies were developed and evaluated using a fast-time simulation consisting of a simple point-mass performance model of a transport-category airplane and an analytical microburst model. The results indicate that the recovery strategy characteristics that best utilize available airplane energy include an initial reduction in pitch attitude to reduce the climb rate, followed by an increase in pitch up to the stick shaker angle of attack. The stick shaker angle of attack should be reached just as the airplane is exiting the microburst. The shallowest angle of climb necessary for obstacle clearance should be used. If the altitude is higher than necessary, an intentional descent to reduce the airspeed deceleration should be used. Of the strategies tested, two flight-path-angle based strategies had the highest recovery altitudes and the least sensitivity to variations in the encounter scenarios.

Secondary hypertension: the ways of management.

PubMed

Rossi, Gian P; Seccia, Teresa M; Pessina, Achille C

2010-11-01

The prevalence of secondary hypertension is lower than that of primary (essential) hypertension, but it is likely that it has been underestimated because appropriate tests were not generally performed. Hence, before embarking on a search for secondary hypertension physicians are generally advised to select populations of patients with a high pre-test probability of secondary forms of hypertension in order to maximize the positive predictive value and the gain in "ruling in" of the diagnostic tests. Based on updated information on prevalence and pathophysiology we herein critically review the general diagnostic strategy and the management of the main forms of secondary hypertension. In particular, strategies for identifying primary aldosteronism, the most frequent form of endocrine secondary hypertension, and for determining its unilateral or bilateral causes are discussed in details, because of the differences of treatment that requires adrenalectomy in the unilateral forms and mineralocorticoid receptor blockade in the bilateral forms. The tests available for the diagnosing pheochromocytoma (pheo), which is much rarer but extremely important to identify, as it can be fatal if unrecognized are also discussed, with emphasis on the recent developments in genetic testing. Renovascular hypertension is also a common curable form of hypertension, which should be identified as early as possible to avoid the onset of cardiovascular target organ damage and events, is also discussed.

Enhancing industry-based dissemination of an occupational sun protection program with theory-based strategies employing personal contact.

PubMed

Buller, David B; Andersen, Peter A; Walkosz, Barbara J; Scott, Michael D; Cutter, Gary R; Dignan, Mark B; Kane, Ilima L; Zhang, Xiao

2012-01-01

Industry-based strategies for dissemination of an evidence-based occupational sun protection program, Go Sun Smart (GSS), were tested. Two dissemination strategies were compared in a randomized trial in 2004-2007. The North American ski industry. Ski areas in the United States and Canada (n  =  69) and their senior managers (n  =  469). Employers received GSS through a basic dissemination strategy (BDS) from the industry's professional association that included conference presentations and free starter kits. Half of the areas also received the enhanced dissemination strategy (EDS), in which project staff met face-to-face with managers and made ongoing contacts to support program use. Observation of program materials in use and managers' reports on communication about sun protection. The effects of two alternative dissemination strategies were compared on program use using PROC MIXED in SAS, adjusted for covariates using one-tailed p values. Ski areas receiving the EDS used more GSS materials (x¯  =  7.36) than those receiving the BDS (x¯  =  5.17; F  =  7.82, p < .01). Managers from more areas receiving the EDS reported communicating about sun protection in employee newsletters/flyers (x¯  =  .97, p  =  .04), in guest e-mail messages (x¯  =  .75, p  =  .02), and on ski area Web sites (x¯  =  .38, p  =  .02) than those receiving the BDS (x¯  =  .84, .50, .15, respectively). Industry professional associations play an important role in disseminating prevention programs; however, active personal communication may be essential to ensure increased implementation fidelity.

Cancer prevention trial of a synergistic mixture of green tea concentrate plus Capsicum (CAPSOL-T) in a random population of subjects ages 40-84

PubMed Central

2014-01-01

Background Experts agree that one of the more promising strategies in cancer management is early detection coupled with early intervention. In this study, we evaluated an early cancer detection strategy of cancer presence based on serum levels of the cancer-specific transcript variants of ENOX2 in serum coupled with an ENOX2-targeted nutraceutical preparation of green tea concentrate plus Capsicum (Capsol-T®) as a strategy of Curative Prevention® involving early detection coupled with early intervention in early stage cancer when in its most susceptible and manageable stages. Experimental design One hundred ten (110) subjects were tested for cancer presence using the ONCOblot® Tissue of Origin 2-D gel/western blot protocol for detection of serum presence of transcript variants of the ENOX2 protein. Subjects testing positive for ENOX2 received 350 mg of Capsol-T® in capsule form every 4 h including during the night for periods of at least 3 to 6 months or longer after which they were again tested for ENOX2 presence using the ONCOblot® Tissue of Origin Cancer Test protocol. Results Of the 110 subjects, both male and female, ages 40 to 84, with no evidence of clinical symptoms of cancer, 40% were positive for ENOX2 presence in the ONCOblot® Tissue of Origin Cancer Test. After completion of 3 to 17 months of Capsol-T® use, 94% of subjects subsequently tested negative for ENOX2 presence. Conclusions Oral Capsol-T® is well tolerated and, for ENOX2 presence in serum in the absence of clinical cancer symptoms, is consistently effective in reducing the serum ENOX2 levels to below detectable limits. PMID:24393573

Impact of a stress management program on stress perception of nurses working with psychiatric patients.

PubMed

Sailaxmi, Gandhi; Lalitha, Krishnasamy

2015-04-01

Nurses caring for psychiatric patients may have to face violent emotions and unpredictable behaviour which can be quite stressful. A stress management program may equip nurses with skills to cope effectively with the stress. A one group pre-test and post-test design was adopted to test this hypothesis. Both gender nurses caring for psychiatric patients were invited to undergo 10 consecutive, one hour sessions of a stress management program. The DCL Stress scale (The De Villiers, Carson & Leary Stress Scale; Carson et al., 1997a,b,c) was used to collect data immediately after intervention and four weeks later. RM ANOVA with spss 16 showed that pre-intervention mean stress reduced significantly (p=0.000) from 57.45±16.42 to 41.06±16.51 immediately following the intervention and 26.43±12.82 (p=0.000) four weeks after the intervention. The stress management strategies positively impacted on nurses' stress levels. Copyright © 2015 Elsevier B.V. All rights reserved.

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

NASA Technical Reports Server (NTRS)

Yan, Jerry C.

1987-01-01

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

An organizational intervention to influence evidence-informed decision making in home health nursing.

PubMed

Gifford, Wendy; Lefebre, Nancy; Davies, Barbara

2014-01-01

The aims of this study were to field test and evaluate a series of organizational strategies to promote evidence-informed decision making (EIDM) by nurse managers and clinical leaders in home healthcare. EIDM is central to delivering high-quality and effective healthcare. Barriers exist and organizational strategies are needed to support EIDM. Management and clinical leaders from 4 units participated in a 20-week organization-focused intervention. Preintervention (n = 32) and postintervention (n = 17) surveys and semistructured interviews (n = 15) were completed. Statistically significant increases were found on 4 of 31 survey items reflecting an increased organizational capacity for participants to acquire and apply research evidence in decision making. Support from designated facilitators with advanced skills in finding, appraising, and applying research was the highest rated intervention strategy. Results are useful to inform the development of organizational infrastructures to increase EIDM capacity in community-based healthcare organizations.

Strategies for Managing the Dual Risk of Sexually Transmitted Infections and Unintended Pregnancy Among Puerto Rican and African American Young Adults

PubMed Central

Hock-Long, Linda; Kraft, Joan Marie; Henry-Moss, Dare; Hatfield-Timajchy, Kendra; Singer, Merrill

2012-01-01

Although young adults in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy, they do not report high rates of dual-method use (condoms plus other contraception) for prevention. We used prospective qualitative data from 69 urban Puerto Rican and African American individuals aged 18 to 25 years to determine how they managed these risks in their heterosexual relationships during a 4- to 8-week period. Hormonal or long-acting contraceptive use, condoms, and withdrawal were the most common unintended pregnancy prevention strategies; condoms, STI testing, and perceived fidelity were dominant among STI prevention strategies. We need to shift the focus from dual-method use toward a broader concept of dual protection to be more responsive to young adults’ concerns, perceptions, and priorities. PMID:22390507

Model-Based Battery Management Systems: From Theory to Practice

NASA Astrophysics Data System (ADS)

Pathak, Manan

Lithium-ion batteries are now extensively being used as the primary storage source. Capacity and power fade, and slow recharging times are key issues that restrict its use in many applications. Battery management systems are critical to address these issues, along with ensuring its safety. This dissertation focuses on exploring various control strategies using detailed physics-based electrochemical models developed previously for lithium-ion batteries, which could be used in advanced battery management systems. Optimal charging profiles for minimizing capacity fade based on SEI-layer formation are derived and the benefits of using such control strategies are shown by experimentally testing them on a 16 Ah NMC-based pouch cell. This dissertation also explores different time-discretization strategies for non-linear models, which gives an improved order of convergence for optimal control problems. Lastly, this dissertation also explores a physics-based model for predicting the linear impedance of a battery, and develops a freeware that is extremely robust and computationally fast. Such a code could be used for estimating transport, kinetic and material properties of the battery based on the linear impedance spectra.

Systematic strategies for the third industrial accident prevention plan in Korea.

PubMed

Kang, Young-sig; Yang, Sung-hwan; Kim, Tae-gu; Kim, Day-sung

2012-01-01

To minimize industrial accidents, it's critical to evaluate a firm's priorities for prevention factors and strategies since such evaluation provides decisive information for preventing industrial accidents and maintaining safety management. Therefore, this paper proposes the evaluation of priorities through statistical testing of prevention factors with a cause analysis in a cause and effect model. A priority matrix criterion is proposed to apply the ranking and for the objectivity of questionnaire results. This paper used regression method (RA), exponential smoothing method (ESM), double exponential smoothing method (DESM), autoregressive integrated moving average (ARIMA) model and proposed analytical function method (PAFM) to analyze trends of accident data that will lead to an accurate prediction. This paper standardized the questionnaire results of workers and managers in manufacturing and construction companies with less than 300 employees, located in the central Korean metropolitan areas where fatal accidents have occurred. Finally, a strategy was provided to construct safety management for the third industrial accident prevention plan and a forecasting method for occupational accident rates and fatality rates for occupational accidents per 10,000 people.

Risk Preferences, Probability Weighting, and Strategy Tradeoffs in Wildfire Management.

PubMed

Hand, Michael S; Wibbenmeyer, Matthew J; Calkin, David E; Thompson, Matthew P

2015-10-01

Wildfires present a complex applied risk management environment, but relatively little attention has been paid to behavioral and cognitive responses to risk among public agency wildfire managers. This study investigates responses to risk, including probability weighting and risk aversion, in a wildfire management context using a survey-based experiment administered to federal wildfire managers. Respondents were presented with a multiattribute lottery-choice experiment where each lottery is defined by three outcome attributes: expenditures for fire suppression, damage to private property, and exposure of firefighters to the risk of aviation-related fatalities. Respondents choose one of two strategies, each of which includes "good" (low cost/low damage) and "bad" (high cost/high damage) outcomes that occur with varying probabilities. The choice task also incorporates an information framing experiment to test whether information about fatality risk to firefighters alters managers' responses to risk. Results suggest that managers exhibit risk aversion and nonlinear probability weighting, which can result in choices that do not minimize expected expenditures, property damage, or firefighter exposure. Information framing tends to result in choices that reduce the risk of aviation fatalities, but exacerbates nonlinear probability weighting. © 2015 Society for Risk Analysis.

Strategy trials: the answer?

PubMed

James, J S

1999-02-19

Although a significant amount of promotional information on drugs was presented at the 6th Conference on Retroviruses and Opportunistic Infections, very little of it was related to practical treatment strategy. Doctors and patients have many options but little guidance on selecting which combination of drugs will be most beneficial in long-term use. There is a growing call for "strategy trials" designed to answer those questions. Pharmaceutical companies traditionally have not done strategy trials; their testing is designed to promote their own products. Managing patients in strategy trials is also difficult because they have to fail a treatment before another combination of drugs is used. In addition, collecting valid data from a stragety trial takes longer than collecting data from a starting regimen trial.

Improving the value of costly genetic reference laboratory testing with active utilization management.

PubMed

Dickerson, Jane A; Cole, Bonnie; Conta, Jessie H; Wellner, Monica; Wallace, Stephanie E; Jack, Rhona M; Rutledge, Joe; Astion, Michael L

2014-01-01

Tests that are performed outside of the ordering institution, send-out tests, represent an area of risk to patients because of complexity associated with sending tests out. Risks related to send-out tests include increased number of handoffs, ordering the wrong or unnecessary test, specimen delays, data entry errors, preventable delays in reporting and acknowledging results, and excess financial liability. Many of the most expensive and most misunderstood tests are send-out genetic tests. To design and develop an active utilization management program to reduce the risk to patients and improve value of genetic send-out tests. Send-out test requests that met defined criteria were reviewed by a rotating team of doctoral-level consultants and a genetic counselor in a pediatric tertiary care center. Two hundred fifty-one cases were reviewed during an 8-month period. After review, nearly one-quarter of genetic test requests were modified in the downward direction, saving a total of 2% of the entire send-out bill and 19% of the test requests under management. Ultimately, these savings were passed on to patients. Implementing an active utilization strategy for expensive send-out tests can be achieved with minimal technical resources and results in improved value of testing to patients.

Leadership Strategies of Performance Measures Impacts in Public Sector Management: A National Content Analysis.

ERIC Educational Resources Information Center

Kubala, James Joseph

A quantitative and qualitative study examined three leadership strategies found in performance-based management (human resource, scientific management and political strategies used in public sector management); a framework by which performance measurement (PM) supports leadership strategies; and how the strategies impact PM. It examined leadership…

The association between quality of care and the intensity of diabetes disease management programs.

PubMed

Mangione, Carol M; Gerzoff, Robert B; Williamson, David F; Steers, W Neil; Kerr, Eve A; Brown, Arleen F; Waitzfelder, Beth E; Marrero, David G; Dudley, R Adams; Kim, Catherine; Herman, William; Thompson, Theodore J; Safford, Monika M; Selby, Joe V

2006-07-18

Although disease management programs are widely implemented, little is known about their effectiveness. To determine whether disease management by physician groups is associated with diabetes care processes, control of intermediate outcomes, or the amount of medication used when intermediate outcomes are above target levels. Cross-sectional study. Patients were randomly sampled from 63 physician groups nested in 7 health plans sponsored by Translating Research into Action for Diabetes (87%) and from 4 health plans with individual physician contracts (13%). 8661 adults with diabetes who completed a survey (2000-2001) and had medical record data. Physician group and health plan directors described their organizations' use of physician reminders, performance feedback, and structured care management on a survey; their responses were used to determine measures of intensity of disease management. The current study measured 8 processes of care, including most recent hemoglobin A1c level, systolic blood pressure, serum low-density lipoprotein cholesterol level, and several measures of medication use. Increased use of any of 3 disease management strategies was significantly associated with higher adjusted rates of retinal screening, nephropathy screening, foot examinations, and measurement of hemoglobin A1c levels. Serum lipid level testing and influenza vaccine administration were associated with greater use of structured care management and performance feedback. Greater use of performance feedback correlated with an increased rate of foot examinations (difference, 5 percentage points [95% CI, 1 to 8 percentage points]), and greater use of physician reminders was associated with an increased rate of nephropathy screening (difference, 15 percentage points [CI, 6 to 23 percentage points]). No strategies were associated with intermediate outcome levels or level of medication management. Physician groups were not randomly sampled from population-based listings, and disease management strategies were not randomly allocated across groups. Disease management strategies were associated with better processes of diabetes care but not with improved intermediate outcomes or level of medication management. A greater focus on direct measurement, feedback, and reporting of intermediate outcome levels or of level of medication management may enhance the effectiveness of these programs.

Protecting raw data and psychological tests from wrongful disclosure: a primer on the law and other persuasive strategies.

PubMed

Kaufmann, Paul M

2009-09-01

Psychologists must advocate for more stringent legal protection of psychological test materials because using standardized tests is the most distinguishing and exclusive feature of psychological evaluation practice. With the rapid growth in forensic consulting, unrestrained discovery of raw data and psychological test materials during litigation erodes the reliability and validity of the test procedures. Dissemination of test materials reduces the interpretive value of the tests and promotes cheating, turning our best methods into junk science in the courtroom. This article proposes to reform the law and to revise the professional ethics of psychologists consistent with the strong public policy of test security as described by the U.S. Supreme Court in Detroit Edison v. NLRB (1979). Currently, federal courts and about 20 states protect psychological tests as a unique methodology, with some states enacting a psychologist nondisclosure privilege/duty to safeguard test materials from wrongful disclosure. The record management practices of psychologists vary considerably and are vulnerable to legal attack unless psychologists are aware of legal arguments to protect test materials from wrongful release. Although this article does not offer legal advice, it describes the most common records management problem confronting neuropsychologists and some practical solutions to the raw data problem. Best practice for protecting psychological tests requires the psychologist to understand the law and to assert the psychologist nondisclosure privilege. Other strategies are presented and evaluated. Organized psychology and the legal community should advocate for a uniform rule to protect the objectivity, fairness, and integrity psychological methods in litigation.

Development of perspective-based water management strategies for the Rhine and Meuse basins.

PubMed

van Deursen, W P A; Middelkoop, H

2005-01-01

Water management is surrounded by uncertainties. Water management thus has to answer the question: given the uncertainties, what is the best management strategy? This paper describes the application of the perspectives method on water management in the Rhine and Meuse basins. In the perspectives method, a structured framework to analyse water management strategies under uncertainty is provided. Various strategies are clustered in perspectives according to their underlying assumptions. This framework allows for an analysis of current water management strategies, but also allows for evaluation of the robustness of proposed future water strategies. It becomes clear that no water management strategy is superior to the others, but that inherent choices on risk acceptance and costs make a real political dilemma which will not be solved by further optimisation.

Research on a power management system for thermoelectric generators to drive wireless sensors on a spindle unit.

PubMed

Li, Sheng; Yao, Xinhua; Fu, Jianzhong

2014-07-16

Thermoelectric energy harvesting is emerging as a promising alternative energy source to drive wireless sensors in mechanical systems. Typically, the waste heat from spindle units in machine tools creates potential for thermoelectric generation. However, the problem of low and fluctuant ambient temperature differences in spindle units limits the application of thermoelectric generation to drive a wireless sensor. This study is devoted to presenting a transformer-based power management system and its associated control strategy to make the wireless sensor work stably at different speeds of the spindle. The charging/discharging time of capacitors is optimized through this energy-harvesting strategy. A rotating spindle platform is set up to test the performance of the power management system at different speeds. The experimental results show that a longer sampling cycle time will increase the stability of the wireless sensor. The experiments also prove that utilizing the optimal time can make the power management system work more effectively compared with other systems using the same sample cycle.

Consensus oriented fuzzified decision support for oil spill contingency management.

PubMed

Liu, Xin; Wirtz, Kai W

2006-06-30

Studies on multi-group multi-criteria decision-making problems for oil spill contingency management are in their infancy. This paper presents a second-order fuzzy comprehensive evaluation (FCE) model to resolve decision-making problems in the area of contingency management after environmental disasters such as oil spills. To assess the performance of different oil combat strategies, second-order FCE allows for the utilization of lexical information, the consideration of ecological and socio-economic criteria and the involvement of a variety of stakeholders. On the other hand, the new approach can be validated by using internal and external checks, which refer to sensitivity tests regarding its internal setups and comparisons with other methods, respectively. Through a case study, the Pallas oil spill in the German Bight in 1998, it is demonstrated that this approach can help decision makers who search for an optimal strategy in multi-thread contingency problems and has a wider application potential in the field of integrated coastal zone management.

Modified endoscopic medial maxillectomy for zygomatic implant salvage

PubMed Central

Tajudeen, Bobby A.; Adappa, Nithin D.; Palmer, James N.

2016-01-01

Objectives: Odontogenic chronic rhinosinusitis (CRS) is an epidemiologically important disease process due, in part, to the increasingly commonplace use of dental restorative procedures such as zygomatic implantation. Traditional management of this clinical entity typically entails extraction of the infected hardware via an open or endoscopic approach. We describe a novel management strategy of odontogenic CRS following bilateral zygomatic implantation for oral rehabilitation that we surgically salvaged via a modified endoscopic medial maxillectomy. Methods: We describe the presentation and management of a case of metachronous development of bilateral CRS subsequent to zygomatic implantation. Results: The patient's postoperative course was characterized by marked endoscopic, radiologic, and symptomatic improvement as measured by the 22-item Sino-Nasal Outcome Test. Conclusion: We describe a novel treatment strategy for the management of odontogenic sinusitis resulting from erroneous zygomatic implant placement. Modified endoscopic medial maxillectomy in this clinical context facilitates mucosal normalization of the affected sinus, while permitting preservation of oral function through salvage of the displaced implant. PMID:28107147

Traceability and Risk Analysis Strategies for Addressing Counterfeit Electronics in Supply Chains for Complex Systems.

PubMed

DiMase, Daniel; Collier, Zachary A; Carlson, Jinae; Gray, Robin B; Linkov, Igor

2016-10-01

Within the microelectronics industry, there is a growing concern regarding the introduction of counterfeit electronic parts into the supply chain. Even though this problem is widespread, there have been limited attempts to implement risk-based approaches for testing and supply chain management. Supply chain risk management tends to focus on the highly visible disruptions of the supply chain instead of the covert entrance of counterfeits; thus counterfeit risk is difficult to mitigate. This article provides an overview of the complexities of the electronics supply chain, and highlights some gaps in risk assessment practices. In particular, this article calls for enhanced traceability capabilities to track and trace parts at risk through various stages of the supply chain. Placing the focus on risk-informed decision making through the following strategies is needed, including prioritization of high-risk parts, moving beyond certificates of conformance, incentivizing best supply chain management practices, adoption of industry standards, and design and management for supply chain resilience. © 2016 Society for Risk Analysis.

Research on a Power Management System for Thermoelectric Generators to Drive Wireless Sensors on a Spindle Unit

PubMed Central

Li, Sheng; Yao, Xinhua; Fu, Jianzhong

2014-01-01

Thermoelectric energy harvesting is emerging as a promising alternative energy source to drive wireless sensors in mechanical systems. Typically, the waste heat from spindle units in machine tools creates potential for thermoelectric generation. However, the problem of low and fluctuant ambient temperature differences in spindle units limits the application of thermoelectric generation to drive a wireless sensor. This study is devoted to presenting a transformer-based power management system and its associated control strategy to make the wireless sensor work stably at different speeds of the spindle. The charging/discharging time of capacitors is optimized through this energy-harvesting strategy. A rotating spindle platform is set up to test the performance of the power management system at different speeds. The experimental results show that a longer sampling cycle time will increase the stability of the wireless sensor. The experiments also prove that utilizing the optimal time can make the power management system work more effectively compared with other systems using the same sample cycle. PMID:25033189

2005 AG20/20 Annual Review

NASA Technical Reports Server (NTRS)

Ross, Kenton W.; McKellip, Rodney D.

2005-01-01

Topics covered include: Implementation and Validation of Sensor-Based Site-Specific Crop Management; Enhanced Management of Agricultural Perennial Systems (EMAPS) Using GIS and Remote Sensing; Validation and Application of Geospatial Information for Early Identification of Stress in Wheat; Adapting and Validating Precision Technologies for Cotton Production in the Mid-Southern United States - 2004 Progress Report; Development of a System to Automatically Geo-Rectify Images; Economics of Precision Agriculture Technologies in Cotton Production-AG 2020 Prescription Farming Automation Algorithms; Field Testing a Sensor-Based Applicator for Nitrogen and Phosphorus Application; Early Detection of Citrus Diseases Using Machine Vision and DGPS; Remote Sensing of Citrus Tree Stress Levels and Factors; Spectral-based Nitrogen Sensing for Citrus; Characterization of Tree Canopies; In-field Sensing of Shallow Water Tables and Hydromorphic Soils with an Electromagnetic Induction Profiler; Maintaining the Competitiveness of Tree Fruit Production Through Precision Agriculture; Modeling and Visualizing Terrain and Remote Sensing Data for Research and Education in Precision Agriculture; Thematic Soil Mapping and Crop-Based Strategies for Site-Specific Management; and Crop-Based Strategies for Site-Specific Management.

Field Test Report of the Self-Directed, Interpretive, and Creative Reading Elements of the Wisconsin Design for Reading Skill Development. Technical Report No. 330.

ERIC Educational Resources Information Center

Chester, Robert; And Others

This study of the self-directed, interpretive, and creative reading elements of the Wisconsin Design for Reading Skill Development was conducted to gather descriptive data about implementation strategies being developed and practiced by field test teachers and to gather evaluative information about the usability of various management and…

High quality diabetes care: testing the effectiveness of strategies of regional implementation teams.

PubMed

Drach-Zahavy, Anat; Shadmi, Efrat; Freund, Anat; Goldfracht, Margalit

2009-01-01

The purpose of this article is to identify and test the effectiveness of work strategies employed by regional implementation teams to attain high quality care for diabetes patients. The study was conducted in a major health maintenance organization (HMO) that provides care for 70 per cent of Israel's diabetes patients. A sequential mixed model design, combining qualitative and quantitative methods was employed. In-depth interviews were conducted with members of six regional implementation teams, each responsible for the care of 25,000-34,000 diabetic patients. Content analysis of the interviews revealed that teams employed four key strategies: task-interdependence, goal-interdependence, reliance on top-down standardised processes and team-learning. These strategies were used to predict the mean percentage performance of eight evidence-based indicators of diabetes care: percentage of patients with HbA1c < 7 per cent, blood pressure < or = 130/80 and cholesterol < or = 100; and performance of: HbA1c tests, LDL cholesterol tests, blood pressure measurements, urine protein tests, and ophthalmic examinations. Teams were found to vary in their use of the four strategies. Mixed linear models analysis indicated that type of indicator (simple process, compound process, and outcome) and goal interdependence were significantly linked to team effectiveness. For simple-process indicators, reliance on top-down standardised processes led to team effectiveness, but for outcome measures this strategy was ineffective, and even counter-effective. For outcome measures, team-learning was more beneficial. The findings have implications for the management of chronic diseases. The advantage of allowing team members flexibility in the choice of the best work strategy to attain high quality diabetes care is attested.

Development and Implementation of a Hardware In-the-Loop Test Bed for Unmanned Aerial Vehicle Control Algorithms

NASA Technical Reports Server (NTRS)

Nyangweso, Emmanuel; Bole, Brian

2014-01-01

Successful prediction and management of battery life using prognostic algorithms through ground and flight tests is important for performance evaluation of electrical systems. This paper details the design of test beds suitable for replicating loading profiles that would be encountered in deployed electrical systems. The test bed data will be used to develop and validate prognostic algorithms for predicting battery discharge time and battery failure time. Online battery prognostic algorithms will enable health management strategies. The platform used for algorithm demonstration is the EDGE 540T electric unmanned aerial vehicle (UAV). The fully designed test beds developed and detailed in this paper can be used to conduct battery life tests by controlling current and recording voltage and temperature to develop a model that makes a prediction of end-of-charge and end-of-life of the system based on rapid state of health (SOH) assessment.

Developing a conservation strategy to maximize persistence of an endangered freshwater mussel species while considering management effectiveness and cost

USGS Publications Warehouse

Smith, David R.; McRae, Sarah E.; Augspurger, Tom; Ratcliffe, Judith A.; Nichols, Robert B.; Eads, Chris B.; Savidge, Tim; Bogan, Arthur E.

2015-01-01

We used a structured decision-making process to develop conservation strategies to increase persistence of Dwarf Wedgemussel (Alasmidonta heterodon) in North Carolina, USA, while accounting for uncertainty in management effectiveness and considering costs. Alternative conservation strategies were portfolios of management actions that differed by location of management actions on the landscape. Objectives of the conservation strategy were to maximize species persistence, maintain genetic diversity, maximize public support, and minimize management costs. We compared 4 conservation strategies: 1) the ‘status quo’ strategy represented current management, 2) the ‘protect the best’ strategy focused on protecting the best populations in the Tar River basin, 3) the ‘expand the distribution’ strategy focused on management of extant populations and establishment of new populations in the Neuse River basin, and 4) the ‘hybrid’ strategy combined elements of each strategy to balance conservation in the Tar and Neuse River basins. A population model informed requirements for population management, and experts projected performance of alternative strategies over a 20-y period. The optimal strategy depended on the relative value placed on competing objectives, which can vary among stakeholders. The protect the best and hybrid strategies were optimal across a wide range of relative values with 2 exceptions: 1) if minimizing management cost was of overriding concern, then status quo was optimal, or 2) if maximizing population persistence in the Neuse River basin was emphasized, then expand the distribution strategy was optimal. The optimal strategy was robust to uncertainty in management effectiveness. Overall, the structured decision process can help identify the most promising strategies for endangered species conservation that maximize conservation benefit given the constraint of limited funding.

Technology-assisted self-testing and management of oral anticoagulation therapy: a qualitative patient-focused study.

PubMed

Kuljis, Jasna; Money, Arthur G; Perry, Mark; Barnett, Julie; Young, Terry

2017-09-01

Oral anticoagulation therapy requires regular blood testing to ensure therapeutic levels are maintained and excessive bleeding/clotting is avoided. Technology-assisted self-testing and management is seen as one of the key areas in which quality of care can be improved whilst reducing costs. Nevertheless, levels of patient engagement in self-testing and management remain low. To date, little research emphasis has been placed on understanding the patients' perspectives for low engagement. The typical approach adopted by healthcare providers is to provide patient education programmes, with the expectation that individual patients will change their behaviour and adopt new self-care strategies. However, if levels of patient engagement are to be increased, healthcare providers must also develop a better understanding of how their clinical service provision is perceived by patients and make adaptations. To explore patient views, needs and expectations of an anticoagulation service and the self-testing and management services provided. Interviews were conducted with 17 patients who currently engage in international normalised ratio (INR) self-testing and management. Thematic coding and analysis were carried out on the interview transcripts. Four high-level themes emerged from interviews: (i) role of clinic, (ii) motivations for self-testing, (iii) managing INR and (iv) trust. The clinic was seen as adding value in terms of specifying testing frequency, dosage profiles and calibrating equipment. Prompt communication from clinic to patient was also valued, although more personalised/real-time communication would help avoid feelings of isolation. Patients felt more in control as self-tester/managers and often took decisions about treatment adjustments themselves. However, some also manipulated their own test results to avoid 'unnecessary' interventions. More personalised/real-time communication, pragmatic and collaborative patient-clinician partnerships and recognition of expert patient knowledge and expertise are needed if increased levels of engagement with self-testing and management service provision is to be realised. © 2016 Nordic College of Caring Science.

Management of postural sensory conflict and dynamic balance control in late-stage Parkinson's disease.

PubMed

Colnat-Coulbois, S; Gauchard, G C; Maillard, L; Barroche, G; Vespignani, H; Auque, J; Perrin, P P

2011-10-13

Parkinson's disease (PD) is known to affect postural control, especially in situations needing a change in balance strategy or when a concurrent task is simultaneously performed. However, few studies assessing postural control in patients with PD included homogeneous population in late stage of the disease. Thus, this study aimed to analyse postural control and strategies in a homogeneous population of patients with idiopathic advanced (late-stage) PD, and to determine the contribution of peripheral inputs in simple and more complex postural tasks, such as sensory conflicting and dynamic tasks. Twenty-four subjects with advanced PD (duration: median (M)=11.0 years, interquartile range (IQR)=4.3 years; Unified Parkinson's Disease Rating Scale (UPDRS): M "on-dopa"=13.5, IQR=7.8; UPDRS: M "off-dopa"=48.5, IQR=16.8; Hoehn and Yahr stage IV in all patients) and 48 age-matched healthy controls underwent static (SPT) and dynamic posturographic (DPT) tests and a sensory organization test (SOT). In SPT, patients with PD showed reduced postural control precision with increased oscillations in both anterior-posterior and medial-lateral planes. In SOT, patients with PD displayed reduced postural performances especially in situations in which visual and vestibular cues became predominant to organize balance control, as was the ability to manage balance in situations for which visual or proprioceptive inputs are disrupted. In DPT, postural restabilization strategies were often inefficient to maintain equilibrium resulting in falls. Postural strategies were often precarious, postural regulation involving more hip joint than ankle joint in patients with advanced PD than in controls. Difficulties in managing complex postural situations, such as sensory conflicting and dynamic situations might reflect an inadequate sensory organization suggesting impairment in central information processing. Copyright © 2011. Published by Elsevier Ltd.

Anthropogenic Trace Compounds (ATCs) in aquatic habitats - research needs on sources, fate, detection and toxicity to ensure timely elimination strategies and risk management.

PubMed

Gerbersdorf, Sabine U; Cimatoribus, Carla; Class, Holger; Engesser, Karl-H; Helbich, Steffen; Hollert, Henner; Lange, Claudia; Kranert, Martin; Metzger, Jörg; Nowak, Wolfgang; Seiler, Thomas-Benjamin; Steger, Kristin; Steinmetz, Heidrun; Wieprecht, Silke

2015-06-01

Anthropogenic Trace Compounds (ATCs) that continuously grow in numbers and concentrations are an emerging issue for water quality in both natural and technical environments. The complex web of exposure pathways as well as the variety in the chemical structure and potency of ATCs represents immense challenges for future research and policy initiatives. This review summarizes current trends and identifies knowledge gaps in innovative, effective monitoring and management strategies while addressing the research questions concerning ATC occurrence, fate, detection and toxicity. We highlight the progressing sensitivity of chemical analytics and the challenges in harmonization of sampling protocols and methods, as well as the need for ATC indicator substances to enable cross-national valid monitoring routine. Secondly, the status quo in ecotoxicology is described to advocate for a better implementation of long-term tests, to address toxicity on community and environmental as well as on human-health levels, and to adapt various test levels and endpoints. Moreover, we discuss potential sources of ATCs and the current removal efficiency of wastewater treatment plants (WWTPs) to indicate the most effective places and elimination strategies. Knowledge gaps in transport and/or detainment of ATCs through their passage in surface waters and groundwaters are further emphasized in relation to their physico-chemical properties, abiotic conditions and biological interactions in order to highlight fundamental research needs. Finally, we demonstrate the importance and remaining challenges of an appropriate ATC risk assessment since this will greatly assist in identifying the most urgent calls for action, in selecting the most promising measures, and in evaluating the success of implemented management strategies. Copyright © 2015. Published by Elsevier Ltd.

Development and validation of the hypoglycaemia problem-solving scale for people with diabetes mellitus

PubMed Central

Juang, Jyuhn-Huarng; Lin, Chia-Hung

2016-01-01

Objective To develop and psychometrically test a new instrument, the hypoglycaemia problem-solving scale (HPSS), which was designed to measure how well people with diabetes mellitus manage their hypoglycaemia-related problems. Methods A cross-sectional survey design approach was used to validate the performance assessment instrument. Patients who had a diagnosis of type 1 or type 2 diabetes mellitus for at least 1 year, who were being treated with insulin and who had experienced at least one hypoglycaemic episode within the previous 6 months were eligible for inclusion in the study. Results A total of 313 patients were included in the study. The initial draft of the HPSS included 28 items. After exploratory factor analysis, the 24-item HPSS consisted of seven factors: problem-solving perception, detection control, identifying problem attributes, setting problem-solving goals, seeking preventive strategies, evaluating strategies, and immediate management. The Cronbach’s α for the total HPSS was 0.83. Conclusions The HPSS was verified as being valid and reliable. Future studies should further test and improve the instrument to increase its effectiveness in helping people with diabetes manage their hypoglycaemia-related problems. PMID:27059292

Development and validation of the hypoglycaemia problem-solving scale for people with diabetes mellitus.

PubMed

Wu, Fei-Ling; Juang, Jyuhn-Huarng; Lin, Chia-Hung

2016-06-01

To develop and psychometrically test a new instrument, the hypoglycaemia problem-solving scale (HPSS), which was designed to measure how well people with diabetes mellitus manage their hypoglycaemia-related problems. A cross-sectional survey design approach was used to validate the performance assessment instrument. Patients who had a diagnosis of type 1 or type 2 diabetes mellitus for at least 1 year, who were being treated with insulin and who had experienced at least one hypoglycaemic episode within the previous 6 months were eligible for inclusion in the study. A total of 313 patients were included in the study. The initial draft of the HPSS included 28 items. After exploratory factor analysis, the 24-item HPSS consisted of seven factors: problem-solving perception, detection control, identifying problem attributes, setting problem-solving goals, seeking preventive strategies, evaluating strategies, and immediate management. The Cronbach's α for the total HPSS was 0.83. The HPSS was verified as being valid and reliable. Future studies should further test and improve the instrument to increase its effectiveness in helping people with diabetes manage their hypoglycaemia-related problems. © The Author(s) 2016.

Population survey and management strategies of free-roaming dogs (Canis familiaris) on Saipan, Commonwealth of the Northern Mariana Islands.

PubMed

Nimer, Adrianna; Meneses, Nashelly; Watson, Zachary D; Shuster, Stephen M; Benford, Russell

2018-01-01

The island of Saipan, Commonwealth of the Northern Mariana Islands, is populated by free-roaming dogs who were introduced during World War II. The local nonhuman animal control agency manages this population; however, the demographic information and public perception of this population remain unknown. To characterize the free-roaming dog population, an island-wide survey on Saipan was conducted. Photographic, mark-recapture data were used to estimate the population size per land type. Age, sex, sociality, and behavior per land type were documented and associations between these variables were tested using G tests. The effects of land type and urbanization on dog abundance were also analyzed. Lastly, in-person surveys provided data on the public perception of free-roaming dogs. Four main findings are reported: (a) The population size of free-roaming dogs on Saipan is estimated at 21,316. (b) Most dogs encountered were sentry adults. (c) Dog abundance increased with urbanization level and was highest in urban areas. (d) The public perceived free-roaming dogs as a health concern and suggested the implementation of leash laws and sheltering initiatives. This article discusses potential and existing population management strategies for free-roaming dogs on Saipan.

Learning and study strategies correlate with medical students' performance in anatomical sciences.

PubMed

Khalil, Mohammed K; Williams, Shanna E; Gregory Hawkins, H

2018-05-06

Much of the content delivered during medical students' preclinical years is assessed nationally by such testing as the United States Medical Licensing Examination ® (USMLE ® ) Step 1 and Comprehensive Osteopathic Medical Licensing Examination ® (COMPLEX-USA ® ) Step 1. Improvement of student study/learning strategies skills is associated with academic success in internal and external (USMLE Step 1) examinations. This research explores the strength of association between the Learning and Study Strategies Inventory (LASSI) scores and student performance in the anatomical sciences and USMLE Step 1 examinations. The LASSI inventory assesses learning and study strategies based on ten subscale measures. These subscales include three components of strategic learning: skill (Information processing, Selecting main ideas, and Test strategies), will (Anxiety, Attitude, and Motivation) and self-regulation (Concentration, Time management, Self-testing, and Study aid). During second year (M2) orientation, 180 students (Classes of 2016, 2017, and 2018) were administered the LASSI survey instrument. Pearson Product-Moment correlation analyses identified significant associations between five of the ten LASSI subscales (Anxiety, Information processing, Motivation, Selecting main idea, and Test strategies) and students' performance in the anatomical sciences and USMLE Step 1 examinations. Identification of students lacking these skills within the anatomical sciences curriculum allows targeted interventions, which not only maximize academic achievement in an aspect of an institution's internal examinations, but in the external measure of success represented by USMLE Step 1 scores. Anat Sci Educ 11: 236-242. © 2017 American Association of Anatomists. © 2017 American Association of Anatomists.

Impact of Laboratory Test Use Strategies in a Turkish Hospital

PubMed Central

Yılmaz, Fatma Meriç; Kahveci, Rabia; Aksoy, Altan; Özer Kucuk, Emine; Akın, Tezcan; Mathew, Joseph Lazar; Meads, Catherine; Zengin, Nurullah

2016-01-01

Objectives Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs. Methods A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months. Results Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6–85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars. Conclusion Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests. PMID:27077653

Do fibromyalgia patients use active pain management strategies? A cohort study.

PubMed

Gauffin, Jarno; Hankama, Tiina; Hannonen, Pekka; Kautiainen, Hannu; Pohjolainen, Timo; Haanpää, Maija

2013-05-01

The aim of this study was to examine the types of pain management strategies used by patients with fibromyalgia. A total of 158 patients with primary fibromyalgia attended a clinical visit to confirm the diagnosis. They completed 3 questionnaires: (i) a self-made questionnaire, (ii) Beck Depression Inventory IA (BDI IA), and (iii) Finnish version of Fibromyalgia Impact Questionnaire. The self-made questionnaire included questions about: intensity of current pain; general well-being; pain management strategies, including pain medications; efficacy of the pain management methods; current health problems other than fibromyalgia. The pain management strategies were subcategorized (e.g., physical exercise, massage and heat treatment). The strategies were also divided into active and passive types. The most frequently reported pain management strategies were physical exercise (54%), physical therapy (32%) and cold treatment (27%). The use of active pain management strategies, BDI IA < 10 points and age were independent predictors of the reported pain management efficacy. Patients who used active pain management strategies reported better efficacy with the BDI IA score ≥ 10 points. Active pain management strategies are most efficacious for fibromyalgia patients, regardless of the severity of fibromyalgia or optional comorbid depression.

Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

PubMed

Carney, Marie

2009-09-01

To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary. Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role. A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100. Less than 10% of journal titles contained the word strategy. What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident. The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent. Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.

Exploring readiness for the adoption of new molecular water quality tests: Insights from interviews with policy makers, laboratory managers and watershed managers.

PubMed

Henrich, Natalie; Holmes, Bev; Isaac-Renton, Judith; Prystajecky, Natalie

2016-01-01

Adoption of molecular-based water quality tests has been limited despite their advantage over traditional culture-based tests. A better understanding of the factors affecting adoption of these tests is needed for effective implementation. The Consolidated Framework for Implementation Research (CFIR) was used to analyze interviews with policy makers, watershed managers and laboratory managers in British Columbia (BC), Canada about their perceptions of molecular water tests currently under development in order to assess readiness for adoption and identify factors that may impact implementation. Many of the CFIR constructs were addressed by study participants, thus confirming their validity in the water-testing context. Other constructs were not mentioned, which suggests that awareness about these constructs need to be increased to ensure that they are incorporated into implementation strategies. In general, there was much enthusiasm for the new tests, which were seen to provide valuable information that could enable improved management of watersheds and treatment of source water. However, prior to adopting the tests, stakeholders would require evidence supporting the tests' validity and reliability, would need to assess the complexity of introducing the tests into laboratories and water sampling processes, and would require support interpreting the test results. Even if all the aforementioned issues are satisfactorily addressed, the tests may not be adopted unless regulations and policies were changed to allow the use of these test results to inform decision making. The results support that implementation of new technologies, such as these water quality tests, need to address potential barriers that could hinder uptake despite the advantages of the new product. Copyright © 2015 Elsevier Ltd. All rights reserved.

Managing complexity in simulations of land surface and near-surface processes

DOE PAGES

Coon, Ethan T.; Moulton, J. David; Painter, Scott L.

2016-01-12

Increasing computing power and the growing role of simulation in Earth systems science have led to an increase in the number and complexity of processes in modern simulators. We present a multiphysics framework that specifies interfaces for coupled processes and automates weak and strong coupling strategies to manage this complexity. Process management is enabled by viewing the system of equations as a tree, where individual equations are associated with leaf nodes and coupling strategies with internal nodes. A dynamically generated dependency graph connects a variable to its dependencies, streamlining and automating model evaluation, easing model development, and ensuring models aremore » modular and flexible. Additionally, the dependency graph is used to ensure that data requirements are consistent between all processes in a given simulation. Here we discuss the design and implementation of these concepts within the Arcos framework, and demonstrate their use for verification testing and hypothesis evaluation in numerical experiments.« less

Management of necrotizing myositis in a field hospital: a case report

PubMed Central

Bharathi, Ramanathan Saranga; Sharma, Vinay; Sood, Rohit; Chakladar, Arunava; Singh, Pragnya; Raman, Deep Kumar

2009-01-01

Necrotizing myositis is a rare and fatal disease of skeletal muscles caused by group A beta hemolytic streptococci (GABHS). Its early detection by advanced imaging forms the basis of current management strategy. Paucity of advanced imaging in field/rural hospitals necessitates adoption of management strategy excluding imaging as its basis. Such a protocol, based on our experience and literature, constitutes: i. Prompt recognition of the clinical triad: disproportionate pain; precipitous course; and early loss of power- in a swollen limb with/without preceding trauma. ii. Support of clinical suspicion by 2 ubiquitous laboratory tests: gram staining- of exudates from bullae/muscles to indicate GABHS infection; and CPK estimation- to indicate myonecrosis. iii. Replacement of empirical antibiotics with high intravenous doses of sodium penicillin and clindamycin iv. Exploratory fasciotomy: to confirm myonecrosis without suppuration- its hallmark v. Emergent radical debridement vi. Primary closure with viable flaps – unconventional, if need be. PMID:19374768

Chlamydia trachomatis testing among young people: what is the role of stigma?

PubMed

Theunissen, Kevin A T M; Bos, Arjan E R; Hoebe, Christian J P A; Kok, Gerjo; Vluggen, Stan; Crutzen, Rik; Dukers-Muijrers, Nicole H T M

2015-07-14

To reach young people for Chlamydia trachomatis (CT) testing, new web-based strategies are used to offer testing via young people's sexual and social networks. The success of such peer-driven strategies depends on whether individuals disclose their own testing and encourage others to get tested. We assessed whether public- and self-stigma would hamper these behaviours, by comparing anticipations and experiences relating to these issues in young men and women who already tested or never tested for CT. Participants were recruited at an STI clinic and two schools in the Netherlands. Semi-structured interviews were analysed from 23 sexually active heterosexual young people between 16-24 years using qualitative content analysis with a framework approach. Both tested and never tested participants perceived public stigma and anticipated shame and self-stigma in relation to testing. Maintaining good health was identified as main reason for testing. Never tested and tested participants anticipated that they would feel shame and receive stigmatizing reactions from people outside their trusted network if they would disclose their testing, or encourage them to test. From a selected group of trusted peers, they anticipated social support and empathy. When tested participants disclosed their testing to trusted peers they did not experience stigma. Due to the fact that no one disclosed their testing behaviour to peers outside their trusted network, stigma was avoided and therefore tested participants reported no negative reactions. Similarly, regarding the encouragement of others to test, most tested participants did not experience negative reactions from sex partners and friends. Young people perceive public stigma and anticipate self-stigma and shame in relation to CT testing, disclosure and encouraging others to test. People do test for CT, including those who anticipate stigma. To avoid stigmatizing reactions, stigma management strategies are applied, such as selective disclosure and the selective encouragement of others to test (i.e. only in a small trusted peer network). Care strategies that deploy sexual and social networks of individuals can reach into small networks surrounding a person. These strategies could be improved by exploring methods to reach high-risk network members outside the small trusted circle of a person.

Segmenting the MBA Market: An Australian Strategy.

ERIC Educational Resources Information Center

Everett, James E.; Armstrong, Robert W.

1990-01-01

A University of Western Australia market segmentation study for the masters program in business administration examined the relationship between Graduate Management Admission Test scores, work experience, faculty of undergraduate degree, gender, and academic success in the program. Implications of the results for establishing admission criteria…

Hazagora: will you survive the next disaster? - A serious game to raise awareness about geohazards and disaster risk reduction

NASA Astrophysics Data System (ADS)

Mossoux, S.; Delcamp, A.; Poppe, S.; Michellier, C.; Canters, F.; Kervyn, M.

2016-01-01

Natural disasters are too often presented as resulting from extreme natural phenomena affecting helpless populations, with people being insufficiently aware of the factors leading to disasters and of the existing strategies to mitigate their impacts. We developed a board game aimed at raising awareness about geohazards and disaster risk reduction strategies. The target groups are (1) secondary school students and citizens and (2) scientists and stakeholders involved in risk management activities. For the first group, the aim is to induce a better understanding of the geohazards and disasters they are confronted with in the media or in their daily lives; for the second, the objective is to generate discussion about risk management strategies. The game was tested with students in Belgium and with citizens, earth scientists, and risk managers in several African countries. Based on analysis of the most common game strategies observed, the players' reactions during the game, and their answers to a short questionnaire, we analyzed the main learning outcomes conveyed by this game. The game Hazagora appears to positively enhance the players' insights into processes involved in disasters. As such, the game is an effective, fun learning tool to introduce participants to the concepts of geohazards and disasters and to generate discussion.

HAZAGORA: will you survive the next disaster? - a serious game to raise awareness about geohazards and disaster risk reduction

NASA Astrophysics Data System (ADS)

Mossoux, S.; Delcamp, A.; Poppe, S.; Michellier, C.; Canters, F.; Kervyn, M.

2015-09-01

Natural disasters are too often presented as resulting from extreme natural phenomena affecting helpless populations, with people being insufficiently aware of the factors leading to disasters and of the existing strategies to mitigate their impacts. We developed a board game aimed at raising awareness about geohazards and disaster risk reduction strategies. The target groups are (1) secondary school students and citizens, and (2) scientists and stakeholders involved in risk management activities. For the first group, the aim is to induce a better understanding of geohazards and disasters they are confronted with in the media or in their daily life; for the second, the objective is to generate discussion about risk management strategies. The game was tested with students in Belgium and with citizens, earth scientists and risk managers in several African countries. Based on the game strategies analysis, the players' reactions during the game and their answers to a short questionnaire, we analyzed the main learning outcomes conveyed by this game. The Hazagora game appears to positively enhance the players' insight in processes involved in disasters. As such, the game is an effective playful learning tool to introduce participants to the concept of geohazard and disaster and to generate discussion.

Population genetic structure in a social landscape: barley in a traditional Ethiopian agricultural system

PubMed Central

Samberg, Leah H; Fishman, Lila; Allendorf, Fred W

2013-01-01

Conservation strategies are increasingly driven by our understanding of the processes and patterns of gene flow across complex landscapes. The expansion of population genetic approaches into traditional agricultural systems requires understanding how social factors contribute to that landscape, and thus to gene flow. This study incorporates extensive farmer interviews and population genetic analysis of barley landraces (Hordeum vulgare) to build a holistic picture of farmer-mediated geneflow in an ancient, traditional agricultural system in the highlands of Ethiopia. We analyze barley samples at 14 microsatellite loci across sites at varying elevations and locations across a contiguous mountain range, and across farmer-identified barley types and management strategies. Genetic structure is analyzed using population-based and individual-based methods, including measures of population differentiation and genetic distance, multivariate Principal Coordinate Analysis, and Bayesian assignment tests. Phenotypic analysis links genetic patterns to traits identified by farmers. We find that differential farmer management strategies lead to markedly different patterns of population structure across elevation classes and barley types. The extent to which farmer seed management appears as a stronger determinant of spatial structure than the physical landscape highlights the need for incorporation of social, landscape, and genetic data for the design of conservation strategies in human-influenced landscapes. PMID:24478796

Climate Control Load Reduction Strategies for Electric Drive Vehicles in Warm Weather

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

Jeffers, M. A.; Chaney, L.; Rugh, J. P.

Passenger compartment climate control is one of the largest auxiliary loads on a vehicle. Like conventional vehicles, electric vehicles (EVs) require climate control to maintain occupant comfort and safety, but cabin heating and air conditioning have a negative impact on driving range for all electric vehicles. Range reduction caused by climate control and other factors is a barrier to widespread adoption of EVs. Reducing the thermal loads on the climate control system will extend driving range, thereby reducing consumer range anxiety and increasing the market penetration of EVs. Researchers at the National Renewable Energy Laboratory have investigated strategies for vehiclemore » climate control load reduction, with special attention toward EVs. Outdoor vehicle thermal testing was conducted on two 2012 Ford Focus Electric vehicles to evaluate thermal management strategies for warm weather, including solar load reduction and cabin pre-ventilation. An advanced thermal test manikin was used to assess a zonal approach to climate control. In addition, vehicle thermal analysis was used to support testing by exploring thermal load reduction strategies, evaluating occupant thermal comfort, and calculating EV range impacts. Through stationary cooling tests and vehicle simulations, a zonal cooling configuration demonstrated range improvement of 6%-15%, depending on the drive cycle. A combined cooling configuration that incorporated thermal load reduction and zonal cooling strategies showed up to 33% improvement in EV range.« less

Porter's generic strategies, discontinuous environments, and performance: a longitudinal study of changing strategies in the hospital industry.

PubMed Central

Lamont, B T; Marlin, D; Hoffman, J J

1993-01-01

OBJECTIVE. Changes in generic strategies in response to discontinuous environments have been relatively ignored in the management literature. This study reports an examination of the relationships between Porter's (1980) generic strategies, discontinuous environments, and performance. DATA SOURCES. Archival data for 1984 and 1988 were collected for 172 acute care hospitals in Florida in order to test these relationships. STUDY DESIGN. To examine fully the performance impact of changes in strategy in a discontinuous environment, a longitudinal research design that identified a firm's strategy at two points in time, 1984 and 1988, was used. PRINCIPAL FINDINGS. Results indicate that firms with a proper strategy environment fit performed the highest, firms that did not change their strategy had no change in performance, and firms that changed their strategy toward a proper strategy environment showed an increase in performance. CONCLUSION. Findings support the notion that hospitals with appropriate strategy-environment combinations will exhibit higher performance. PMID:8270424

Implementing health care reform in Israel: organizational response to perceived incentives.

PubMed

Gross, Revital

2003-08-01

Devising new incentives was a main element of health care reform in Israel, which created a regulated market that embodies many principles of managed competition. This study examined sick fund directors' perceptions of the new incentives and their strategic responses to these incentives, enabling the testing of how managed competition works in practice. The methodology used was a multiple case study of Israel's four sick funds. Data were gathered through in-depth interviews with 160 senior officials, analysis of national health insurance legislation, and analysis of published and unpublished archival documents, newspaper articles, public statements of senior managers, and other published data on the sick funds' behavior. The study revealed discrepancies between planned and perceived incentives and highlighted the effect of the latter on strategy formulation. Analysis of sick fund strategies showed that their responses to managed competition incentives deviated from theoretical expectations, compromising some of the objectives of the reform. The study also shows that contextual features account for the specific model of managed competition that was implemented and for the specific strategies employed by the sick funds. The study concludes by highlighting the need to build a process that will enable policy makers to consider local contextual factors when planning and implementing reform, involving health care providers in designing incentives, continuously monitoring processes and outcomes in the reformed system, and allowing for flexibility in policy making.

Impact of cogongrass management strategies on generalist predators in cogongrass-infested longleaf pine plantations.

PubMed

Sells, Sallie M; Held, David W; Enloe, Stephen F; Loewenstein, Nancy J; Eckhardt, Lori G

2015-03-01

Cogongrass (Imperata cylindrica Beav.) is an aggressive, invasive weed with a global distribution. In North America, it threatens the integrity of southeastern pine agroecosystems, including longleaf pine (Pinus palustris Mill.). While studies have examined the impacts of cogongrass and various vegetation management strategies on longleaf pine understory plant communities, little is known about how they impact associated insect communities. To understand the effect of cogongrass management strategies on arthropod natural enemies and bark beetles, a split-plot design was used to test fire (whole-plot) and four subplot treatments (control, herbicide, seeding and herbicide plus seeding). Arthropods were sampled using pitfall traps and sweep samples. After 2 years of sampling, total natural enemies were not significantly affected by subplot treatment but were affected by burn treatment. Upon subdividing natural enemies into groups, only spiders were significantly affected by subplot treatment, but predatory beetles and ants were significantly affected by burn treatment. The abundance of root-feeding bark beetles (Hylastes spp.) was not significant by subplot or whole-plot treatments. Multiple applications of herbicide remain the most effective way to manage cogongrass in longleaf pine. In this study, we found limited evidence that cogongrass management with herbicides would negatively impact arthropod natural enemies associated with longleaf pine or locally increase root-feeding bark beetles. © 2014 Society of Chemical Industry.

The diffusion of evidence-based decision making among local health department practitioners in the United States.

PubMed

Harris, Jenine K; Erwin, Paul C; Smith, Carson; Brownson, Ross C

2015-01-01

Evidence-based decision making (EBDM) is the process, in local health departments (LHDs) and other settings, of translating the best available scientific evidence into practice. Local health departments are more likely to be successful if they use evidence-based strategies. However, EBDM and use of evidence-based strategies by LHDs are not widespread. Drawing on diffusion of innovations theory, we sought to understand how LHD directors and program managers perceive the relative advantage, compatibility, simplicity, and testability of EBDM. Directors and managers of programs in chronic disease, environmental health, and infectious disease from LHDs nationwide completed a survey including demographic information and questions about diffusion attributes (advantage, compatibility, simplicity, and testability) related to EBDM. Bivariate inferential tests were used to compare responses between directors and managers and to examine associations between participant characteristics and diffusion attributes. Relative advantage and compatibility scores were high for directors and managers, whereas simplicity and testability scores were lower. Although health department directors and managers of programs in chronic disease generally had higher scores than other groups, there were few significant or large differences between directors and managers across the diffusion attributes. Larger jurisdiction population size was associated with higher relative advantage and compatibility scores for both directors and managers. Overall, directors and managers were in strong agreement on the relative advantage of an LHD using EBDM, with directors in stronger agreement than managers. Perceived relative advantage has been demonstrated to be the most important factor in the rate of innovation adoption, suggesting an opportunity for directors to speed EBDM adoption. However, lower average scores across all groups for simplicity and testability may be hindering EBDM adoption. Recommended strategies for increasing perceived EBDM simplicity and testability are provided.

An information system to improve financial management, resource allocation and activity planning: evaluation results.

PubMed

Ruland, C M; Ravn, I H

2001-01-01

An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals. To evaluate CLASSICA, a Decision Support System (DSS), that assists nurse managers in financial management, resource allocation, staffing, and activity planning. Using a pre-post test design with control units, CLASSICA was evaluated in four test units. Baseline data and simultaneous parallel measures were collected prior to system implementation at test sites and control units. Using expense reports, staffing and financial statistics, surveys, interviews with nurse managers, and logs as data sources, CLASSICA was evaluated on: cost reduction, quality of management information; usefulness as decision support for improved financial management and decision-making; user satisfaction; and ease of use. Evaluation results showed a 41% reduction in expenditures for overtime and extra hours as compared to a 1.8% reduction in control units during the same time period. Users reported a significant improvement in management information; nurse managers stated that they had gained control over costs. The system helped them analyze the relationships between patient activity staffing, and cost of care. Users reported high satisfaction with the system, the information and decision support it provided, and its ease of use. These results suggest that CLASSICA is a DSS that successfully assists nurse managers in cost effective management of their units.

In vitro genotoxicity testing strategy for nanomaterials and the adaptation of current OECD guidelines

PubMed Central

Doak, S.H.; Manshian, B.; Jenkins, G.J.S.; Singh, N.

2012-01-01

There is a pressing requirement to define a hazard identification and risk management strategy for nanomaterials due to the rapid growth in the nanotechnology industry and their promise of life-style revolutions through the development of wide-ranging nano-containing consumer products. Consequently, a battery of well defined and appropriate in vitro assays to assess a number of genotoxicity endpoints is required to minimise extensive and costly in vivo testing. However, the validity of the established protocols in current OECD recognised genotoxicity assays for nanomaterials is currently being questioned. In this report, we therefore consider the in vitro OECD genotoxicity test battery including the Ames, micronucleus and HPRT forward mutation assays, and their potential role in the safety assessment of nanomaterial induced DNA damage in vitro. PMID:21971291

Pigeons at the edge of the empire: Bioarchaeological evidences for extensive management of pigeons in a Byzantine desert settlement in the southern Levant

PubMed Central

Rosen, Baruch; Tepper, Yotam; Bar-Oz, Guy

2018-01-01

Metric data of 6th century CE pigeons from the Negev Desert, Israel, are employed to test competing hypotheses on flock management strategies: that directed selection for size or shape took place under intensive management; or, alternatively, that stabilizing selection was a stronger determinant of size and shape under extensive management conditions. The results of the analysis support the second hypothesis by demonstrating that the Byzantine Negev pigeons were like wild pigeon (Columba livia) in shape, albeit small-sized. The inferred extensive management system is then discussed in the context of pigeon domestication and human micro-ecologies in marginal regions. PMID:29561880

Active management of food allergy: an emerging concept.

PubMed

Anagnostou, Katherine; Stiefel, Gary; Brough, Helen; du Toit, George; Lack, Gideon; Fox, Adam T

2015-04-01

IgE-mediated food allergies are common and currently there is no cure. Traditionally, management has relied upon patient education, food avoidance and the provision of an emergency medication plan. Despite this, food allergy can significantly impact on quality of life. Therefore, in recent years, evolving research has explored alternative management strategies. A more active approach to management is being adopted, which includes early introduction of potentially allergenic foods, anticipatory testing, active monitoring, desensitisation to food allergens and active risk management. This review will discuss these areas in turn. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Urine and oral fluid drug testing in support of pain management.

PubMed

Kwong, Tai C; Magnani, Barbarajean; Moore, Christine

2017-09-01

In recent years, the abuse of opioid drugs has resulted in greater prevalence of addiction, overdose, and deaths attributable to opioid abuse. The epidemic of opioid abuse has prompted professional and government agencies to issue practice guidelines for prescribing opioids to manage chronic pain. An important tool available to providers is the drug test for use in the initial assessment of patients for possible opioid therapy, subsequent monitoring of compliance, and documentation of suspected aberrant drug behaviors. This review discusses the issues that most affect the clinical utility of drug testing in chronic pain management with opioid therapy. It focuses on the two most commonly used specimen matrices in drug testing: urine and oral fluid. The advantages and disadvantages of urine and oral fluid in the entire testing process, from specimen collection and analytical methodologies to result interpretation are reviewed. The analytical sensitivity and specificity limitations of immunoassays used for testing are examined in detail to draw attention to how these shortcomings can affect result interpretation and influence clinical decision-making in pain management. The need for specific identification and quantitative measurement of the drugs and metabolites present to investigate suspected aberrant drug behavior or unexpected positive results is analyzed. Also presented are recent developments in optimization of test menus and testing strategies, such as the modification of the standard screen and reflexed-confirmation testing model by eliminating some of the initial immunoassay-based tests and proceeding directly to definitive testing by mass spectrometry assays.

Analysis of Human Resources Management Strategy in China Electronic Commerce Enterprises

NASA Astrophysics Data System (ADS)

Shao, Fang

The paper discussed electronic-commerce's influence on enterprise human resources management, proposed and proved the human resources management strategy which electronic commerce enterprise should adopt from recruitment strategy to training strategy, keeping talent strategy and other ways.

Design an optimum safety policy for personnel safety management - A system dynamic approach

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

Balaji, P.

2014-10-06

Personnel safety management (PSM) ensures that employee's work conditions are healthy and safe by various proactive and reactive approaches. Nowadays it is a complex phenomenon because of increasing dynamic nature of organisations which results in an increase of accidents. An important part of accident prevention is to understand the existing system properly and make safety strategies for that system. System dynamics modelling appears to be an appropriate methodology to explore and make strategy for PSM. Many system dynamics models of industrial systems have been built entirely for specific host firms. This thesis illustrates an alternative approach. The generic system dynamicsmore » model of Personnel safety management was developed and tested in a host firm. The model was undergone various structural, behavioural and policy tests. The utility and effectiveness of model was further explored through modelling a safety scenario. In order to create effective safety policy under resource constraint, DOE (Design of experiment) was used. DOE uses classic designs, namely, fractional factorials and central composite designs. It used to make second order regression equation which serve as an objective function. That function was optimized under budget constraint and optimum value used for safety policy which shown greatest improvement in overall PSM. The outcome of this research indicates that personnel safety management model has the capability for acting as instruction tool to improve understanding of safety management and also as an aid to policy making.« less

Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults.

PubMed

Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G

2017-11-01

Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

A comprehensive theoretical framework for the implementation and evaluation of opt-out HIV testing.

PubMed

Leidel, Stacy; Leslie, Gavin; Boldy, Duncan; Girdler, Sonya

2017-04-01

Opt-out HIV testing (in which patients are offered HIV testing as a default) is a potentially powerful strategy for increasing the number of people who know their HIV status and thus limiting viral transmission. Like any change in clinical practice, implementation of opt-out HIV testing in a health service requires a change management strategy, which should have theoretical support. This paper considers the application of three theories to the implementation and evaluation of an opt-out HIV testing programme: Behavioural Economics, the Health Belief Model and Normalisation Process Theory. An awareness, understanding and integration of these theories may motivate health care providers to order HIV tests that they may not routinely order, influence their beliefs about who should be tested for HIV and inform the operational aspects of opt-out HIV testing. Ongoing process evaluation of opt-out HIV testing programmes (based on these theories) will help to achieve individual health care provider self-efficacy and group collective action, thereby improving testing rates and health outcomes. © 2016 John Wiley & Sons, Ltd.

Managing human resources for successful strategy execution.

PubMed

Arnold, Edwin

2010-01-01

Managers face difficult challenges when they implement organizational strategies to achieve important goals. Execution of strategy has become more dependent upon the effective management of human resources. This article suggests how people can be managed more effectively to facilitate the execution of strategies and improve organizational performance.

Assessing Methods to Protect Susceptible Oak and Tanoak Stands from Sudden Oak Death

Treesearch

Tedmund Swiecki; Elizabeth Bernhardt

2010-01-01

Landowners and managers have been seeking ways to protect susceptible oak (Quercus) species and tanoak (Lithocarpus densiflorus) from sudden oak death (SOD) caused by Phytophthora ramorum. Because disease epidemiology differs between tanoaks and susceptible oaks, we are testing different control strategies...

Technologies as Rural Special Education Problem Solvers--A Status Report and Successful Strategies.

ERIC Educational Resources Information Center

Helge, Doris

Rural schools can help solve their special education problems by using advanced technology to provide instructional support (computer managed instruction, satellite television, library searches, resource networks, on-line testing), instructional applications (computer assisted instruction, reading machines, mobile vans, instructional television),…

Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project).

PubMed

Aragonès, Enric; Palao, Diego; López-Cortacans, Germán; Caballero, Antonia; Cardoner, Narcís; Casaus, Pilar; Cavero, Myriam; Monreal, José Antonio; Pérez-Sola, Víctor; Cirera, Miquel; Loren, Maite; Bellerino, Eva; Tomé-Pires, Catarina; Palacios, Laura

2017-12-13

Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice. Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care. A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system. The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia). The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework. Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact. This project tests the transferability of a healthcare intervention supported by scientific research to clinical practice. If implementation is successful in this experimental phase, we will use the information and experience obtained to propose and plan the generalization of the INDI model for depression in the Catalan healthcare system. We expect the program to benefit patients, the healthcare system, and society. ClinicalTrials.gov identifier: NCT03285659 ; Registered 12th September, 2017.

Cervical cancer prevention in El Salvador (CAPE)-An HPV testing-based demonstration project: Changing the secondary prevention paradigm in a lower middle-income country.

PubMed

Maza, Mauricio; Alfaro, Karla; Garai, Jillian; Velado, Mario Morales; Gage, Julia C; Castle, Philip E; Felix, Juan; Luciani, Silvana; Campos, Nicole; Kim, Jane; Masch, Rachel; Cremer, Miriam

2017-05-01

•CareHPV tests were used to compare screen-and-treat and colposcopy management.•Screen-and-treat strategy with HPV testing was found to be very cost-effective.•CAPE has screened > 25,000 women in the Paracentral region.•Over 70% of screen-positive women received recommended treatment within six months.•CAPE is an example of public-private partnership resulting in paradigm change.

Effect of Canine Play Interventions as a Stress Reduction Strategy in College Students.

PubMed

Delgado, Cheryl; Toukonen, Margaret; Wheeler, Corinne

Forty-eight students engaged with a therapy dog for 15 minutes during finals week to evaluate the effect on stress. Psychological (Perceived Stress Scale, visual analog scales) and physiologic stress (vital signs, salivary cortisol) measures were collected before and after the intervention. Paired t tests showed significant reductions in all psychological and physiologic measures except diastolic blood pressure. This supports animal-assisted therapy as an effective stress management strategy for nursing and other college students.

Rapid testing for respiratory syncytial virus in a paediatric emergency department: benefits for infection control and bed management.

PubMed

Mills, J M; Harper, J; Broomfield, D; Templeton, K E

2011-03-01

Respiratory syncytial virus (RSV) is responsible for annual winter outbreaks of respiratory tract infection among children in temperate climates, placing severe pressure on hospital beds. Cohorting of affected infants has been demonstrated to be an effective strategy in reducing nosocomial transmission of RSV, and may keep cubicles free for other patients who require them. Testing of symptomatic children for RSV is standard practice, but unfortunately traditional laboratory testing is not rapid enough to aid decision-making processes. Rapid point-of-care testing (POCT) in the emergency department has been suggested as an alternative. We performed a prospective study to quantify the amount of cubicle time saved by using POCT results to allow a targeted cohorting strategy. Over the four-month study period, the POCT allowed 183 children to be admitted directly to a designated cohort area, thus saving 568.5 cubicle-days for other patients. This is equivalent to five cubicles being left free for each day of the study period. This is the first time the benefits of using POCT have been quantified in this way. POCT for RSV is a safe, cost-effective and efficient way to improve bed management. Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Development of a model to simulate infection dynamics of Mycobacterium bovis in cattle herds in the United States

PubMed Central

Smith, Rebecca L.; Schukken, Ynte H.; Lu, Zhao; Mitchell, Rebecca M.; Grohn, Yrjo T.

2013-01-01

Objective To develop a mathematical model to simulate infection dynamics of Mycobacterium bovis in cattle herds in the United States and predict efficacy of the current national control strategy for tuberculosis in cattle. Design Stochastic simulation model. Sample Theoretical cattle herds in the United States. Procedures A model of within-herd M bovis transmission dynamics following introduction of 1 latently infected cow was developed. Frequency- and density-dependent transmission modes and 3 tuberculin-test based culling strategies (no test-based culling, constant (annual) testing with test-based culling, and the current strategy of slaughterhouse detection-based testing and culling) were investigated. Results were evaluated for 3 herd sizes over a 10-year period and validated via simulation of known outbreaks of M bovis infection. Results On the basis of 1,000 simulations (1000 herds each) at replacement rates typical for dairy cattle (0.33/y), median time to detection of M bovis infection in medium-sized herds (276 adult cattle) via slaughterhouse surveillance was 27 months after introduction, and 58% of these herds would spontaneously clear the infection prior to that time. Sixty-two percent of medium-sized herds without intervention and 99% of those managed with constant test-based culling were predicted to clear infection < 10 years after introduction. The model predicted observed outbreaks best for frequency-dependent transmission, and probability of clearance was most sensitive to replacement rate. Conclusions and Clinical Relevance Although modeling indicated the current national control strategy was sufficient for elimination of M bovis infection from dairy herds after detection, slaughterhouse surveillance was not sufficient to detect M bovis infection in all herds and resulted in subjectively delayed detection, compared with the constant testing method. Further research is required to economically optimize this strategy. PMID:23865885

Assertive Classroom Management Strategies and Students' Performance: The Case of EFL Classroom

ERIC Educational Resources Information Center

Aliakbari, Mohammad; Bozorgmanesh, Bafrin

2015-01-01

Ample research findings support the effective role that classroom management strategies play in enhancing students' learning. Drawing upon Iranian high school teachers' classroom management strategies, this article is intended to examine the extent to which these teachers follow assertive classroom management strategies and if these strategies…

Effect of different dry period lengths on milk production and somatic cell count in subsequent lactations in commercial Dutch dairy herds.

PubMed

Steeneveld, W; Schukken, Y H; van Knegsel, A T M; Hogeveen, H

2013-05-01

Shortening the dry period (DP) has been proposed as a management strategy to improve energy balance in early lactation. It is well known that both shortening and complete omission of the DP reduces milk production in the subsequent lactations. In most of these studies milk production data were obtained from planned animal experiments where cows were randomly assigned to DP length treatments, and cow management and diet composition did not differ among treatments. It may therefore be hypothesized that cows on commercial herds which apply a no-DP or short-DP-strategy, and support this by management adjustments, will have a less dramatic reduction in milk production. In this study, milk production and somatic cell count (SCC) following different DP lengths was investigated under commercial circumstances. Milk production of 342 cows (2,077 test-day records) was available from 5 Dutch commercial dairy herds which started a no DP-strategy for all cows. Test days of the year before applying the no-DP strategy are used as control (323 cows, 1,717 test-day records). Six other herds applied an individual cow approach and have different preplanned DP lengths within one herd. From these herds, information on 81 cows (482 test-day records) with a DP length between 0 and 20 d, 127 cows (925 test-day records) with a DP length between 21 and 35 d, and 143 cows (1,075 test-day records) with a DP length of more than 35 d was available. A generalized linear model incorporating an autoregressive covariance structure accounting for repeated test-day yields within cow was developed to estimate the daily yield (milk, fat and protein) and SCC of all cows. Applying no DP for all cows in the herd resulted in a reduction in postpartum milk production compared with within-herd control lactations (until 305 DIM) between 3.2 and 9.1 kg/d, which was a reduction of 12 and 32%, respectively. For the 6 herds that applied an individual cow approach with different preplanned DP lengths, the cow-specific DP strategy was based on milk production and SCC approximately 2 mo before calving. Cows with a preplanned DP length ranging between 0 and 20 d had a reduction in postpartum milk production between 5.7 and 13 kg/d compared with cows with a DP length of >35 d. Cows with a preplanned DP length ranging from 21 to 35 d had a numerically lower milk production (between 0.6 and 5.3 kg/d) than cows with a preplanned DP length of >35 d, but this difference was significant in only one herd. When corrected for milk yield, no difference in postpartum SCC for cows with different DP lengths was found. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Urethritis in men: benefits, risks, and costs of alternative strategies of management.

PubMed

Braun, P; Sherman, H; Komaroff, A L

1982-01-01

Four alternative strategies for the management of men with acute urethritis were analyzed: treating patients with tetracycline, with or without a urethral culture, without basing the initial treatment decision on the results of a gram-stained smear; treating patients with penicillin, without basing initial treatment on the results of a gram-stained smear; basing initial treatment with tetracycline or penicillin on the results of a gram-stained smear; and basing treatment on the results of both a gram-stained smear and a culture. The tetracycline strategy resulted in fewer days of morbidity, a lower probability of premature death, lower dollar costs, and a much lower rate of uncured nongonococcal urethritis, but in slightly higher rates of uncured gonorrhea and syphilis than more traditional strategies. Use of culture with the tetracycline strategy (1A) permitted tracing of gonorrhea contacts, achieved the same low morbidity, and added little cost. The conclusions were true regardless of the probability of gonorrhea and for reasonable estimates of probable compliance with oral medication regimens. Test-of-cure cultures for patients who were asymptomatic after treatment for gonorrhea required the expenditure of from $4,900 to $109,800 for each case of asymptomatic persistent gonorrhea discovered and cured, depending on the strategy used.

Are nurses prepared for retirement?

PubMed

Blakeley, Judith; Ribeiro, Violeta

2008-09-01

This study explored various factors and income sources that registered nurses believe are important in retirement planning. In many countries worldwide, many registered nurses are approaching retirement age. This raises concerns related to the level of preparedness of retiring nurses. A mail-out questionnaire was sent to 200 randomly selected nurses aged 45 and older. SPSS descriptors were used to outline the data. Multiple t-tests were conducted to test for significant differences between selected responses by staff nurses and a group of nurse managers, educators and researchers. Of 124 respondents, 71% planned to retire by age 60. Only 24% had done a large amount of planning. The top four planning strategies identified were related to keeping healthy and active, both physically and mentally; a major financial planning strategy ranked fifth. Work pensions, a government pension and a personal savings plan were ranked as the top three retirement income sources. No significant differences were found between the staff nurse and manager groups on any of the items. IMPLICATIONS FOR NURSING MANAGERS/CONCLUSIONS: The results of this study suggest that managers' preparation for retirement is no different from that of staff nurses. All nurses may need to focus more on financial preparation, and begin the process early in their careers if they are to have a comfortable and healthy retirement. Nurse managers are in a position to advocate with senior management for early and comprehensive pre-retirement education for all nurses and to promote educational sessions among their staff. Managers may find the content of this paper helpful as they work with nurses to help them better prepare for retirement. This exploratory study adds to the limited amount of research available on the topic.

Influence of prehospital airway management on neurological outcome in patients transferred to a heart attack centre following out-of-hospital cardiac arrest.

PubMed

Edwards, Timothy; Williams, Julia; Cottee, Michaela

2018-05-11

To describe the association between prehospital airway management and neurological outcomes in patients transferred by the ambulance service directly to a heart attack centre (HAC) post-return of spontaneous circulation (ROSC). A retrospective observational cohort study in which ambulance records were reviewed to determine prehospital airway management strategy and collect physiological and demographic data. HAC notes were obtained to determine in-hospital management and quantify neurological outcome via the cerebral performance category (CPC) scale. Statistical analyses were performed via χ 2 -test, Mann-Whitney U-test, odds ratios and binomial logistic regression. Two hundred and twenty patients were included between August 2013 and August 2014, with complete outcome data obtained for 209. Median age of patients with complete outcome data was 67 years and 71.3% were male (n = 149). Airway management was provided using a supraglottic airway (SGA) in 72.7% of cases (n = 152) with the remainder undergoing endotracheal intubation (ETI). There was no significant difference in the proportion of patients who had a good neurological outcome (CPC 1 and 2) at discharge between the SGA and ETI groups (P = 0.29). Binomial logistic regression incorporating factors known to influence outcome demonstrated no significant difference in neurological outcomes between the SGA and ETI groups (adjusted OR 0.73, 95% CI 0.34-1.56). In this observational study, there was no significant difference in the proportion of good neurological outcomes in patients managed with SGA versus ETI during cardiac arrest and in the post-ROSC transfer phase. Further research is required to provide more definitive evidence in relation to the optimal airway management strategy in out-of-hospital cardiac arrest. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Enhancing Industry-based Dissemination of an Occupational Sun Protection Program with Theory-based Strategies Employing Personal Contact

PubMed Central

Buller, David B.; Andersen, Peter A.; Walkosz, Barbara J.; Scott, Michael D.; Cutter, Gary R.; Dignan, Mark B.; Kane, Ilima L.; Zhang, Xiao

2012-01-01

Purpose Industry-based strategies for dissemination of an evidence-based occupational sun protection program, Go Sun Smart (GSS), were tested. Design Two dissemination strategies were compared in a randomized trial in 2004 – 2007. Setting The North American ski industry. Subjects Ski areas in the United States and Canada (n=69) and their senior managers (n=469). Intervention Employers received GSS through a Basic Dissemination Strategy (BDS) from the industry’s professional association which included conference presentations and free starter kits. Half of the areas also received the Enhanced Dissemination Strategy (EDS), in which project staff met face-to-face with managers and made ongoing contacts to support program use. Measures Observation of program materials in use and managers’ reports on communication about sun protection. Analysis The effects of two alternative dissemination strategies were compared on program use using PROC MIXED in SAS, adjusted for covariates using 1-tailed p-values. Results Ski areas receiving the EDS used more GSS materials (M=7.36) than those receiving the BDS (M=5.17; F=7.82, p<.01). Managers from more areas receiving the EDS reported communicating about sun protection in employee newsletters/flyers (M=0.97, p=.04), in guest email messages (M=0.75, p=.02), and on ski area websites (M=0.38, p=.02) than those receiving the BDS (M=0.84, 0.50, 0.15, respectively). Conclusion Industry professional associations play an important role in disseminating prevention programs; however, active personal communication may be essential to ensure increased implementation fidelity. PMID:22747318

Employee stress management: An examination of adaptive and maladaptive coping strategies on employee health.

PubMed

Holton, M Kim; Barry, Adam E; Chaney, J Don

2015-01-01

Employees commonly report feeling stressed at work. Examine how employees cope with work and personal stress, whether their coping strategies are adaptive (protective to health) or maladaptive (detrimental to health), and if the manner in which employees cope with stress influences perceived stress management. In this cross-sectional study, a random sample of 2,500 full-time university non-student employees (i.e. faculty, salaried professionals, and hourly non-professionals) were surveyed on health related behaviors including stress and coping. Approximately 1,277 completed the survey (51% ). Hierarchical logistic regression was used to assess the ability of adaptive and maladaptive coping strategies to predict self-reported stress management, while controlling for multiple demographic variables. Over half of employees surveyed reported effective stress management. Most frequently used adaptive coping strategies were communication with friend/family member and exercise, while most frequently used maladaptive coping strategies were drinking alcohol and eating more than usual. Both adaptive and maladaptive coping strategies made significant (p < 0.05) contributions to predicting employee's perceived stress management. Only adaptive coping strategies (B = 0.265) predicted whether someone would self-identify as effectively managing stress. Use of maladaptive coping strategies decreased likelihood of self-reporting effective stress management. Actual coping strategies employed may influence employees' perceived stress management. Adaptive coping strategies may be more influential than maladaptive coping strategies on perceived stress management. Results illustrate themes for effective workplace stress management programs. Stress management programs focused on increasing use of adaptive coping may have a greater impact on employee stress management than those focused on decreasing use of maladaptive coping. Coping is not only a reaction to stressful experiences but also a consequence of coping resources. Thereby increasing the availability of resources in the workplace to facilitate the use of adaptive coping strategies is necessary for successful stress management and, ultimately, healthier employees.

Efficacy of a novel strategy for poststernotomy deep sternal infection after thoracic aorta replacement using a prosthetic graft.

PubMed

Kuriyama, Motone; Yoshida, Yukitaka; Ninomiya, Hitoshi; Yamamoto, Shin; Sasaguri, Shiro; Akita, Shinsuke; Mitsukawa, Nobuyuki

2018-05-01

Poststernotomy deep sternal wound infections are persistent and occasionally fatal, especially in cases involving prosthetic grafts, because of their complicated structure and virtual impossibility of removal. We aimed to verify the influence of cooperation with plastic surgeons and our novel strategy for treating deep sternal wound infection after aortic replacement on cardiovascular surgery outcomes. Nine hundred eighty-three consecutive patients were divided into two groups: an early group (2012-2013) and a late group (2014-2015). The late group had received cooperatively improved perioperative wound management: our novel strategy of deep sternal infection based on radical debridement and immediate reconstruction decided by reference to severities of the patient's general condition and widespread infection by early intervention of plastic surgeons. The groups were analysed retrospectively. Binary variables were analysed statistically with the Fisher exact test and continuous variables with the Mann-Whitney U test. Inter-group differences were assessed with the chi-square test. Twenty of 390 cases in the early group and 13 of 593 cases in the late group were associated with deep sternal infection. Morbidity rates of deep sternal wound infection and associated mortality rates 1 year after reconstruction surgery were significantly less (p <0.05 for both) in the late group. Intervention by plastic surgeons improved perioperative wound management outcomes. Our treatment strategy for deep sternal wound infection also reduced associated mortality rates. Facilities should consider the early inclusion of plastic surgeons in the treatment of patients undergoing aortic replacement to facilitate better outcomes. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention

PubMed Central

Levesque, Deborah A; Broderick, Lynne E; Bailey, Dustin G; Kerns, Robert D

2017-01-01

Background Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. Objective The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans’ stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Methods Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Results Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Conclusions Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program’s long-term effects on pain and pain self-management. PMID:29042341

Chlamydia screening strategies and outcomes in educational settings: a systematic review.

PubMed

Jamil, Muhammad Shahid; Bauer, Heidi M; Hocking, Jane S; Ali, Hammad; Wand, Handan; Walker, Jennifer; Douglas, Laura; Donovan, Basil; Kaldor, John M; Guy, Rebecca J

2014-03-01

Chlamydia trachomatis (CT) screening programs have been established in educational settings in many countries during the past 2 decades. However, recent evidence suggests that high uptake of screening and management (treatment, partner notification, and retesting for reinfection) improves program effectiveness. We conducted a systematic review to understand the screening strategies, the extent of screening conducted, and uptake of management strategies in educational settings. Screening studies in educational settings were identified through a systematic search of published literature from 2005 to 2011. We identified 27 studies describing 30 screening programs in the United States/Canada (n = 10), Europe (n = 8), Australia/New Zealand (n = 5), and Asia (n = 4). Most studies targeted both male and female students (74%). Classroom-based strategies resulted in 21,117 testes overall (4 programs), followed by opportunistic screening during routine health examination (n = 13,470; 5 programs) and opportunistic screening at school-based health centers (n = 13,006; 5 programs). The overall median CT positivity was 4.7% (range, 1.3%-18.1%). Only 5 programs reported treatment rates (median, 100%; range, 86%-100%), 1 partner notification rate (71%), 1 retesting rate within a year of an initial CT diagnosis (47%), and 2 reported repeat positivity rates (21.1% and 26.3%). In conclusion, this systematic review shows that a variety of strategies have been used to screen large numbers of students in educational settings; however, only a few studies have reported CT management outcomes.

Measuring the effectiveness of earthquake forecasting in insurance strategies

NASA Astrophysics Data System (ADS)

Mignan, A.; Muir-Wood, R.

2009-04-01

Given the difficulty of judging whether the skill of a particular methodology of earthquake forecasts is offset by the inevitable false alarms and missed predictions, it is important to find a means to weigh the successes and failures according to a common currency. Rather than judge subjectively the relative costs and benefits of predictions, we develop a simple method to determine if the use of earthquake forecasts can increase the profitability of active financial risk management strategies employed in standard insurance procedures. Three types of risk management transactions are employed: (1) insurance underwriting, (2) reinsurance purchasing and (3) investment in CAT bonds. For each case premiums are collected based on modelled technical risk costs and losses are modelled for the portfolio in force at the time of the earthquake. A set of predetermined actions follow from the announcement of any change in earthquake hazard, so that, for each earthquake forecaster, the financial performance of an active risk management strategy can be compared with the equivalent passive strategy in which no notice is taken of earthquake forecasts. Overall performance can be tracked through time to determine which strategy gives the best long term financial performance. This will be determined by whether the skill in forecasting the location and timing of a significant earthquake (where loss is avoided) is outweighed by false predictions (when no premium is collected). This methodology is to be tested in California, where catastrophe modeling is reasonably mature and where a number of researchers issue earthquake forecasts.

A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan

PubMed Central

Yokoo, Kyoko; Funaba, Yuuki; Fukushima, Sayo; Fukuhara, Rie; Uchida, Mieko; Aiba, Satoru; Doi, Miki; Nishimura, Akira; Hayakawa, Masahiro; Nishimura, Yutaka; Oohira, Mitsuko

2017-01-01

Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting. PMID:28114148

Developing Sustainable Leadership

ERIC Educational Resources Information Center

Davies, Brent

2007-01-01

The emphasis on short-term accountability measures has often prioritised the use of short-term management strategies to meet test and Ofsted measures. Moving away from short-termism to more fundamental consideration of sustainable leadership is the focus of this paper. While it would be naive or unrealistic to suggest that school leaders do not…

Field tests on biochar to reduce emissions from soil fumigation

USDA-ARS?s Scientific Manuscript database

Soil fumigation continues to be one of the most important strategies for pest management in orchards. Although low permeability tarp such as totally impermeable film (TIF) has shown to be the most effective in reducing fumigant emissions, costs are high and tarp disposal is needed after use. The obj...

Manure storage capacity and application timing influence watershed-level nutrient losses

USDA-ARS?s Scientific Manuscript database

Current concerns over water quality requires best management practices for land-applied manure. One important strategy is to apply manure at right timing, which though is often greatly affected by manure generation and storage capacities in a given watershed. This study was to test the hypotheses: (...

Testing for Blackleg and Dickeya in the 2017 field season

USDA-ARS?s Scientific Manuscript database

This article is aimed at raising awareness of the recently emerged potato blackleg disease and the research being conducted at USDA-ARS Ithaca and Cornell University to address this problem. This article explains the current management strategies for this disease and explains our research team’s re...

Adaptive management for subsurface pressure and plume control in application to geological CO2 storage

NASA Astrophysics Data System (ADS)

Gonzalez-Nicolas, A.; Cihan, A.; Birkholzer, J. T.; Petrusak, R.; Zhou, Q.; Riestenberg, D. E.; Trautz, R. C.; Godec, M.

2016-12-01

Industrial-scale injection of CO2 into the subsurface can cause reservoir pressure increases that must be properly controlled to prevent any potential environmental impact. Excessive pressure buildup in reservoir may result in ground water contamination stemming from leakage through conductive pathways, such as improperly plugged abandoned wells or distant faults, and the potential for fault reactivation and possibly seal breaching. Brine extraction is a viable approach for managing formation pressure, effective stress, and plume movement during industrial-scale CO2 injection projects. The main objectives of this study are to investigate suitable different pressure management strategies involving active brine extraction and passive pressure relief wells. Adaptive optimized management of CO2 storage projects utilizes the advanced automated optimization algorithms and suitable process models. The adaptive management integrates monitoring, forward modeling, inversion modeling and optimization through an iterative process. In this study, we employ an adaptive framework to understand primarily the effects of initial site characterization and frequency of the model update (calibration) and optimization calculations for controlling extraction rates based on the monitoring data on the accuracy and the success of the management without violating pressure buildup constraints in the subsurface reservoir system. We will present results of applying the adaptive framework to test appropriateness of different management strategies for a realistic field injection project.

Management strategies and medication use for treating paediatric patients with concussions.

PubMed

Kinnaman, Karen A; Mannix, Rebekah C; Comstock, R Dawn; Meehan, William P

2013-09-01

To assess management strategies for paediatric patients suffering from concussions. A 17-item questionnaire was distributed to 1305 section members of the American Academy of Pediatrics Sections on Adolescent Health, Sports Medicine and Fitness, Community Pediatrics and School Health. The use of medications, neuropsychological testing, neuroimaging and published guidelines in concussion management was queried. Two hundred and twenty respondents (17%) completed the questionnaire, of which 64% had been an attending for greater than 10 years. A majority of respondents (92%) managed patients with concussions, with 26% treating more than 24 patients per year. Most paediatricians (84%) reported using a published guideline. The majority of respondents (89%) manage the symptoms of concussed patients with medications, most commonly acetaminophen (62%) or nonsteroidal anti-inflammatory medications (54%). The use of prescriptions medications such as tricyclic antidepressants (23%), amantadine (10%) and methylphenidate (8%) was also commonly reported. Paediatricians treating >16 patients per year with concussion were more likely to prescribe tricyclic antidepressants, stimulants and agents used for sleep disturbance. Paediatricians nationwide routinely use medications when managing patients with concussions. The pharmacological agents used differ according to number of patients treated per year. In addition, most paediatricians use published guidelines in concussion management. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Developing Asthma-Friendly Childcare Centers with Online Training and Evaluation

PubMed Central

Nowakowski, Alexandra Catherine Hayes; Carretta, Henry Joseph; Pineda, Nicole; Dudley, Julie Kurlfink; Forrest, Jamie R.

2016-01-01

In 2011, the Florida Asthma Coalition (FAC) began offering its Asthma-Friendly Childcare Center (AFCC) training online. This course teaches childcare center employees the fundamentals of effective asthma management. It covers basic asthma physiology, ways to recognize asthma attacks, techniques to help children experiencing attacks, and strategies to create healthy environments for asthmatics. A team of health services researchers evaluated both years of the online training. Evaluators used a quasi-experimental design with pretest, posttest, and follow-up assessment. Questions measured knowledge gain and retention, user satisfaction, and implementation of management strategies. Over 650 people from nearly all 67 Florida counties took AFCC training online between 2011 and 2013. Test scores improved by a minimum of 11% points in all program years evaluated. Gains in both knowledge and confidence were substantial and highly significant across years. While individual trainees did forget some content on follow-up, they seemed to retain the specific messages most relevant for their own workplaces. Most trainees also planned to implement multiple management strategies recommended by the training. A large majority of participants rated the training as excellent on all quality metrics, including relevance of content and time efficiency of the online format. Nearly all respondents perceived the training as useful for both providing improved care and fulfilling licensure or certification requirements. Many participants also indicated that their centers would pursue formal certification as AFCCs via the program offered by FAC. The online AFCC course performed strongly in its first years, yielding both high participant satisfaction and substantial improvement in workplace asthma management activity. This training holds promise for introducing and improving multidimensional asthma management strategies at childcare facilities nationwide. PMID:27014676

An Integrated Data-Driven Strategy for Safe-by-Design Nanoparticles: The FP7 MODERN Project.

PubMed

Brehm, Martin; Kafka, Alexander; Bamler, Markus; Kühne, Ralph; Schüürmann, Gerrit; Sikk, Lauri; Burk, Jaanus; Burk, Peeter; Tamm, Tarmo; Tämm, Kaido; Pokhrel, Suman; Mädler, Lutz; Kahru, Anne; Aruoja, Villem; Sihtmäe, Mariliis; Scott-Fordsmand, Janeck; Sorensen, Peter B; Escorihuela, Laura; Roca, Carlos P; Fernández, Alberto; Giralt, Francesc; Rallo, Robert

2017-01-01

The development and implementation of safe-by-design strategies is key for the safe development of future generations of nanotechnology enabled products. The safety testing of the huge variety of nanomaterials that can be synthetized is unfeasible due to time and cost constraints. Computational modeling facilitates the implementation of alternative testing strategies in a time and cost effective way. The development of predictive nanotoxicology models requires the use of high quality experimental data on the structure, physicochemical properties and bioactivity of nanomaterials. The FP7 Project MODERN has developed and evaluated the main components of a computational framework for the evaluation of the environmental and health impacts of nanoparticles. This chapter describes each of the elements of the framework including aspects related to data generation, management and integration; development of nanodescriptors; establishment of nanostructure-activity relationships; identification of nanoparticle categories; hazard ranking and risk assessment.

Human capital strategy: talent management.

PubMed

Nagra, Michael

2011-01-01

Large organizations, including the US Army Medical Department and the Army Nurse Corps, are people-based organizations. Consequently, effective and efficient management of the human capital within these organizations is a strategic goal for the leadership. Over time, the Department of Defense has used many different systems and strategies to manage people throughout their service life-cycle. The current system in use is called Human Capital Management. In the near future, the Army's human capital will be managed based on skills, knowledge, and behaviors through various measurement tools. This article elaborates the human capital management strategy within the Army Nurse Corps, which identifies, develops, and implements key talent management strategies under the umbrella of the Corps' human capital goals. The talent management strategy solutions are aligned under the Nurse Corps business strategy captured by the 2008 Army Nurse Corps Campaign Plan, and are implemented within the context of the culture and core values of the organization.

Modulation of the host inflammatory response in periodontal disease management: exciting new directions.

PubMed

Bhatavadekar, Neel B; Williams, Ray C

2009-10-01

New strategies for periodontal disease management have been emerging as more is learned about the role of the host response. Our increasing understanding of inflammation and its resolution has opened the door to the study of new periodontal treatment strategies. This review examines periodontal disease in the light of a new understanding of the role of inflammation in disease expression thus setting the stage for the development of new prevention and treatment strategies of a widespread disease. We examined current publications and focused on articles relating to anti-inflammatory and pro-resolution mechanisms in periodontal disease. Recent research has examined the inflammatory and resolution cascade in greater detail while looking at endogenous and exogenous mediators that can be utilised to achieve therapeutic end-points. The possible introduction of 'resolution indices' for drug testing warrants a new look at pharmacologic agents that might have been overlooked for their beneficial effects in periodontal disease treatment. The emerging awareness of inflammation and its control in periodontal disease management underscores the importance of exploring inflammatory pathways and mediators, thus exploring new ways to control inflammation. This direction of research promises a new era in drug discovery and therapeutics for periodontal disease treatment.

[Platelet allo-antibodies identification strategies for preventing and managing platelet refractoriness].

PubMed

Basire, A; Picard, C

2014-11-01

Platelet refractoriness is a serious complication for patients receiving recurrent platelet transfusions, which can be explained by non-immune and immune causes. Human Leukocyte Antigens (HLA) allo-immunization, especially against HLA class I, is the major cause for immune platelet refractoriness. To a lesser extent, allo-antibodies against specific Human Platelet Antigen (HPA) are also involved. Pregnancy, transplantation and previous transfusions can lead to allo-immune reaction against platelet antigens. After transfusion, platelet count is decreased by accelerated platelet destruction related to antibodies fixation on incompatible platelet antigens. New laboratory tests for allo-antibodies identification were developed to improve sensibility and specificity, especially with the LUMINEX(®) technology. The good use and interpretation of these antibodies assays can improve strategies for platelet refractoriness prevention and management with a patient adapted response. Compatible platelets units can be selected according to their identity with recipient typing or immune compatibility regarding HLA or HPA antibodies or HLA epitope compatibility. Prospective studies are needed to further confirm the clinical benefit of new allo-antibodies identification methods and consensus strategies for immune platelet refractoriness management. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Strategies for sustainable management of renewable resources during environmental change.

PubMed

Lindkvist, Emilie; Ekeberg, Örjan; Norberg, Jon

2017-03-15

As a consequence of global environmental change, management strategies that can deal with unexpected change in resource dynamics are becoming increasingly important. In this paper we undertake a novel approach to studying resource growth problems using a computational form of adaptive management to find optimal strategies for prevalent natural resource management dilemmas. We scrutinize adaptive management, or learning-by-doing, to better understand how to simultaneously manage and learn about a system when its dynamics are unknown. We study important trade-offs in decision-making with respect to choosing optimal actions (harvest efforts) for sustainable management during change. This is operationalized through an artificially intelligent model where we analyze how different trends and fluctuations in growth rates of a renewable resource affect the performance of different management strategies. Our results show that the optimal strategy for managing resources with declining growth is capable of managing resources with fluctuating or increasing growth at a negligible cost, creating in a management strategy that is both efficient and robust towards future unknown changes. To obtain this strategy, adaptive management should strive for: high learning rates to new knowledge, high valuation of future outcomes and modest exploration around what is perceived as the optimal action. © 2017 The Author(s).

Field Test of Wake Steering at an Offshore Wind Farm

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

Fleming, Paul; Annoni, Jennifer; Shah, Jigar J.

In this paper, a field test of wake steering control is presented. The field test is the result of a collaboration between the National Renewable Energy Laboratory (NREL) and Envision Energy, a smart energy management company and turbine manufacturer. In the campaign, an array of turbines within an operating commercial offshore wind farm in China have the normal yaw controller modified to implement wake steering according to a yaw control strategy. The strategy was designed using NREL wind farm models, including a computational fluid dynamics model, SOWFA, for understanding wake dynamics and an engineering model, FLORIS, for yaw control optimization.more » Results indicate that, within the certainty afforded by the data, the wake-steering controller was successful in increasing power capture, by amounts similar to those predicted from the models.« less

Field Test of Wake Steering at an Offshore Wind Farm

DOE PAGES

Fleming, Paul; Annoni, Jennifer; Shah, Jigar J.; ...

2017-02-06

In this paper, a field test of wake steering control is presented. The field test is the result of a collaboration between the National Renewable Energy Laboratory (NREL) and Envision Energy, a smart energy management company and turbine manufacturer. In the campaign, an array of turbines within an operating commercial offshore wind farm in China have the normal yaw controller modified to implement wake steering according to a yaw control strategy. The strategy was designed using NREL wind farm models, including a computational fluid dynamics model, SOWFA, for understanding wake dynamics and an engineering model, FLORIS, for yaw control optimization.more » Results indicate that, within the certainty afforded by the data, the wake-steering controller was successful in increasing power capture, by amounts similar to those predicted from the models.« less

Development and Comparison of Technical Solutions for Electricity Monitoring Equipment

NASA Astrophysics Data System (ADS)

Potapovs, A.; Obushevs, A.

2017-12-01

The paper focuses on the elaboration of a demand-side management platform for optimal energy management strategies; the topicality is related to the description and comparison of the developed electricity monitoring and control equipment. The article describes two versions based on Atmega328 and STM32 microcontrollers, a lower and higher level of precision, and other distinct performance parameters. At the end of the article, the results of the testing of the two types of equipment are given and their comparison is made.

Hardware Specific Integration Strategy for Impedance-Based Structural Health Monitoring of Aerospace Systems

NASA Technical Reports Server (NTRS)

Owen, Robert B.; Gyekenyesi, Andrew L.; Inman, Daniel J.; Ha, Dong S.

2011-01-01

The Integrated Vehicle Health Management (IVHM) Project, sponsored by NASA's Aeronautics Research Mission Directorate, is conducting research to advance the state of highly integrated and complex flight-critical health management technologies and systems. An effective IVHM system requires Structural Health Monitoring (SHM). The impedance method is one such SHM technique for detection and monitoring complex structures for damage. This position paper on the impedance method presents the current state of the art, future directions, applications and possible flight test demonstrations.

Guidelines for the management of neuroendocrine tumours by the Brazilian gastrointestinal tumour group

PubMed Central

Riechelmann, Rachel P; Weschenfelder, Rui F; Costa, Frederico P; Andrade, Aline Chaves; Osvaldt, Alessandro Bersch; Quidute, Ana Rosa P; dos Santos, Allan; Hoff, Ana Amélia O; Gumz, Brenda; Buchpiguel, Carlos; Vilhena Pereira, Bruno S; Lourenço Junior, Delmar Muniz; da Rocha Filho, Duilio Reis; Fonseca, Eduardo Antunes; Riello Mello, Eduardo Linhares; Makdissi, Fabio Ferrari; Waechter, Fabio Luiz; Carnevale, Francisco Cesar; Coura-Filho, George B; de Paulo, Gustavo Andrade; Girotto, Gustavo Colagiovanni; Neto, João Evangelista Bezerra; Glasberg, João; Casali-da-Rocha, Jose Claudio; Rego, Juliana Florinda M; de Meirelles, Luciana Rodrigues; Hajjar, Ludhmila; Menezes, Marcos; Bronstein, Marcello D; Sapienza, Marcelo Tatit; Fragoso, Maria Candida Barisson Villares; Pereira, Maria Adelaide Albergaria; Barros, Milton; Forones, Nora Manoukian; do Amaral, Paulo Cezar Galvão; de Medeiros, Raphael Salles Scortegagna; Araujo, Raphael L C; Bezerra, Regis Otaviano França; Peixoto, Renata D’Alpino; Aguiar, Samuel; Ribeiro, Ulysses; Pfiffer, Tulio; Hoff, Paulo M; Coutinho, Anelisa K

2017-01-01

Neuroendocrine tumours are a heterogeneous group of diseases with a significant variety of diagnostic tests and treatment modalities. Guidelines were developed by North American and European groups to recommend their best management. However, local particularities and relativisms found worldwide led us to create Brazilian guidelines. Our consensus considered the best feasible strategies in an environment involving more limited resources. We believe that our recommendations may be extended to other countries with similar economic standards. PMID:28194228

Bringing science to the art of strategy.

PubMed

Lafley, A G; Martin, Roger L; Rivkin, Jan W; Siggelkow, Nicolaj

2012-09-01

Many managers feel doomed to trade off the futile rigor of ordinary strategic planning for the hit-or-miss creativity of the alternatives. In fact, the two can be reconciled to produce novel but realistic strategies. The key is to recognize that conventional strategic planning, for all its analysis, is not actually scientific-it lacks the careful generation and testing of hypotheses that are at the heart of the scientific method. The authors outline a strategy-making process that combines rigor and creativity. A team begins by formulating options, or possibilities, and asks what must be true for each to succeed. Once it has listed all the conditions, it assesses their likelihood and thereby identifies the barriers to each choice. The team then tests the key barrier conditions to see which hold true. From here, choosing a strategy is simple: The group need only review the test results and choose the possibility with the fewest serious barriers. This is the path P&G took in the late 1990s, when it was looking to become a major global player in skin care. After testing the barrier conditions for several possibilities, it opted for a bold strategy that might never have surfaced in the traditional process: reinventing Olay as a prestigelike product also sold to mass consumers. The new Olay succeeded beyond expectations-showing what can happen when teams shift from asking "What is the right answer" and focus instead on figuring out "What are the right questions?".

Wilderness monitoring and data management

USGS Publications Warehouse

Riebau, A. R.

1994-01-01

In the last decade, increased public interest in natural areas has resulted in increased monitoring activity by federal wilderness managers to assess the status of wilderness values. Wilderness values are those large-scale entities of wilderness which comprise, in sum, wilderness character. Data collected through wilderness monitoring must support the maintenance of wilderness values. Wilderness monitoring must include the development of clear data management strategies and provisions for hypothesis testing. Unfortunately, some monitoring programs do not support the status assessment of wilderness values. Often wilderness monitoring programs have neglected even the most rudimentary principles of data management. This paper presents a model for wilderness monitoring, guidelines for data management, and an overview of a PC-compatible wilderness monitoring data base, the Monitoring Information Data Analysis System (MIDAS).

[Posture and aging. Current fundamental studies and management concepts].

PubMed

Mourey, F; Camus, A; Pfitzenmeyer, P

2000-02-19

FUNDAMENTAL IMPORTANCE OF POSTURE: In the elderly subject, preservation of posture is fundamental to maintaining functional independence. In recent years, there has been much progress in our understanding of the mechanisms underlying strategies used to control equilibrium in the upright position. Physiological aging, associated with diverse disease states, dangerously alters the postural function, particularly anticipated adjustments which allow an adaptation of posture to movement. CLINICAL ASSESSMENT OF POSTURE: Several tests have been developed to assess posture in the elderly subject, particularly the time it takes to start walking. We selected certain tests which can be used in everyday practice to predict falls: the stance test, the improved Romberg test, the "timed get up and go test", measurement of walking cadence, assessment of balance reactions, sitting-standing and standing-sitting movements and capacity to get up off the floor. PATIENT CARE: Elderly patients with equilibrium disorders can benefit from specific personalized rehabilitation protocols. Different techniques have been developed for multiple afferential stimulation, reprogramming postural strategies, and correcting for deficient motor automatisms.

Encouraging smoking cessation among disadvantaged groups: a qualitative study of the financial aspects of cessation.

PubMed

Bonevski, Billie; Bryant, Jamie; Paul, Christine

2011-07-01

This study aimed to explore perceptions about financial aspects of smoking cessation among a group of disadvantaged welfare agency clients and their carers. Qualitative focus groups and in-depth interviews were supplemented with participant exit surveys about preferred smoking cessation strategies. Each discussion was audiotaped, transcribed and analysed using a thematic analysis. The setting was six non-government community welfare service organisations operating in New South Wales, Australia. Eleven social services offered by these organisations participated. Thirty two clients participated in six client focus groups, 35 staff participated in six staff focus groups and eight manager telephone interviews were conducted. Clients indicated that the cost of nicotine replacement therapy was a barrier to its use and that financial incentives were acceptable. Of the 16 possible strategies listed in the exit survey, the three selected as the most preferred by clients incorporated financial or non-financial assistance. By contrast, staff and managers selected financial and non-financial incentives as the least preferred and least feasible strategies. The study found high acceptance of incentives as a smoking cessation strategy among a disadvantaged group of non-government welfare service clients. The comparatively low level of desirability and feasibility from the perspective of service staff and managers suggests implementation of such an approach within the community service setting requires careful further testing. © 2010 Australasian Professional Society on Alcohol and other Drugs.

Downsizing genomic medicine: approaching the ethical complexity of whole-genome sequencing by starting small.

PubMed

Sharp, Richard R

2011-03-01

As we look to a time when whole-genome sequencing is integrated into patient care, it is possible to anticipate a number of ethical challenges that will need to be addressed. The most intractable of these concern informed consent and the responsible management of very large amounts of genetic information. Given the range of possible findings, it remains unclear to what extent it will be possible to obtain meaningful patient consent to genomic testing. Equally unclear is how clinicians will disseminate the enormous volume of genetic information produced by whole-genome sequencing. Toward developing practical strategies for managing these ethical challenges, we propose a research agenda that approaches multiplexed forms of clinical genetic testing as natural laboratories in which to develop best practices for managing the ethical complexities of genomic medicine.

Economic evaluation of laboratory testing strategies for hospital-associated Clostridium difficile infection.

PubMed

Schroeder, Lee F; Robilotti, Elizabeth; Peterson, Lance R; Banaei, Niaz; Dowdy, David W

2014-02-01

Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in health care settings, and for patients presumed to have CDI, their isolation while awaiting laboratory results is costly. Newer rapid tests for CDI may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. We used decision analysis from the hospital perspective to compare multiple CDI testing algorithms for adult inpatients with suspected CDI, assuming patient management according to laboratory results. CDI testing strategies included combinations of on-demand PCR (odPCR), batch PCR, lateral-flow diagnostics, plate-reader enzyme immunoassay, and direct tissue culture cytotoxicity. In the reference scenario, algorithms incorporating rapid testing were cost-effective relative to nonrapid algorithms. For every 10,000 symptomatic adults, relative to a strategy of treating nobody, lateral-flow glutamate dehydrogenase (GDH)/odPCR generated 831 true-positive results and cost $1,600 per additional true-positive case treated. Stand-alone odPCR was more effective and more expensive, identifying 174 additional true-positive cases at $6,900 per additional case treated. All other testing strategies were dominated by (i.e., more costly and less effective than) stand-alone odPCR or odPCR preceded by lateral-flow screening. A cost-benefit analysis (including estimated costs of missed cases) favored stand-alone odPCR in most settings but favored odPCR preceded by lateral-flow testing if a missed CDI case resulted in less than $5,000 of extended hospital stay costs and <2 transmissions, if lateral-flow GDH diagnostic sensitivity was >93%, or if the symptomatic carrier proportion among the toxigenic culture-positive cases was >80%. These results can aid guideline developers and laboratory directors who are considering rapid testing algorithms for diagnosing CDI.

Economic Evaluation of Laboratory Testing Strategies for Hospital-Associated Clostridium difficile Infection

PubMed Central

Robilotti, Elizabeth; Peterson, Lance R.; Banaei, Niaz; Dowdy, David W.

2014-01-01

Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in health care settings, and for patients presumed to have CDI, their isolation while awaiting laboratory results is costly. Newer rapid tests for CDI may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. We used decision analysis from the hospital perspective to compare multiple CDI testing algorithms for adult inpatients with suspected CDI, assuming patient management according to laboratory results. CDI testing strategies included combinations of on-demand PCR (odPCR), batch PCR, lateral-flow diagnostics, plate-reader enzyme immunoassay, and direct tissue culture cytotoxicity. In the reference scenario, algorithms incorporating rapid testing were cost-effective relative to nonrapid algorithms. For every 10,000 symptomatic adults, relative to a strategy of treating nobody, lateral-flow glutamate dehydrogenase (GDH)/odPCR generated 831 true-positive results and cost $1,600 per additional true-positive case treated. Stand-alone odPCR was more effective and more expensive, identifying 174 additional true-positive cases at $6,900 per additional case treated. All other testing strategies were dominated by (i.e., more costly and less effective than) stand-alone odPCR or odPCR preceded by lateral-flow screening. A cost-benefit analysis (including estimated costs of missed cases) favored stand-alone odPCR in most settings but favored odPCR preceded by lateral-flow testing if a missed CDI case resulted in less than $5,000 of extended hospital stay costs and <2 transmissions, if lateral-flow GDH diagnostic sensitivity was >93%, or if the symptomatic carrier proportion among the toxigenic culture-positive cases was >80%. These results can aid guideline developers and laboratory directors who are considering rapid testing algorithms for diagnosing CDI. PMID:24478478

Chronic disease management interventions for people with chronic kidney disease in primary care: a systematic review and meta-analysis.

PubMed

Galbraith, Lauren; Jacobs, Casey; Hemmelgarn, Brenda R; Donald, Maoliosa; Manns, Braden J; Jun, Min

2018-01-01

Primary care providers manage the majority of patients with chronic kidney disease (CKD), although the most effective chronic disease management (CDM) strategies for these patients are unknown. We assessed the efficacy of CDM interventions used by primary care providers managing patients with CKD. The Medline, Embase and Cochrane Central databases were systematically searched (inception to November 2014) for randomized controlled trials (RCTs) assessing education-based and computer-assisted CDM interventions targeting primary care providers managing patients with CKD in the community. The efficacy of CDM interventions was assessed using quality indicators [use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), proteinuria measurement and achievement of blood pressure (BP) targets] and clinical outcomes (change in BP and glomerular filtration rate). Two independent reviewers evaluated studies for inclusion, quality and extracted data. Random effects models were used to estimate pooled odds ratios (ORs) and weighted mean differences for outcomes of interest. Five studies (188 clinics; 494 physicians; 42 852 patients with CKD) were included. Two studies compared computer-assisted intervention strategies with usual care, two studies compared education-based intervention strategies with computer-assisted intervention strategies and one study compared both these intervention strategies with usual care. Compared with usual care, computer-assisted CDM interventions did not increase the likelihood of ACEI/ARB use among patients with CKD {pooled OR 1.00 [95% confidence interval (CI) 0.83-1.21]; I2 = 0.0%}. Similarly, education-related CDM interventions did not increase the likelihood of ACEI/ARB use compared with computer-assisted CDM interventions [pooled OR 1.12 (95% CI 0.77-1.64); I2 = 0.0%]. Inconsistencies in reporting methods limited further pooling of data. To date, there have been very few randomized trials testing CDM interventions targeting primary care providers with the goal of improving care of people with CKD. Those conducted to date have shown minimal impact, suggesting that other strategies, or multifaceted interventions, may be required to enhance care for patients with CKD in the community. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Homosexuality in Turkey: strategies for managing heterosexism.

PubMed

Bakacak, Ayça Gelgeç; Oktem, Pinar

2014-01-01

The goal of this study was to identify the strategies used by young homosexuals to manage their sexual minority status in Turkey. In-depth interviews were conducted with 15 self-identified homosexual university students. The data on the strategies employed by homosexuals suggested a categorization of these strategies into four interrelated areas: strategies employed in the process of self-acceptance; strategies to manage sexual stigma and prejudice; strategies specific to the coming-out process; and the strategies used while openly expressing their sexual identities.

Evolution of CMS workload management towards multicore job support

NASA Astrophysics Data System (ADS)

Pérez-Calero Yzquierdo, A.; Hernández, J. M.; Khan, F. A.; Letts, J.; Majewski, K.; Rodrigues, A. M.; McCrea, A.; Vaandering, E.

2015-12-01

The successful exploitation of multicore processor architectures is a key element of the LHC distributed computing system in the coming era of the LHC Run 2. High-pileup complex-collision events represent a challenge for the traditional sequential programming in terms of memory and processing time budget. The CMS data production and processing framework is introducing the parallel execution of the reconstruction and simulation algorithms to overcome these limitations. CMS plans to execute multicore jobs while still supporting singlecore processing for other tasks difficult to parallelize, such as user analysis. The CMS strategy for job management thus aims at integrating single and multicore job scheduling across the Grid. This is accomplished by employing multicore pilots with internal dynamic partitioning of the allocated resources, capable of running payloads of various core counts simultaneously. An extensive test programme has been conducted to enable multicore scheduling with the various local batch systems available at CMS sites, with the focus on the Tier-0 and Tier-1s, responsible during 2015 of the prompt data reconstruction. Scale tests have been run to analyse the performance of this scheduling strategy and ensure an efficient use of the distributed resources. This paper presents the evolution of the CMS job management and resource provisioning systems in order to support this hybrid scheduling model, as well as its deployment and performance tests, which will enable CMS to transition to a multicore production model for the second LHC run.

Evolution of CMS Workload Management Towards Multicore Job Support

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

Perez-Calero Yzquierdo, A.; Hernández, J. M.; Khan, F. A.

The successful exploitation of multicore processor architectures is a key element of the LHC distributed computing system in the coming era of the LHC Run 2. High-pileup complex-collision events represent a challenge for the traditional sequential programming in terms of memory and processing time budget. The CMS data production and processing framework is introducing the parallel execution of the reconstruction and simulation algorithms to overcome these limitations. CMS plans to execute multicore jobs while still supporting singlecore processing for other tasks difficult to parallelize, such as user analysis. The CMS strategy for job management thus aims at integrating single andmore » multicore job scheduling across the Grid. This is accomplished by employing multicore pilots with internal dynamic partitioning of the allocated resources, capable of running payloads of various core counts simultaneously. An extensive test programme has been conducted to enable multicore scheduling with the various local batch systems available at CMS sites, with the focus on the Tier-0 and Tier-1s, responsible during 2015 of the prompt data reconstruction. Scale tests have been run to analyse the performance of this scheduling strategy and ensure an efficient use of the distributed resources. This paper presents the evolution of the CMS job management and resource provisioning systems in order to support this hybrid scheduling model, as well as its deployment and performance tests, which will enable CMS to transition to a multicore production model for the second LHC run.« less

What women want. Women's preferences for the management of low-grade abnormal cervical screening tests: a systematic review.

PubMed

Frederiksen, M E; Lynge, E; Rebolj, M

2012-01-01

If human papillomavirus (HPV) testing will replace cytology in primary cervical screening, the frequency of low-grade abnormal screening tests will double. Several available alternatives for the follow-up of low-grade abnormal screening tests have similar outcomes. In this situation, women's preferences have been proposed as a guide for management decisions. To determine women's preferences for the follow-up of low-grade cervical screening abnormalities. Using Medical Subject Headings (MeSH) terms, PubMed was searched for articles published up to December 2010. The reference lists of the retrieved studies were consulted. Studies asking women to state a preference between active follow-up and observation for the management of low-grade abnormalities on screening cytology or HPV tests. Information on study design, participants and outcomes was retrieved using a prespecified form. Studies were sorted by design. Thirteen studies were included in the review. In all five studies that surveyed women with abnormal tests before any management had started, two-thirds preferred active follow-up, predominantly as immediate colposcopy, to observation, predominantly as repeated Pap smears. In all but two studies testing other situations, women more often expressed a preference for active follow-up than for observation; however, women appeared to be somewhat more willing to accept observation if reassured of the low risk of cervical cancer. Even for low-grade abnormal cervical tests, women tend to prefer active management strategies. It may be a challenge to meet their expectations of optimal follow-up when HPV testing is used in primary screening. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Management Development Programs: The Effects of Management Level and Corporate Strategy. [and] Invited Reaction: Level and Strategy Should and Do Make a Difference!

ERIC Educational Resources Information Center

Blakely, Gerald L.; And Others

1994-01-01

Consensus of survey responses from 155 of 600 human resource managers was as follows: management development programs emphasized technical skills at lower levels, entrepreneurial skills at senior levels; organizations with corporate growth strategies focused on more areas than those with stability or retrenchment strategies. (Muschewske's reaction…

Strategic threat management: an exploration of nursing strategies in the pediatric intensive care unit.

PubMed

Durso, Francis T; Ferguson, Ashley N; Kazi, Sadaf; Cunningham, Charlene; Ryan, Christina

2015-03-01

Part of the work of a critical care nurse is to manage the threats that arise that could impede efficient and effective job performance. Nurses manage threats by employing various strategies to keep performance high and workload manageable. We investigated strategic threat management by using the Threat-Strategy Interview. Threats frequently involved technology, staff, or organizational components. The threats were managed by a toolbox of multifaceted strategies, the most frequent of which involved staff-, treatment- (patient + technology), examination- (patient + clinician), and patient-oriented strategies. The profile of strategies for a particular threat often leveraged work facets similar to the work facet that characterized the threat. In such cases, the nurse's strategy was directed at eliminating the threat (not working around it). A description at both a domain invariant level - useful for understanding strategic threat management generally - and a description at an operational, specific level - useful for guiding interventions-- are presented. A structural description of the relationship among threats, strategies, and the cues that trigger them is presented in the form of an evidence accumulation framework of strategic threat management. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Recognizing and responding to uncertainty: a grounded theory of nurses' uncertainty.

PubMed

Cranley, Lisa A; Doran, Diane M; Tourangeau, Ann E; Kushniruk, Andre; Nagle, Lynn

2012-08-01

There has been little research to date exploring nurses' uncertainty in their practice. Understanding nurses' uncertainty is important because it has potential implications for how care is delivered. The purpose of this study is to develop a substantive theory to explain how staff nurses experience and respond to uncertainty in their practice. Between 2006 and 2008, a grounded theory study was conducted that included in-depth semi-structured interviews. Fourteen staff nurses working in adult medical-surgical intensive care units at two teaching hospitals in Ontario, Canada, participated in the study. The theory recognizing and responding to uncertainty characterizes the processes through which nurses' uncertainty manifested and how it was managed. Recognizing uncertainty involved the processes of assessing, reflecting, questioning, and/or being unable to predict aspects of the patient situation. Nurses' responses to uncertainty highlighted the cognitive-affective strategies used to manage uncertainty. Study findings highlight the importance of acknowledging uncertainty and having collegial support to manage uncertainty. The theory adds to our understanding the processes involved in recognizing uncertainty, strategies and outcomes of managing uncertainty, and influencing factors. Tailored nursing education programs should be developed to assist nurses in developing skills in articulating and managing their uncertainty. Further research is needed to extend, test and refine the theory of recognizing and responding to uncertainty to develop strategies for managing uncertainty. This theory advances the nursing perspective of uncertainty in clinical practice. The theory is relevant to nurses who are faced with uncertainty and complex clinical decisions, to managers who support nurses in their clinical decision-making, and to researchers who investigate ways to improve decision-making and care delivery. ©2012 Sigma Theta Tau International.

Management considerations in heifer development and puberty.

PubMed

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

1992-12-01

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

Specific Pathogen Free Macaque Colonies: A Review of Principles and Recent Advances for Viral Testing and Colony Management

PubMed Central

Yee, JoAnn L.; Vandeford, Thomas H.; Didier, Elizabeth S.; Gray, Stanton; Lewis, Anne; Roberts, Jeffrey; Taylor, Kerry; Bohm, Rudolf P.

2016-01-01

Specific Pathogen Free (SPF) macaques provide valuable animal models for biomedical research. In 1989 the National Center for Research Resources (now Office of Research Infrastructure Programs ORIP) of the National Institutes of Health initiated experimental research contracts to establish and maintain SPF colonies. The derivation and maintenance of SPF macaque colonies is a complex undertaking requiring knowledge of the biology of the agents for exclusion and normal physiology and behavior of macaques, application of the latest diagnostic technology, facilities management, and animal husbandry. This review provides information on the biology of the four viral agents targeted for exclusion in ORIP SPF macaque colonies, describes current state-of-the-art viral diagnostic algorithms, presents data from proficiency testing of diagnostic assays between laboratories at institutions participating in the ORIP SPF program, and outlines management strategies for maintaining the integrity of SPF colonies using results of diagnostic testing as a guide to decision making. PMID:26932456

INVESTIGATING ALTERNATIVES TO THE FISH EARLY-LIFE STAGE TEST: A STRATEGY FOR DISCOVERING AND ANNOTATING ADVERSE OUTCOME PATHWAYS FOR EARLY FISH DEVELOPMENT

PubMed Central

Villeneuve, Daniel; Volz, David C; Embry, Michelle R; Ankley, Gerald T; Belanger, Scott E; Léonard, Marc; Schirmer, Kristin; Tanguay, Robert; Truong, Lisa; Wehmas, Leah

2014-01-01

The fish early-life stage (FELS) test (Organisation for Economic Co-operation and Development [OECD] test guideline 210) is the primary test used internationally to estimate chronic fish toxicity in support of ecological risk assessments and chemical management programs. As part of an ongoing effort to develop efficient and cost-effective alternatives to the FELS test, there is a need to identify and describe potential adverse outcome pathways (AOPs) relevant to FELS toxicity. To support this endeavor, the authors outline and illustrate an overall strategy for the discovery and annotation of FELS AOPs. Key events represented by major developmental landmarks were organized into a preliminary conceptual model of fish development. Using swim bladder inflation as an example, a weight-of-evidence–based approach was used to support linkage of key molecular initiating events to adverse phenotypic outcomes and reduced young-of-year survival. Based on an iterative approach, the feasibility of using key events as the foundation for expanding a network of plausible linkages and AOP knowledge was explored and, in the process, important knowledge gaps were identified. Given the scope and scale of the task, prioritization of AOP development was recommended and key research objectives were defined relative to factors such as current animal-use restrictions in the European Union and increased demands for fish toxicity data in chemical management programs globally. The example and strategy described are intended to guide collective efforts to define FELS-related AOPs and develop resource-efficient predictive assays that address the toxicological domain of the OECD 210 test. Environ Toxicol Chem 2014;33:158–169. © 2013 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals, Inc. on behalf of SETAC. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. PMID:24115264

Managing demand for laboratory tests: a laboratory toolkit.

PubMed

Fryer, Anthony A; Smellie, W Stuart A

2013-01-01

Healthcare budgets worldwide are facing increasing pressure to reduce costs and improve efficiency, while maintaining quality. Laboratory testing has not escaped this pressure, particularly since pathology investigations cost the National Health Service £2.5 billion per year. Indeed, the Carter Review, a UK Department of Health-commissioned review of pathology services in England, estimated that 20% of this could be saved by improving pathology services, despite an average annual increase of 8%-10% in workload. One area of increasing importance is managing the demands for pathology tests and reducing inappropriate requesting. The Carter Review estimated that 25% of pathology tests were unnecessary, representing a huge potential waste. Certainly, the large variability in levels of requesting between general practitioners suggests that inappropriate requesting is widespread. Unlocking the key to this variation and implementing measures to reduce inappropriate requesting would have major implications for patients and healthcare resources alike. This article reviews the approaches to demand management. Specifically, it aims to (a) define demand management and inappropriate requesting, (b) assess the drivers for demand management, (c) examine the various approaches used, illustrating the potential of electronic requesting and (d) provide a wider context. It will cover issues, such as educational approaches, information technology opportunities and challenges, vetting, duplicate request identification and management, the role of key performance indicators, profile composition and assessment of downstream impact of inappropriate requesting. Currently, many laboratories are exploring demand management using a plethora of disparate approaches. Hence, this review seeks to provide a 'toolkit' with the view to allowing laboratories to develop a standardised demand management strategy.

Optimizing care in osteoporosis: The Canadian quality circle project

PubMed Central

Ioannidis, George; Thabane, Lehana; Gafni, Amiram; Hodsman, Anthony; Kvern, Brent; Johnstone, Dan; Plumley, Nathalie; Salach, Lena; Jiwa, Famida; Adachi, Jonathan D; Papaioannou, Alexandra

2008-01-01

Background While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines. Methods The project consisted of five Quality Circle phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 circle members formed 34 quality circles and participated in the study. The generalized estimating equations approach was used to model physician awareness of risk factors for osteoporosis and appropriate utilization of bone mineral density testing pre and post educational intervention (first year of the study). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Results After the 1st year of the study, physicians' certainty of their patients' risk factor status increased. Certainty varied from an OR of 1.4 (95% CI: 1.1, 1.8) for prior vertebral fracture status to 6.3 (95% CI: 2.3, 17.9) for prior hip fracture status. Furthermore, bone mineral density testing increased in high risk as compared with low risk patients (OR: 1.4; 95% CI: 1.2, 1.7). Conclusion Quality Circle methodology was successful in increasing both physicians' awareness of osteoporosis risk factors and appropriate bone mineral density testing in accordance with the 2002 Canadian guidelines. PMID:18828906

KAZAN: Will you survive the next geodisaster? An educational game for raising awareness about geohazards and risk reduction strategies

NASA Astrophysics Data System (ADS)

Mossoux, Sophie; Delcamp, Audray; Poppe, Sam; Kervyn, Matthieu

2015-04-01

Natural disasters remain too often presented in the media as the results from extreme natural phenomena affecting helpless people. School students and stakeholders, especially in developing countries, have a limited awareness of the different components of disasters and of the complementary strategies existing to mitigate their impacts. Using the specific example of the Ngazidja Island (Comoros), we developed and tested a new board game aiming at raising awareness about geohazards (i.e. earthquake, tsunami, lava flow, volcanic ash fall). This game highlights the various and spatially-variable geohazard impacts on the exposed population, the key role played by livelihood strategies and the access to natural resources in controlling long term impacts, and the capacity of a community to act in reducing its vulnerability to natural hazards. The target public of this game are 1. secondary school students, 2. scientists and stakeholders involved to some degree in risk management activities, and 3. people exposed to these hazards. For the first group, the aim is to allow them to better interpret the disaster to which they are confronted in the media, whereas for the second group, the objective is to generate discussion about the efficiency and complementarity of contrasted risk management strategies. The objective for the last group is to help them to understand the hazard to which they are confronted in order to be better prepared. In this contribution, we will present the game board and the implemented rules. This game was tested with several groups of secondary school students in Belgium and with geologists and risk managers in Tanzania and in the Comores. On the basis of the analysis of the game strategies developed by the players, their reactions during the game and their answers to a short questionnaire, we analyse the main learning outcomes that are conveyed by this game. We compare these outcomes with key elements of the risk management, focusing on geohazards in developing countries. Kazan game appears as an effective and activating learning tool to transfer important concepts and generate debate about natural disasters, focusing on the spatial competition for natural resources and the control of household's livelihood on their vulnerability to hazards.

Clinical decision support tools for osteoporosis disease management: a systematic review of randomized controlled trials.

PubMed

Kastner, Monika; Straus, Sharon E

2008-12-01

Studies indicate a gap between evidence and clinical practice in osteoporosis management. Tools that facilitate clinical decision making at the point of care are promising strategies for closing these practice gaps. To systematically review the literature to identify and describe the effectiveness of tools that support clinical decision making in osteoporosis disease management. Medline, EMBASE, CINAHL, and EBM Reviews (CDSR, DARE, CCTR, and ACP J Club), and contact with experts in the field. Randomized controlled trials (RCTs) in any language from 1966 to July 2006 investigating disease management interventions in patients at risk for osteoporosis. Outcomes included fractures and bone mineral density (BMD) testing. Two investigators independently assessed articles for relevance and study quality, and extracted data using standardized forms. Of 1,246 citations that were screened for relevance, 13 RCTs met the inclusion criteria. Reported study quality was generally poor. Meta-analysis was not done because of methodological and clinical heterogeneity; 77% of studies included a reminder or education as a component of their intervention. Three studies of reminders plus education targeted to physicians and patients showed increased BMD testing (RR range 1.43 to 8.67) and osteoporosis medication use (RR range 1.60 to 8.67). A physician reminder plus a patient risk assessment strategy found reduced fractures [RR 0.58, 95% confidence interval (CI) 0.37 to 0.90] and increased osteoporosis therapy (RR 2.44, CI 1.43 to 4.17). Multi-component tools that are targeted to physicians and patients may be effective for supporting clinical decision making in osteoporosis disease management.

Regulatory perspectives on acceptability testing of dosage forms in children.

PubMed

Kozarewicz, Piotr

2014-08-05

Current knowledge about the age-appropriateness of different dosage forms is still fragmented or limited. Applicants are asked to demonstrate that the target age group(s) can manage the dosage form or propose an alternative strategy. However, questions remain about how far the applicant must go and what percentage of patients must find the strategy 'acceptable'. The aim of this overview is to provide an update on current thinking and understanding of the problem, and discuss issues relating to the acceptability testing. This overview should be considered as means to start a wider discussion which hopefully will result in a harmonised, globally acceptable approach for confirmation of the acceptability in the future. Copyright © 2014 Elsevier B.V. All rights reserved.

Enabling a flexible exchange of energy of a photovoltaic plant with the grid by means of a controlled storage system

NASA Astrophysics Data System (ADS)

Lazzari, R.; Parma, C.; De Marco, A.; Bittanti, S.

2015-07-01

In this paper, we describe a control strategy for a photovoltaic (PV) power plant equipped with an energy storage system (ESS), based on lithium-ion battery. The plant consists of the following units: the PV generator, the energy storage system, the DC-bus and the inverter. The control, organised in a hierarchical manner, maximises the self-consumption of the local load unit. In particular, the ESS action performs power balance in case of low solar radiation or surplus of PV generation, thus managing the power exchange variability at the plant with the grid. The implemented control strategy is under testing in RSE pilot test facility in Milan, Italy.

Self-management in young adults with bipolar disorder: Strategies and challenges.

PubMed

Nicholas, Jennifer; Boydell, Katherine; Christensen, Helen

2017-02-01

Early adoption of effective self-management strategies for bipolar disorder (BD) results in better clinical outcomes and increased quality of life. Therefore, facilitation of these strategies in young adults who are early in their illness course is vital. However, an understanding of self-management practices and needs of young adults with BD is lacking. This study explores young adult's perspectives of disorder self-management practices and challenges. Young adults with BD completed an online survey about disorder management strategies and challenges. Self-management was investigated through self-report and ratings of literature-derived strategies. Results were analysed using descriptive statistics and qualitative thematic analysis. Eighty-nine participants aged 18-30 (M=24.4; SD=3.9) completed the survey. Adherence to treatment, disorder psychoeducation, and sleep-management were the strategies rated most helpful. Six participant-reported self-management strategies were identified (1) Maintaining a healthy lifestyle; (2) Treatment attendance and adherence; (3) Participation in meaningful activities; (4) Engagement with social support; (5) Meditation and relaxation practices; and (6) Symptom monitoring. The most common self-management challenges experienced by young adults concerned the nature of the disorder, interpersonal relationships, and stigma. Participants likely represent a sub-set of young adults engaged with healthcare and therefore may not be representative of the population. Strategies reported vital by those successfully managing their disorder are not adequately utilised by young adults with BD. Both differences in strategy use and perceived self-management challenges represent important areas of clinical support and intervention. This increased understanding will help facilitate self-management skill development in this population. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of vegetation management in constructed wetland treatment cells on water quality and mosquito production

USGS Publications Warehouse

Thullen, J.S.; Sartoris, J.J.; Nelson, S.M.

2002-01-01

The impact of three vegetation management strategies on wetland treatment function and mosquito production was assessed in eight free water surface wetland test cells in southern California during 1998–1999. The effectiveness of the strategies to limit bulrush Schoenoplectus californicus culm density within the cells was also investigated. Removing accumulated emergent biomass and physically limiting the area in which vegetation could reestablish, significantly improved the ammonia–nitrogen removal efficiency of the wetland cells, which received an ammonia-dominated municipal wastewater effluent (average loading rate=9.88 kg/ha per day NH4-N). We determined that interspersing open water with emergent vegetation is critical for maintaining the wetland's treatment capability, particularly for systems high in NH4-N. Burning aboveground plant parts and thinning rhizomes only temporarily curtailed vegetation proliferation in shallow zones, whereas creating hummocks surrounded by deeper water successfully restricted the emergent vegetation to the shallower hummock areas. Since the hummock configuration kept open water areas interspersed throughout the stands of emergent vegetation, the strategy was also effective in reducing mosquito production. Decreasing vegetation biomass reduced mosquito refuge areas while increasing mosquito predator habitat. Therefore, the combined goals of water quality improvement and mosquito management were achieved by managing the spatial pattern of emergent vegetation to mimic an early successional growth stage, i.e. actively growing plants interspersed with open water.

Effects of vegetation management in constructed wetland treatment cells on water quality and mosquito production

USGS Publications Warehouse

Thullen, J.S.; Sartoris, J.J.; Walton, W.E.

2002-01-01

The impact of three vegetation management strategies on wetland treatment function and mosquito production was assessed in eight free water surface wetland test cells in southern California during 1998-1999. The effectiveness of the strategies to limit bulrush Schoenoplectus californicus culm density within the cells was also investigated. Removing accumulated emergent biomass and physically limiting the area in which vegetation could reestablish, significantly improved the ammonia - nitrogen removal efficiency of the wetland cells, which received an ammonia-dominated municipal wastewater effluent (average loading rate = 9.88 kg/ha per day NH4-N). We determined that interspersing open water with emergent vegetation is critical for maintaining the wetland's treatment capability, particularly for systems high in NH4-N. Burning aboveground plant parts and thinning rhizomes only temporarily curtailed vegetation proliferation in shallow zones, whereas creating hummocks surrounded by deeper water successfully restricted the emergent vegetation to the shallower hummock areas. Since the hummock configuration kept open water areas interspersed throughout the stands of emergent vegetation, the strategy was also effective in reducing mosquito production. Decreasing vegetation biomass reduced mosquito refuge areas while increasing mosquito predator habitat. Therefore, the combined goals of water quality improvement and mosquito management were achieved by managing the spatial pattern of emergent vegetation to mimic an early successional growth stage, i.e. actively growing plants interspersed with open water. ?? 2002 Elsevier Science B.V. All rights reserved.

Evaluating data worth for ground-water management under uncertainty

USGS Publications Warehouse

Wagner, B.J.

1999-01-01

A decision framework is presented for assessing the value of ground-water sampling within the context of ground-water management under uncertainty. The framework couples two optimization models-a chance-constrained ground-water management model and an integer-programing sampling network design model-to identify optimal pumping and sampling strategies. The methodology consists of four steps: (1) The optimal ground-water management strategy for the present level of model uncertainty is determined using the chance-constrained management model; (2) for a specified data collection budget, the monitoring network design model identifies, prior to data collection, the sampling strategy that will minimize model uncertainty; (3) the optimal ground-water management strategy is recalculated on the basis of the projected model uncertainty after sampling; and (4) the worth of the monitoring strategy is assessed by comparing the value of the sample information-i.e., the projected reduction in management costs-with the cost of data collection. Steps 2-4 are repeated for a series of data collection budgets, producing a suite of management/monitoring alternatives, from which the best alternative can be selected. A hypothetical example demonstrates the methodology's ability to identify the ground-water sampling strategy with greatest net economic benefit for ground-water management.A decision framework is presented for assessing the value of ground-water sampling within the context of ground-water management under uncertainty. The framework couples two optimization models - a chance-constrained ground-water management model and an integer-programming sampling network design model - to identify optimal pumping and sampling strategies. The methodology consists of four steps: (1) The optimal ground-water management strategy for the present level of model uncertainty is determined using the chance-constrained management model; (2) for a specified data collection budget, the monitoring network design model identifies, prior to data collection, the sampling strategy that will minimize model uncertainty; (3) the optimal ground-water management strategy is recalculated on the basis of the projected model uncertainty after sampling; and (4) the worth of the monitoring strategy is assessed by comparing the value of the sample information - i.e., the projected reduction in management costs - with the cost of data collection. Steps 2-4 are repeated for a series of data collection budgets, producing a suite of management/monitoring alternatives, from which the best alternative can be selected. A hypothetical example demonstrates the methodology's ability to identify the ground-water sampling strategy with greatest net economic benefit for ground-water management.

The integrated rangeland fire management strategy actionable science plan

USGS Publications Warehouse

Aldridge, Cameron L.; Berg, Ken; Boyd, Chad S.; Boyte, Stephen P.; Bradford, John B.; Brunson, Ed; Cissel, John H.; Conway, Courtney J.; Chalfoun, Anna D.; Chambers, Jeanne C.; Clark, Patrick; Coates, Peter S.; Crist, Michele R.; Davis, Dawn M.; DeCrappeo, Nicole; Deibert, Patricia A.; Doherty, Kevin E.; Evers, Louisa B.; Finch, Deborah M.; Finn, Sean P.; Germino, Matthew J.; Glenn, Nancy F.; Gucker, Corey; Hall, John A.; Hanser, Steven E.; Havlina, Douglas W.; Heinrichs, Julie; Heller, Matt; Homer, Collin G.; Hunter, Molly E.; Jacobs, Ruth W.; Karl, Jason W.; Kearney, Richard; Kemp, Susan K; Kilkenny, Francis F.; Knick, Steven T.; Launchbaugh, Karen; Manier, Daniel J.; Mayer, Kenneth E.; Meyer, Susan E.; Monroe, Adrian; MontBlanc, Eugénie; Newingham, Beth A.; Pellant, Michael L.; Phillips, Susan L.; Pilliod, David S.; Ricca, Mark A.; Richardson, Bryce A.; Rose, Jeffrey A.; Shaw, Nancy; Sheley, Roger L.; Shinneman, Douglas J.; Wiechman , Lief A.; Wylie, Bruce K.

2016-01-01

The Integrated Rangeland Fire Management Strategy (hereafter Strategy, DOI 2015) outlined the need for coordinated, science-based adaptive management to achieve long-term protection, conservation, and restoration of the sagebrush (Artemisia spp.) ecosystem. A key component of this management approach is the identification of knowledge gaps that limit implementation of effective strategies to meet current management challenges. The tasks and actions identified in the Strategy address several broad topics related to management of the sagebrush ecosystem. This science plan is organized around these topics and specifically focuses on fire, invasive plant species and their effects on altering fire regimes, restoration, sagebrush and greater sage-grouse (Centrocercus urophasianus), and climate and weather.

Dissemination of sustainable irrigation strategies for almond and olive orchards via a participatory approach. Project LIFE+IRRIMAN

NASA Astrophysics Data System (ADS)

Garcia-Vila, Margarita; Gamero-Ojeda, Pablo; Ascension Carmona, Maria; Berlanga, Jose; Fereres, Elias

2017-04-01

Dissemination of sustainable irrigation strategies for almond and olive orchards via a participatory approach. Project LIFE+IRRIMAN Spain is the world's first and third largest producer of olive oil and almond, respectively. Despite huge efforts in the last years by the production sector towards intensification, cultural issues relative to the traditional rain-fed crop management know how, prevent farmers from adoption of sustainable irrigation management practices. Consequently, even though there has been progress in irrigation management research for these two crops, adoption of modern irrigation techniques by farmers has been slow. Sustainable irrigation strategies for olive and almond orchards are being designed, implemented, validated and disseminated under the framework of the LIFE+ IRRIMAN project, through a participatory approach. The implementation of the LIFE+ IRRIMAN innovative and demonstrative actions has been carried out in an irrigation district of Southern Spain (Genil-Cabra Irrigation Scheme, Andalusia). The approach designed has four phases: i) design and implementation of sustainable irrigation strategies in demonstration farms; ii) dissemination of best irrigation practices which were tested in the initial year throughout the irrigation scheme by the irrigation advisory service; iii) assessment of degree of adoption and re-design of the dissemination strategies; and, iv) based on the results obtained, elaboration of sustainable irrigation guidelines for knowledge transfer in the district at regional and national levels to promote changes in irrigation practices. Participatory approaches have proven to be effective tools for successful irrigation strategies design and diffusion, especially in traditional rain fed crops such as olive and almond trees in the Mediterranean countries. Acknowledgements This work has been funded by the European Union LIFE+ project IRRIMAN (LIFE13 ENV/ES/000539).

Found in Translation: What’s going on at the USDA’s Beltsville Bee Research Laboratory

USDA-ARS?s Scientific Manuscript database

Practical research discoveries follow a twisting path. Basic research driven by the human need to understand nature can, often years or even decades later, lead to huge advances that benefit people or the environment. Alternatively, sure-thing tests of a new product, management strategy, or breeding...

Predicting Community College and University Student Success: A Test of the Triadic Reciprocal Model for Two Populations

ERIC Educational Resources Information Center

Heller, Monica L.; Cassady, Jerrell C.

2017-01-01

The current study explored the differential influences that behavioral learning strategies (i.e., cognitive-metacognitive, resource management), motivational profiles, and academic anxiety appraisals have on college-level learners in two unique learning contexts. Using multivariate analysis of variance and discriminant analysis, the study first…

Forest treatment strategies for Phytophthora ramorum

Treesearch

Yana Valachovic; Chris Lee; Jack Marshall; Hugh Scanlon

2010-01-01

Although there is no known cure or preventative on a landscape scale for sudden oak death (SOD), the plant disease caused by Phytophthora ramorum, a variety of management options has been tested with the goal of developing an integrated program of treatment for the pathogen. This paper presents a first attempt to gather together individual...

Test of localized nanagement for reducing deer browsing in forest regeneration areas

Treesearch

Brad F. Miller; Tyler A. Campbell; Ben R. Laseter; W.Mark Ford; Karl V. Miller

2010-01-01

White-tailed deer (Odocoileus virginianus) browsing in forest regeneration sites can affect current and future stand structure and species composition. Removal of deer social units (localized management) has been proposed as a strategy to alleviate deer overbrowsing in forest systems. We conducted an experimental localized removal in a high-density...

A differential nursery for testing nodulation effectiveness of rhizobium strains in common beans

USDA-ARS?s Scientific Manuscript database

Most common beans (Phaseolus vulgaris L.) in Central America are produced on soils having low nitrogen (N) and phosphorous content. The small-scale farmers do not have resources to use fertilizers or implement soil management practices. Strategies to improve the adaptation of beans to low N soils in...

Evaluating mustard and arugula volatiles and refuge plants for sustainable control of insect pests

USDA-ARS?s Scientific Manuscript database

Whiteflies and aphids are important insect pests in vegetable crops. To mitigate the use of chemical insecticides, “push-pull” strategies can be used as components of sustainable or cultural pest management. We conducted laboratory olfactometer or odor detecting tests to measure the effects of arugu...

Screening and Testing Phytochemicals in Eastern Redcedar (Juniperus virginiana) for Development of Potential Entrepreneurial Opportunities

USDA-ARS?s Scientific Manuscript database

Eastern redcedar (Juniperus virginiana) is often considered a “trash or nuisance” tree. In some states, this species has been declared invasive and management strategies have been adopted to destroy it. However, value-added phytochemical products from eastern redcedar have the potential to create n...

A Test of the Spirit: The Duquesne University Shootings

ERIC Educational Resources Information Center

Guskey, Audrey

2013-01-01

In September 2006, five key Duquesne University basketball players were shot on the campus by an outside visitor after a school dance. This case explores how students learned firsthand Crisis Management 101--how to survive and thrive during a crisis. Student learning activities included writing journals, discussions of the university's strategies,…

Action Planning and Recording Achievement.

ERIC Educational Resources Information Center

Green, Muriel

This document examines strategies and procedures that British further education (FE) colleges can use to develop and enhance systems and structures for guiding and supporting learners and learning. It is based on the findings of a field test of the Managing Learning model for planning and recording the process of FE students. First, the importance…

Does market integration buffer risk, erode traditional sharing practices and increase inequality? A test among Bolivian forager-farmers

PubMed Central

Gurven, Michael; Jaeggi, Adrian V.; von Rueden, Chris; Hooper, Paul L.; Kaplan, Hillard

2015-01-01

Sharing and exchange are common practices for minimizing food insecurity in rural populations. The advent of markets and monetization in egalitarian indigenous populations presents an alternative means of managing risk, with the potential impact of eroding traditional networks. We test whether market involvement buffers several types of risk and reduces traditional sharing behavior among Tsimane Amerindians of the Bolivian Amazon. Results vary based on type of market integration and scale of analysis (household vs. village), consistent with the notion that local culture and ecology shape risk management strategies. Greater wealth and income were unassociated with the reliance on others for food, or on reciprocity, but wealth was associated with a greater proportion of food given to others (i.e., giving intensity) and a greater number of sharing partners (i.e., sharing breadth). Across villages, greater mean income was negatively associated with reciprocity, but economic inequality was positively associated with giving intensity and sharing breadth. Incipient market integration does not necessarily replace traditional buffering strategies but instead can often enhance social capital. PMID:26526638

Does market integration buffer risk, erode traditional sharing practices and increase inequality? A test among Bolivian forager-farmers.

PubMed

Gurven, Michael; Jaeggi, Adrian V; von Rueden, Chris; Hooper, Paul L; Kaplan, Hillard

2015-08-01

Sharing and exchange are common practices for minimizing food insecurity in rural populations. The advent of markets and monetization in egalitarian indigenous populations presents an alternative means of managing risk, with the potential impact of eroding traditional networks. We test whether market involvement buffers several types of risk and reduces traditional sharing behavior among Tsimane Amerindians of the Bolivian Amazon. Results vary based on type of market integration and scale of analysis (household vs. village), consistent with the notion that local culture and ecology shape risk management strategies. Greater wealth and income were unassociated with the reliance on others for food, or on reciprocity, but wealth was associated with a greater proportion of food given to others (i.e., giving intensity) and a greater number of sharing partners (i.e., sharing breadth). Across villages, greater mean income was negatively associated with reciprocity, but economic inequality was positively associated with giving intensity and sharing breadth. Incipient market integration does not necessarily replace traditional buffering strategies but instead can often enhance social capital.

Relationship-Driven Classroom Management: Strategies That Promote Student Motivation.

ERIC Educational Resources Information Center

Vitto, John M.

This book combines information about resiliency, classroom management, and discipline into a user-friendly discussion suitable for all teachers. The material covers both preventive strategies and reactive strategies. The chapters of part 1, "Reinventive Strategies," are: (1) "Relationship-Driven Classroom Management and Resilience"; (2)…

Antecedents and consequences of intra-group conflict among nurses.

PubMed

Almost, Joan; Doran, Diane M; McGillis Hall, Linda; Spence Laschinger, Heather K

2010-11-01

To test a theoretical model linking selected antecedent variables to intra-group conflict among nurses, and subsequently conflict management style, job stress and job satisfaction. A contributing factor to the nursing shortage is job dissatisfaction as a result of conflict among nurses. To develop strategies to reduce conflict, research is needed to understand the causes and outcomes of conflict in nursing work environments. A predictive, non-experimental design was used in a random sample of 277 acute care nurses. Structural equation modelling was used to analyse the hypothesised model. Nurses' core self-evaluations, complexity of care and relationships with managers and nursing colleagues influenced their perceived level of conflict. Conflict management style partially mediated the relationship between conflict and job satisfaction. Job stress had a direct effect on job satisfaction and core self-evaluation had a direct effect on job stress. Conflict and its associated outcomes is a complex process, affected by dispositional, contextual and interpersonal factors. How nurses manage conflict may not prevent the negative effects of conflict, however, learning to manage conflict using collaboration and accommodation may help nurses experience greater job satisfaction. Strategies to manage and reduce conflict include building interactional justice practices and positive interpersonal relationships. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Influence of personality and neuropsychological ability on social functioning and self-management in bipolar disorder.

PubMed

Vierck, Esther; Joyce, Peter R

2015-10-30

A majority of bipolar patients (BD) show functional difficulties even in remission. In recent years cognitive functions and personality characteristics have been associated with occupational and psychosocial outcomes, but findings are not consistent. We assessed personality and cognitive functioning through a range of tests in BD and control participants. Three cognitive domains-verbal memory, facial-executive, and spatial memory-were extracted by principal component analysis. These factors and selected personality dimensions were included in hierarchical regression analysis to predict psychosocial functioning and the use of self-management strategies while controlling for mood status. The best determinants of good psychosocial functioning were good verbal memory and high self-directedness. The use of self-management techniques was associated with a low level of harm-avoidance. Our findings indicate that strategies to improve memory and self-directedness may be useful for increasing functioning in individuals with bipolar disorder. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Detecting local establishment strategies of wild cherry (Prunus avium L.).

PubMed

Höltken, Aki M; Gregorius, Hans-Rolf

2006-10-04

P. avium, a pioneer tree species that colonizes early forest successional stages, is assumed to require an effective strategy allowing stably repeatable rounds of local establishment, dispersal and local extinction. Consequently, the early replacement of cherry by climax tree species makes the establishment of several local generations very unlikely, especially in central European continuous cover forests. This has to be seen in connection with the mixed reproduction system involving asexual reproduction as a complementary adaptational strategy. Tests of the local establishment of wild cherry must therefore consider the possibility of first generation establishment via seedling recruitment potentially followed by an asexual generation (root suckering). Successful establishment can therefore be determined only among adult individuals with the option of detecting vegetative reproduction at these stages. To test the implied suggestion about local establishment strategies of wild cherry, nuclear microsatellites were used to analyse patterns of asexual propagation among adult stages that have been subjected to one of two major types of forest management. These management types, the historical "coppice with standards system" (CWS) and the "high forest system" (HFS), can be reasonably assumed to have affected the reproduction system of P. avium. Clear differences were found in the reproduction pattern between two stands representing the two forest management types: 1) Clonal propagation is observed in both management systems, but with a distinctly higher frequency in the CWS. Hence, sexual recruitment as a first local generation is followed by a second asexual generation in both, whereas in the CWS there is evidence for an additional clonal generation. 2) The estimation of amounts of clonal reproduction critically depends on the assumptions about multilocus gene associations. This is revealed by the application of newly developed methods of quantifying gene associations. 3) Haplotype diversities are higher in the CWS and found to be associated with a large degree of heterozygosity for the second largest clonal group. 4) Seed set was sparse over the last eight years of observation in the CWS stand. This study provides useful guidelines for more comprehensive investigations, particularly on the interrelationships between degrees of cloning and capacity of sexual reproduction, amounts of multilocus gene associations, effects of heterozygosity on cloning success, and sustainability of different forest management types.

Making strategy: learning by doing.

PubMed

Christensen, C M

1997-01-01

Companies find it difficult to change strategy for many reasons, but one stands out: strategic thinking is not a core managerial competence at most companies. Executives hone their capabilities by tackling problems over and over again. Changing strategy, however, is not usually a task that they face repeatedly. Once companies have found a strategy that works, they want to use it, not change it. Consequently, most managers do not develop a competence in strategic thinking. This Manager's Tool Kit presents a three-stage method executives can use to conceive and implement a creative and coherent strategy themselves. The first stage is to identify and map the driving forces that the company needs to address. The process of mapping provides strategy-making teams with visual representations of team members' assumptions, those pictures, in turn, enable managers to achieve consensus in determining the driving forces. Once a senior management team has formulated a new strategy, it must align the strategy with the company's resource-allocation process to make implementation possible. Senior management teams can translate their strategy into action by using aggregate project planning. And management teams that link strategy and innovation through that planning process will develop a competence in implementing strategic change. The author guides the reader through the three stages of strategy making by examining the case of a manufacturing company that was losing ground to competitors. After mapping the driving forces, the company's senior managers were able to devise a new strategy that allowed the business to maintain a competitive advantage in its industry.

Prevention of surgical resident attrition by a novel selection strategy.

PubMed

Kelz, Rachel R; Mullen, James L; Kaiser, Larry R; Pray, Lori A; Shea, Gregory P; Drebin, Jeff A; Wirtalla, Chris J; Morris, Jon B

2010-09-01

We modified the resident selection strategy in an attempt to reduce resident attrition (RA). Despite implementation of the Accreditation Council for Graduate Medical Education work rules, lifestyle and generational priorities have fostered a persistent and relatively high attrition rate for surgical trainees. An independent external review of residents who left the training program and a detailed analysis of the resident selection strategy were performed by an organizational management expert. Modifications implemented in 2005 (the intervention) included standardization of the screening and interview format. Applicants were required to submit a 500 words essay related to stress management, organizational skills, future aspirations, and prioritization abilities. Their responses formed the basis of an extended, personalized, and structured interview script. Candidate characteristics and RA were compared for the 5 years before and after the intervention, using Fisher exact test or chi2. Age, sex, birthplace, medical school ranking, step 1 score, and American Board of Surgey In-Training Examination performance were not significantly different between the selection strategy groups. Risk factors for RA included ABSITE performance and gender. Resident performance and subsequent RA were significantly affected by the resident selection strategy. RA was dramatically reduced following the intervention. A custom designed process to identify candidates most likely to succeed substantially improved resident retention in a demanding academic training program.

Symptom management strategies for men with early-stage prostate cancer: results from the Prostate Cancer Patient Education Program (PC PEP).

PubMed

Vij, Alok; Kowalkowski, Marc A; Hart, Tae; Goltz, Heather Honoré; Hoffman, David J; Knight, Sara J; Caroll, Peter R; Latini, David M

2013-12-01

While the literature on prostate cancer health-related quality of life has grown extensively, little is known about symptom management strategies used by men to manage treatment-related side effects and the effectiveness of those strategies. We collected 628 symptom management reports from 98 men treated for localized prostate cancer. Participants were recruited from email lists and a prostate cancer clinic in Northern California. Data were collected using the Critical Incident Technique. Symptom management reports were assigned to categories of urinary, sexual, bowel, mental health, systemic, or "other." We calculated descriptive statistics by symptom type and management strategy effectiveness. The most common symptoms were urinary (26 %) and sexual (23 %). Participants' symptom management strategies varied widely, from medical and surgical interventions (20 %) to behavioral strategies (11 %) to diet and lifestyle interventions (12 %). The effectiveness of symptom management strategies varied, with sexual symptoms being managed effectively only 47 % of the time to mental health symptom management strategies considered effective 89 % of the time. Doing nothing was a commonly reported (15 %) response to symptoms and was effective only 14 % of the time. Men report the least effectiveness in symptom management for sexual dysfunction after prostate cancer treatment. Including men's experience with managing treatment side effects may be an important way to improve survivorship programs and make them more acceptable to men. More work is needed to find out why men frequently do nothing in response to symptoms when effective solutions exist and how providers can successfully engage such men.

Symptom Management Strategies for Men with Early-Stage Prostate Cancer: Results from the Prostate Cancer Patient Education Program (PCPEP)

PubMed Central

Vij, Alok; Kowalkowski, Marc A.; Hart, Tae; Goltz, Heather Honoré; Hoffman, David J.; Knight, Sara J.; Caroll, Peter R.

2013-01-01

While the literature on prostate cancer health-related quality of life has grown extensively, little is known about symptom management strategies used by men to manage treatment-related side effects and the effectiveness of those strategies. We collected 628 symptom management reports from 98 men treated for localized prostate cancer. Participants were recruited from email lists and a prostate cancer clinic in Northern California. Data were collected using the Critical Incident Technique. Symptom management reports were assigned to categories of urinary, sexual, bowel, mental health, systemic, or “other.” We calculated descriptive statistics by symptom type and management strategy effectiveness. The most common symptoms were urinary (26 %) and sexual (23 %). Participants’ symptom management strategies varied widely, from medical and surgical interventions (20 %) to behavioral strategies (11 %) to diet and lifestyle interventions (12 %). The effectiveness of symptom management strategies varied, with sexual symptoms being managed effectively only 47 % of the time to mental health symptom management strategies considered effective 89 % of the time. Doing nothing was a commonly reported (15 %) response to symptoms and was effective only 14 % of the time. Men report the least effectiveness in symptom management for sexual dysfunction after prostate cancer treatment. Including men’s experience with managing treatment side effects may be an important way to improve survivorship programs and make them more acceptable to men. More work is needed to find out why men frequently do nothing in response to symptoms when effective solutions exist and how providers can successfully engage such men. PMID:23996206

Prevention and Screening in Hereditary Breast and Ovarian Cancer.

PubMed

Zeichner, Simon B; Stanislaw, Christine; Meisel, Jane L

2016-10-15

In recent years, we have learned a great deal about pathogenic mutations that increase the risk of breast and ovarian cancer, particularly mutations in the BRCA1 and BRCA2 genes. Here we review current guidelines on breast and ovarian cancer screening, prophylactic surgery, and other risk-reduction strategies in patients with these mutations, and we detail the data that drive these recommendations. We also discuss guidelines on screening and management for other cancers associated with BRCA1 and BRCA2, such as male breast cancer, pancreatic cancer, and prostate cancer. Discussions about genetic testing have become more complex with the advent of panel testing, which often allows for testing of a more comprehensive panel of genes than traditional BRCA1 and BRCA2 testing, but which is also associated with a higher likelihood of obtaining results with less clear data to inform management. It is difficult to come to a consensus on how best to address the varied and potentially challenging situations that may arise from genetic testing. The complexity inherent in managing these cases makes a multidisciplinary team-including medical oncologists, surgical oncologists, genetic counselors, reproductive endocrinologists, and medical ethicists-critical to optimization of care.

Systematic review of strategies to manage and allocate scarce resources during mass casualty events.

PubMed

Timbie, Justin W; Ringel, Jeanne S; Fox, D Steven; Pillemer, Francesca; Waxman, Daniel A; Moore, Melinda; Hansen, Cynthia K; Knebel, Ann R; Ricciardi, Richard; Kellermann, Arthur L

2013-06-01

Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of scarce resources across a wide range of mass casualty event contexts and study designs. Our literature search included MEDLINE, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Database of Systematic Reviews, from 1990 through late 2011. We also searched the gray literature, using the New York Academy of Medicine's Grey Literature Report and key Web sites. We included both English- and foreign-language articles. We included studies that evaluated strategies used in actual mass casualty events or tested through drills, exercises, or computer simulations. We excluded studies that lacked a comparison group or did not report quantitative outcomes. Data extraction, quality assessment, and strength of evidence ratings were conducted by a single researcher and reviewed by a second; discrepancies were reconciled by the 2 reviewers. Because of heterogeneity in outcome measures, we qualitatively synthesized findings within categories of strategies. From 5,716 potentially relevant citations, 74 studies met inclusion criteria. Strategies included reducing demand for health care services (18 studies), optimizing use of existing resources (50), augmenting existing resources (5), implementing crisis standards of care (5), and multiple categories (4). The evidence was sufficient to form conclusions on 2 strategies, although the strength of evidence was rated as low. First, as a strategy to reduce demand for health care services, points of dispensing can be used to efficiently distribute biological countermeasures after a bioterrorism attack or influenza pandemic, and their organization influences speed of distribution. Second, as a strategy to optimize use of existing resources, commonly used field triage systems do not perform consistently during actual mass casualty events. The number of high-quality studies addressing other strategies was insufficient to support conclusions about their effectiveness because of differences in study context, comparison groups, and outcome measures. Our literature search may have missed key resource management and allocation strategies because of their extreme heterogeneity. Interrater reliability was not assessed for quality assessments or strength of evidence ratings. Publication bias is likely, given the large number of studies reporting positive findings. The current evidence base is inadequate to inform providers and policymakers about the most effective strategies for managing or allocating scarce resources during mass casualty events. Consensus on methodological standards that encompass a range of study designs is needed to guide future research and strengthen the evidence base. Evidentiary standards should be developed to promote consensus interpretations of the evidence supporting individual strategies. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Managing Conflict: 50 Strategies for School Leaders

ERIC Educational Resources Information Center

Edmonson, Stacey; Combs, Julie; Harris, Sandra

2008-01-01

This book offers 50 easy-to-read strategies for managing conflicts in your school involving students, parents, and teachers. Individually, these strategies provide specific insights into conflict resolution, reduction, and management. As a whole, the 50 strategies provide a comprehensive method to lead constructive change in your school. With…

Effectiveness of alternative management strategies in meeting conservation objectives

Treesearch

Richards S. Holthausen; Carolyn Hull Sieg

2007-01-01

This chapter evaluates how well various management strategies meet a variety of conservation objectives, summarizes their effectiveness in meeting objectives for rare or little-known (RLK) species, and proposes ways to combine strategies to meet overall conservation objectives. We address two broad categories of management strategies. Species approaches result in...

Laboratory Test Utilization Management: General Principles and Applications in Hematopathology.

PubMed

Reichard, Kaaren K; Wood, Adam J

2016-03-01

As the cost of health care continues to rise and reimbursement rates decrease, there is a growing demand and need to cut overall costs, enhance quality of services, and maintain as a top priority the needs and safety of the patient. In this article, we provide an introduction to test utilization and outline a general approach to creating an efficient, cost-effective test utilization strategy. We also present and discuss 2 test utilization algorithms that are evidence-based and may be of clinical utility as we move toward the future of doing the necessary tests at the right time. Copyright © 2016 Elsevier Inc. All rights reserved.

Preservice Teachers' Knowledge and Perceptions of Effective Behavior Management Strategies

ERIC Educational Resources Information Center

Nields, Allison N.

2014-01-01

This study examined student teachers' perceptions and knowledge of behavior management strategies. A questionnaire that included questions about broad behavior management techniques, behavioral learning theory, and behavior management strategies related to behavioral learning theory was given to sixty-one student teacher candidates at a large…

Development of risk-based air quality management strategies under impacts of climate change.

PubMed

Liao, Kuo-Jen; Amar, Praveen; Tagaris, Efthimios; Russell, Armistead G

2012-05-01

Climate change is forecast to adversely affect air quality through perturbations in meteorological conditions, photochemical reactions, and precursor emissions. To protect the environment and human health from air pollution, there is an increasing recognition of the necessity of developing effective air quality management strategies under the impacts of climate change. This paper presents a framework for developing risk-based air quality management strategies that can help policy makers improve their decision-making processes in response to current and future climate change about 30-50 years from now. Development of air quality management strategies under the impacts of climate change is fundamentally a risk assessment and risk management process involving four steps: (1) assessment of the impacts of climate change and associated uncertainties; (2) determination of air quality targets; (3) selections of potential air quality management options; and (4) identification of preferred air quality management strategies that minimize control costs, maximize benefits, or limit the adverse effects of climate change on air quality when considering the scarcity of resources. The main challenge relates to the level of uncertainties associated with climate change forecasts and advancements in future control measures, since they will significantly affect the risk assessment results and development of effective air quality management plans. The concept presented in this paper can help decision makers make appropriate responses to climate change, since it provides an integrated approach for climate risk assessment and management when developing air quality management strategies. Development of climate-responsive air quality management strategies is fundamentally a risk assessment and risk management process. The risk assessment process includes quantification of climate change impacts on air quality and associated uncertainties. Risk management for air quality under the impacts of climate change includes determination of air quality targets, selections of potential management options, and identification of effective air quality management strategies through decision-making models. The risk-based decision-making framework can also be applied to develop climate-responsive management strategies for the other environmental dimensions and assess costs and benefits of future environmental management policies.

Practice Patterns Compared with Evidence-based Strategies for the Management of Androgen Deprivation Therapy-Induced Side Effects in Prostate Cancer Patients: Results of a European Web-based Survey.

PubMed

Bultijnck, Renée; Surcel, Cristian; Ploussard, Guillaume; Briganti, Alberto; De Visschere, Pieter; Fütterer, Jurgen; Ghadjar, Pirus; Giannarini, Gianluca; Isbarn, Hendrik; Massard, Christophe; Sooriakumaran, Prasanna; Valerio, Massimo; van den Bergh, Roderick; Ost, Piet

2016-12-01

Evidence-based recommendations are available for the management of androgen deprivation therapy (ADT)-induced side effects; however, there are no data on the implementation of the recommendations into daily practice patterns. To compare practice patterns in the management of ADT-induced side effects with evidence-based strategies. A European Web-based survey was conducted from January 16, 2015, to June 24, 2015. The 25-item questionnaire was designed with the aid of expert opinion and covered general respondent information, ADT preference per disease stage, patient communication on ADT-induced side effects, and strategies to mitigate side effects. All questions referred to patients with long-term ADT use. Reported practice patterns were compared with available evidence-based strategies. Following data collection, descriptive statistics were used for analysis. Frequency distributions were compiled and compared using a generalised chi-square test. In total, 489 eligible respondents completed the survey. Luteinising hormone-releasing hormone-agonist with or without an antiandrogen was the preferred method of ADT in different settings. Patients were well informed about loss of libido (90%), hot flushes (85%), fatigue (67%), and osteoporosis (63%). An osteoporotic and metabolic risk assessment prior to commencing ADT was done by one-quarter of physicians. The majority (85%) took preventive measures and applied at least one evidence-based strategy. Exercise was recommended by three-quarters of physicians who advocate its positive effects; however, only 25% of physicians had access to exercise programmes. Although the minimum sample size was set at 400 participants, the current survey remains susceptible to volunteer and nonresponder bias. Patients were well informed about several ADT-induced complications but uncommonly underwent an osteoporotic and metabolic risk assessment. Nevertheless, physicians partially provided evidence-based strategies for the management of the complications. Physicians often advised exercise to reduce ADT-induced side effects, but programmes were not widely available. Implementation of evidence-based strategies for androgen deprivation therapy-induced side effects in real-life practice patterns should be improved. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Integrated Adaptive Scenarios for Ariculture: Synergies and Tradeoffs.

NASA Astrophysics Data System (ADS)

Malek, K.; Rajagopalan, K.; Adam, J. C.; Brady, M.; Stockle, C.; Liu, M.; Kruger, C. E.

2017-12-01

A wide variety of factors can drive adaptation of the agricultural production sector in response to climate change. Warming and increased growing season length can lead to adoption of newer plant varieties as well as increases in double cropping systems. Changes in expectations of drought frequency or economic factors could lead to adoption of new technology (such as irrigation technology or water trading systems) or crop choices with a view of reducing farm-level risk, and these choices can result in unintended system wide effects. These are all examples of producer adaptation decisions made with a long-term (multiple decades) view. In addition, producers respond to short-term (current year) shocks - such as drought events - through management strategies that include deficit irrigation, fallowing, nutrient management, and engaging in water trading. The effects of these short- and long-term decisions are not independent, and can drive or be driven by the other. For example, investment in new irrigation systems (long-term) can be driven by expectations of short-term crop productivity losses in drought years. Similarly, the capacity to manage for short-term shocks will depend on crop type and variety as well as adopted irrigation technologies. Our overarching objective is to understand the synergies and tradeoffs that exist when combining three potential long-term adaptation strategies and two short-term adaptation strategies, with a view of understanding the synergies and tradeoffs. We apply the integrated crop-hydrology modeling framework VIC-CropSyst, along with the water management module Yakima RiverWare to address these questions over our test area, the Yakima River basin. We consider adoption of a) more efficient irrigation technologies, slower growing crop varieties, and increased prevalence of double cropping systems as long-term adaptation strategies; and b) fallowing and deficit irrigation as short-term responses to droughts. We evaluate the individual and combined effect of these strategies on agricultural production. Preliminary results indicate that long-term adaptation strategies impact short-run adaptive capacities to drought shocks. The strategies are complementary under certain situations and results in tradeoffs in other situations, and we characterize these differences.

The effect of web quest and team-based learning on students' self-regulation.

PubMed

Badiyepeymaie Jahromi, Zohreh; Mosalanejad, Leili; Rezaee, Rita

2016-04-01

In this study, the authors aimed to examine the effects of cooperative learning methods using Web Quest and team-based learning on students' self-direction, self-regulation, and academic achievement. This is a comparative study of students taking a course in mental health and psychiatric disorders. In two consecutive years, a group of students were trained using the WebQuest approach as a teaching strategy (n = 38), while the other group was taught using team-based learning (n=39). Data gathering was based on Guglielmino's self-directed learning readiness scale (SDLRS) and Buford's self-regulation questionnaire. The data were analyzed by descriptive test using M (IQR), Wilcoxon signed-rank test, and the Mann-Whitney U-test in SPSS software, version 13. p<0.05 was considered as the significance level. The results of the Mann-Whitney U test showed that the participants' self- directed (self-management) and self-regulated learning differed between the two groups (p=0.04 and p=0.01, respectively). Wilcoxon test revealed that self-directed learning indices (self-control and self-management) were differed between the two strategies before and after the intervention. However, the scores related to learning (students' final scores) were higher in the WebQuest approach than in team-based learning. By employing modern educational approaches, students are not only more successful in their studies but also acquire the necessary professional skills for future performance. Further research to compare the effects of new methods of teaching is required.

Development and Pilot of the Caregiver Strategies Inventory.

PubMed

Kirby, Anne V; Little, Lauren M; Schultz, Beth; Watson, Linda R; Zhang, Wanqing; Baranek, Grace T

2016-01-01

Children with autism spectrum disorder often demonstrate unusual behavioral responses to sensory stimuli (i.e., sensory features). To manage everyday activities, caregivers may implement strategies to address these features during family routines. However, investigation of specific strategies used by caregivers is limited by the lack of empirically developed measures. In this study, we describe the development and pilot results of the Caregiver Strategies Inventory (CSI), a supplement to the Sensory Experiences Questionnaire Version 3.0 (SEQ 3.0; Baranek, 2009) that measures caregivers' strategies in response to their children's sensory features. Three conceptually derived and empirically grounded strategy types were tested: cognitive-behavioral, sensory-perceptual, and avoidance. Results indicated that the CSI demonstrated good internal consistency and that strategy use was related to child age and cognition. Moreover, parent feedback after completing the CSI supported its utility and social validity. The CSI may be used alongside the SEQ 3.0 to facilitate a family-centered approach to assessment and intervention planning. Copyright © 2016 by the American Occupational Therapy Association, Inc.

Self-Management Interventions in Stages 1-4 Chronic Kidney Disease: An Integrative Review

PubMed Central

Johnson, Michelle; Zimmerman, Lani; Russell, Cynthia L.; Perkins, Susan M.; Decker, Brian S.

2014-01-01

The prevalence, effect on health outcomes, and economic impact of chronic kidney disease (CKD) have created interest in self-management interventions to help slow disease progression to kidney failure. Seven studies were reviewed to identify knowledge gaps and future directions for research. All studies were published between 2010 and 2013; no investigations were conducted in the United States. Knowledge gaps included the focus on medical self-management tasks with no attention to role or emotional tasks, lack of family involvement during intervention delivery, and an inability to form conclusions about the efficacy of interventions because methodological rigor was insufficient. Educational content varied across studies. Strategies to improve self-management skills and enhance self-efficacy varied and were limited in scope. Further development and testing of theory-based interventions are warranted. There is a critical need for future research using well-designed trials with appropriately powered sample sizes, well-tested instruments, and clear and consistent reporting of results. PMID:25239136

My46: a web-based tool for self-guided management of genomic test results in research and clinical settings

PubMed Central

Tabor, Holly K.; Jamal, Seema M.; Yu, Joon-Ho; Crouch, Julia M.; Shankar, Aditi G.; Dent, Karin M.; Anderson, Nick; Miller, Damon A.; Futral, Brett T.; Bamshad, Michael J.

2016-01-01

A major challenge to implementing precision medicine is the need for an efficient and cost-effective strategy for returning individual genomic test results that is easily scalable and can be incorporated into multiple models of clinical practice. My46 is a web-based tool for managing the return of genetic results that was designed and developed to support a wide range of approaches to results disclosure, ranging from traditional face-to-face disclosure to self-guided models. My46 has five key functions: set and modify results return preferences, return results, educate, manage return of results, and assess return of results. These key functions are supported by six distinct modules and a suite of features that enhance the user experience, ease site navigation, facilitate knowledge sharing, and enable results return tracking. My46 is a potentially effective solution for returning results and supports current trends toward shared decision-making between patient and provider and patient-driven health management. PMID:27632689

Development and Psychometric Testing of a Scale for Evaluating Self-Management Needs of Knee Osteoarthritis (SMNKOA) in Taiwan.

PubMed

Kao, Mei-Hua; Tsai, Yun-Fang

2017-06-01

Self-management of osteoarthritis (OA) of the knee is important for treating this chronic disease. This study developed and psychometrically tested a new instrument for measuring adult patients' self-management needs of knee osteoarthritis (SMNKOA). The theoretical framework of self-care guided the development of the 35-item SMNKOA scale. Participants ( N = 372) were purposively sampled from orthopedic clinics at medical centers in Taiwan. The content validity index was 0.83. Principal components analysis identified a three-factor solution, accounting for 53.19% of the variance. The divergent validity was -0.67; convergent validity was -0.51. Cronbach's alpha was .95, Pearson's correlation coefficient was .88, and the intraclass correlation coefficient was .95. The scale's reliability and validity supports the SMNKOA, as a tool to measure self-management needs of adults with knee OA. Nurses and other health care providers can use this instrument to evaluate knee OA patients and identify strategies for improving health-related outcomes and patient education.

Self-management interventions in stages 1 to 4 chronic kidney disease: an integrative review.

PubMed

Welch, Janet L; Johnson, Michelle; Zimmerman, Lani; Russell, Cynthia L; Perkins, Susan M; Decker, Brian S

2015-05-01

The prevalence, effect on health outcomes, and economic impact of chronic kidney disease (CKD) have created interest in self-management interventions to help slow disease progression to kidney failure. Seven studies were reviewed to identify knowledge gaps and future directions for research. All studies were published between 2010 and 2013; no investigations were conducted in the United States. Knowledge gaps included the focus on medical self-management tasks with no attention to role or emotional tasks, lack of family involvement during intervention delivery, and an inability to form conclusions about the efficacy of interventions because methodological rigor was insufficient. Educational content varied across studies. Strategies to improve self-management skills and enhance self-efficacy varied and were limited in scope. Further development and testing of theory-based interventions are warranted. There is a critical need for future research using well-designed trials with appropriately powered sample sizes, well-tested instruments, and clear and consistent reporting of results. © The Author(s) 2014.

Environmental factors and health information technology management strategy.

PubMed

Menachemi, Nir; Shin, Dong Yeong; Ford, Eric W; Yu, Feliciano

2011-01-01

: Previous studies have provided theoretical and empirical evidence that environmental forces influence hospital strategy. : Rooted in resource dependence theory and the information uncertainty perspective, this study examined the relationship between environmental market characteristics and hospitals' selection of a health information technology (HIT) management strategy. : A cross-sectional design is used to analyze secondary data from the American Hospital Association Annual Survey, the Healthcare Information and Management Systems Society Analytics Database, and the Area Resource File. Univariate and multinomial logistic regression analyses are used. : Overall, 3,221 hospitals were studied, of which 60.9% pursed a single-vendor HIT management strategy, 28.9% pursued a best-of-suite strategy, and 10.2% used a best-of-breed strategy. Multivariate analyses controlling for hospital characteristics found that measures of environmental factors representing munificence, dynamism, and/or complexity were systematically associated with various hospital HIT management strategy use. Specifically, the number of generalist physicians per capita was positively associated with the single-vendor strategy (B = -5.64, p = .10). Hospitals in urban markets were more likely to pursue the best-of-suite strategy (B = 0.622, p < .001). Dynamism, measured as the number of managed care contracts for a given hospital, was negatively associated with the single-vendor strategy (B = 0.004, p = .049). Lastly, complexity, measured as market competition, was positively associated with the best-of-breed strategy (B = 0.623, p = .042). : By and large, environmental factors are associated with hospital HIT management strategies in mostly theoretically supported ways. Hospital leaders and policy makers interested in influencing the adoption of hospital HIT should consider how market conditions influence HIT management decisions as part of programs to promote meaningful use.

Blending Effective Behavior Management and Literacy Strategies for Preschoolers Exhibiting Negative Behavior

ERIC Educational Resources Information Center

Smith, Jaime

2009-01-01

Sometimes students will exhibit various aggressive behaviors in the preschool classroom. Early childhood educators need to have behavior management strategies to manage the students' negative behaviors within the classroom setting. This article will provide a rationale for embedding literacy instruction within behavior management strategies to…

Invasive Candidiasis in Various Patient Populations: Incorporating Non-Culture Diagnostic Tests into Rational Management Strategies

PubMed Central

Clancy, Cornelius J.; Shields, Ryan K.; Nguyen, M. Hong

2016-01-01

Mortality rates due to invasive candidiasis remain unacceptably high, in part because the poor sensitivity and slow turn-around time of cultures delay the initiation of antifungal treatment. β-d-glucan (Fungitell) and polymerase chain reaction (PCR)-based (T2Candida) assays are FDA-approved adjuncts to cultures for diagnosing invasive candidiasis, but their clinical roles are unclear. We propose a Bayesian framework for interpreting non-culture test results and developing rational patient management strategies, which considers test performance and types of invasive candidiasis that are most common in various patient populations. β-d-glucan sensitivity/specificity for candidemia and intra-abdominal candidiasis is ~80%/80% and ~60%/75%, respectively. In settings with 1%–10% likelihood of candidemia, anticipated β-d-glucan positive and negative predictive values are ~4%–31% and ≥97%, respectively. Corresponding values in settings with 3%–30% likelihood of intra-abdominal candidiasis are ~7%–51% and ~78%–98%. β-d-glucan is predicted to be useful in guiding antifungal treatment for wide ranges of populations at-risk for candidemia (incidence ~5%–40%) or intra-abdominal candidiasis (~7%–20%). Validated PCR-based assays should broaden windows to include populations at lower-risk for candidemia (incidence ≥~2%) and higher-risk for intra-abdominal candidiasis (up to ~40%). In the management of individual patients, non-culture tests may also have value outside of these windows. The proposals we put forth are not definitive treatment guidelines, but rather represent starting points for clinical trial design and debate by the infectious diseases community. The principles presented here will be applicable to other assays as they enter the clinic, and to existing assays as more data become available from different populations. PMID:29376927

Medication management strategies used by older adults with heart failure: A systems-based analysis.

PubMed

Mickelson, Robin S; Holden, Richard J

2017-09-01

Older adults with heart failure use strategies to cope with the constraining barriers impeding medication management. Strategies are behavioral adaptations that allow goal achievement despite these constraining conditions. When strategies do not exist, are ineffective or maladaptive, medication performance and health outcomes are at risk. While constraints to medication adherence are described in literature, strategies used by patients to manage medications are less well-described or understood. Guided by cognitive engineering concepts, the aim of this study was to describe and analyze the strategies used by older adults with heart failure to achieve their medication management goals. This mixed methods study employed an empirical strategies analysis method to elicit medication management strategies used by older adults with heart failure. Observation and interview data collected from 61 older adults with heart failure and 31 caregivers were analyzed using qualitative content analysis to derive categories, patterns and themes within and across cases. Data derived thematic sub-categories described planned and ad hoc methods of strategic adaptations. Stable strategies proactively adjusted the medication management process, environment, or the patients themselves. Patients applied situational strategies (planned or ad hoc) to irregular or unexpected situations. Medication non-adherence was a strategy employed when life goals conflicted with medication adherence. The health system was a source of constraints without providing commensurate strategies. Patients strived to control their medication system and achieve goals using adaptive strategies. Future patient self-mangement research can benefit from methods and theories used to study professional work, such as strategies analysis.

Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention.

PubMed

Johnson, Sara S; Levesque, Deborah A; Broderick, Lynne E; Bailey, Dustin G; Kerns, Robert D

2017-10-17

Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans' stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program's long-term effects on pain and pain self-management. ©Sara S Johnson, Deborah A Levesque, Lynne E Broderick, Dustin G Bailey, Robert D Kerns. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 17.10.2017.

Management strategies for trace organic chemicals in water - A review of international approaches.

PubMed

Bieber, Stefan; Snyder, Shane A; Dagnino, Sonia; Rauch-Williams, Tanja; Drewes, Jörg E

2018-03-01

To ensure an appropriate management of potential health risks and uncertainties from the release of trace organic chemicals (TOrCs) into the aqueous environment, many countries have evaluated and implemented strategies to manage TOrCs. The aim of this study was to evaluate existing management strategies for TOrCs in different countries to derive and compare underlying core principles and paradigms and to develop suggestions for more holistic management strategies to protect the environment and drinking water supplies from the discharge of undesired TOrCs. The strategies in different industrial countries were summarized and subsequently compared with regards to three particular questions: 1) Do the approaches different countries have implemented manage all or only specific portions of the universe of chemicals; 2) What implementation and compliance strategies are used to manage aquatic and human health risk and what are their pros and cons; and 3) How are site-specific watershed differences being addressed? While management strategies of the different countries target similar TOrCs, the programs differ in several important aspects, including underlying principles, the balance between aquatic or human health protection, implementation methods, and financing mechanisms used to fund regulatory programs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Computer-Based Internet-Hosted Assessment of L2 Literacy: Computerizing and Administering of the Oxford Quick Placement Test in ExamView and Moodle

NASA Astrophysics Data System (ADS)

Meurant, Robert C.

Sorting of Korean English-as-a-Foreign-Language (EFL) university students by Second Language (L2) aptitude allocates students to classes of compatible ability level, and was here used to screen candidates for interview. Paper-and-pen versions of the Oxford Quick Placement Test were adapted to computer-based testing via online hosting using FSCreations ExamView. Problems with their online hosting site led to conversion to the popular computer-based learning management system Moodle, hosted on www.ninehub.com. 317 sophomores were tested online to encourage L2 digital literacy. Strategies for effective hybrid implementation of Learning Management Systems in L2 tertiary education include computer-based Internet-hosted L2 aptitude tests. These potentially provide a convenient measure of student progress in developing L2 fluency, and offer a more objective and relevant means of teacher- and course-assessment than student evaluations, which tend to confuse entertainment value and teacher popularity with academic credibility and pedagogical effectiveness.

[Developing and testing the effects of a psychosocial intervention on stress response and coping in Korean breast cancer survivors: a pilot study].

PubMed

Kim, Cho-Ja; Hur, Hea-Kung; Kang, Duck-Hee; Kim, Bo-Hwan

2004-10-01

The purpose of this study was to develop a socioculturally-appropriate psychosocial intervention program for Korean patients with breast cancer and test its effects on stress, anxiety, depression, and coping strategies. One group pretest and posttest design was used to test the effects of the intervention. A post-intervention interview was conducted to refine the nature of the intervention. A convenience sample of 10 breast cancer survivors was recruited from the outpatients clinics. Psychosocial intervention was developed to provide the health education, stress management, coping skill training and support weekly (90 min) for 6 weeks. There was a significant decrease in stress scores following the intervention (Z= -2.388, p=0.017). However, no significant changes were noted in the use of problem-focused and emotion-focused coping strategies, nor in the changes of anxiety and depression levels. Content analysis of interview data revealed six clusters; changes in perception, changes in problem solving approaches, changes in anger management, changes in life pattern, social support and reduction of perceived stress. Based on quantitative and qualitative data, we recommend the refinements of the intervention in the following areas for future studies: 1) duration, activities, and progression of psychosocial intervention; 2) research design and sample size; and 3) measurements.

Real Time Data Management for Estimating Probabilities of Incidents and Near Misses

NASA Astrophysics Data System (ADS)

Stanitsas, P. D.; Stephanedes, Y. J.

2011-08-01

Advances in real-time data collection, data storage and computational systems have led to development of algorithms for transport administrators and engineers that improve traffic safety and reduce cost of road operations. Despite these advances, problems in effectively integrating real-time data acquisition, processing, modelling and road-use strategies at complex intersections and motorways remain. These are related to increasing system performance in identification, analysis, detection and prediction of traffic state in real time. This research develops dynamic models to estimate the probability of road incidents, such as crashes and conflicts, and incident-prone conditions based on real-time data. The models support integration of anticipatory information and fee-based road use strategies in traveller information and management. Development includes macroscopic/microscopic probabilistic models, neural networks, and vector autoregressions tested via machine vision at EU and US sites.

Logistics modelling: improving resource management and public information strategies in Florida.

PubMed

Walsh, Daniel M; Van Groningen, Chuck; Craig, Brian

2011-10-01

One of the most time-sensitive and logistically-challenging emergency response operations today is to provide mass prophylaxis to every man, woman and child in a community within 48 hours of a bioterrorism attack. To meet this challenge, federal, state and local public health departments in the USA have joined forces to develop, test and execute large-scale bioterrorism response plans. This preparedness and response effort is funded through the US Centers for Disease Control and Prevention's Cities Readiness Initiative, a programme dedicated to providing oral antibiotics to an entire population within 48 hours of a weaponised inhalation anthrax attack. This paper will demonstrate how the State of Florida used a logistics modelling tool to improve its CRI mass prophylaxis plans. Special focus will be on how logistics modelling strengthened Florida's resource management policies and validated its public information strategies.

Coping strategies as a mediator of internet-delivered psychosocial treatment: Secondary analysis from a NIDA CTN multisite effectiveness trial.

PubMed

Lévesque, Annie; Campbell, Aimee N C; Pavlicova, Martina; Hu, Mei-Chen; Walker, Robrina; McClure, Erin A; Ghitza, Udi E; Bailey, Genie; Stitzer, Maxine; Nunes, Edward V

2017-02-01

Coping strategies are a predictor of abstinence among patients with substance use disorders. However, little is known regarding the role of coping strategies in the effectiveness of the Community Reinforcement Approach (CRA). Using data from a 12week randomized control trial assessing the effectiveness of the Therapeutic Education System (TES), an internet-delivered version of the CRA combined with contingency management, we tested the role of coping strategies as a mediator of treatment effectiveness. 507 participants entering 10 outpatient addiction treatment programs received either treatment-as-usual (TAU), a counselor-delivered treatment (Arm 1), or reduced TAU plus TES wherein 2h of TAU per week were replaced by TES (Arm 2). Abstinence from drugs and alcohol was evaluated using urine toxicology and self-report. Coping strategies were measured using the Coping Strategies Scale-Brief Version. Mediation analyses were done following Baron and Kenny's and path analysis approaches. The average baseline coping strategies scores were not significantly different between the two treatment arms. Overall, TES intervention was significantly associated with higher coping strategies scores when accounting for baseline scores (F 1,1342 =8.3, p=0.004). Additionally, higher coping strategies scores at week 12 were associated with an increased likelihood of abstinence during the last 4weeks of the treatment, while accounting for treatment assignment and baseline abstinence. The effect of TES intervention on abstinence was no longer significant after controlling for coping strategies scores at week 12. Our results support the importance of coping skills as a partial mediator of the effectiveness of an internet-version of the CRA combined with contingency management. Copyright © 2016. Published by Elsevier Ltd.

CON4EI: Development of serious eye damage and eye irritation testing strategies with respect to the requirements of the UN GHS/EU CLP hazard categories.

PubMed

Verstraelen, Sandra; Van Rompay, An R

2018-06-01

The main objective of the CON4EI (CONsortium for in vitro Eye Irritation testing strategy) project (2015-2016) was to develop tiered, non-animal testing strategies for serious eye damage and eye irritation assessment in relation to the most important drivers of classification. The serious eye damage and eye irritation potential of a set of 80 chemicals was identified based on existing in vivo Draize eye test data and testing was conducted using the following eight alternative test methods: BCOP (Bovine Corneal Opacity and Permeability)+histopathology, BCOP-LLBO (BCOP Laser Light-Based Opacitometer), ICE (Isolated Chicken Eye)+histopathology, STE (Short Term Exposure), EpiOcular™ EIT (EpiOcular Eye Irritation Test), EpiOcular™ ET-50 (EpiOcular™ Time-to-toxicity), SkinEthic™ HCE EIT (SkinEthic™ Human Corneal Epithelial Eye Irritation Test), and SMI (Slug Mucosal Irritation). Project management decided to not include the ICE data in this project since the execution showed relevant, and not predictable, deviations from Organisation for Economic Co-operation and Development (OECD) Test Guideline (TG) 438 and Guidance Document 160. At this stage, the outcome of these deviations has not been fully assessed. In addition to these alternative test methods, the computational models Toxtree and Case Ultra were taken into account. This project assessed the relevance of these test methods, their applicability domains and limitations in terms of 'drivers of classification', and their strengths and weaknesses. In this way, methods were identified that fit into a tiered-testing strategy for serious eye damage/eye irritation assessment to distinguish United Nations Globally Harmonized System of Classification and Labelling of Chemicals (UN GHS) Category 1 (Cat 1) chemicals from non-Cat 1 chemicals and address the gap namely distinguish between Category 2 (Cat 2) and Cat 1 chemicals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

PubMed Central

Donington, Jessica; Lynch, William R.; Mazzone, Peter J.; Midthun, David E.; Naidich, David P.; Wiener, Renda Soylemez

2013-01-01

Objectives: The objective of this article is to update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules. Methods: We updated prior literature reviews, synthesized evidence, and formulated recommendations by using the methods described in the “Methodology for Development of Guidelines for Lung Cancer” in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed. Results: We formulated recommendations for evaluating solid pulmonary nodules that measure > 8 mm in diameter, solid nodules that measure ≤ 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefits and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences. Conclusions: Individuals with pulmonary nodules should be evaluated and managed by estimating the probability of malignancy, performing imaging tests to better characterize the lesions, evaluating the risks associated with various management alternatives, and eliciting their preferences for management. PMID:23649456

Comparative field trial of alternative vector control strategies for non-domiciliated Triatoma dimidiata.

PubMed

Ferral, Jhibran; Chavez-Nuñez, Leysi; Euan-Garcia, Maria; Ramirez-Sierra, Maria Jesus; Najera-Vazquez, M Rosario; Dumonteil, Eric

2010-01-01

Chagas disease is a major vector-borne disease, and regional initiatives based on insecticide spraying have successfully controlled domiciliated vectors in many regions. Non-domiciliated vectors remain responsible for a significant transmission risk, and their control is a challenge. We performed a proof-of-concept field trial to test alternative strategies in rural Yucatan, Mexico. Follow-up of house infestation for two seasons following the interventions confirmed that insecticide spraying should be performed annually for the effective control of Triatoma dimidiata; however, it also confirmed that insect screens or long-lasting impregnated curtains may represent good alternative strategies for the sustained control of these vectors. Ecosystemic peridomicile management would be an excellent complementary strategy to improve the cost-effectiveness of interventions. Because these strategies would also be effective against other vector-borne diseases, such as malaria or dengue, they could be integrated within a multi-disease control program.

CTN summary of DSREDS, EDCARS, EDMICS CALS readiness testing. [Computer-aided Acquisition and Logistic Support (CALS) CALS Test Network (CTN), Digital Storage Retrieval Eng. Data System (DSREDS), Eng. Data Computer Assisted Retrieval System (EDCARS), Eng. Data Management Information and Control System (EDMICS)

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

Mitschkowetz, N.; Vickers, D.L.

This report provides a summary of the Computer-aided Acquisition and Logistic Support (CALS) Test Network (CTN) Laboratory Acceptance Test (LAT) and User Application Test (UAT) activities undertaken to evaluate the CALS capabilities being implemented as part of the Department of Defense (DOD) engineering repositories. Although the individual testing activities provided detailed reports for each repository, a synthesis of the results, conclusions, and recommendations is offered to provide a more concise presentation of the issues and the strategies, as viewed from the CTN perspective.

Strategies to address management challenges in larger intensive care units.

PubMed

Matlakala, M C; Bezuidenhout, M C; Botha, A D H

2015-10-01

To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU). The challenges faced by intensive care nursing in South Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise. Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North-West province, South Africa. Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses. ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified. This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs. © 2014 John Wiley & Sons Ltd.

A framework for engaging stakeholders on the management of alien species.

PubMed

Novoa, Ana; Shackleton, Ross; Canavan, Susan; Cybèle, Cathleen; Davies, Sarah J; Dehnen-Schmutz, Katharina; Fried, Jana; Gaertner, Mirijam; Geerts, Sjirk; Griffiths, Charles L; Kaplan, Haylee; Kumschick, Sabrina; Le Maitre, David C; Measey, G John; Nunes, Ana L; Richardson, David M; Robinson, Tamara B; Touza, Julia; Wilson, John R U

2018-01-01

Alien species can have major ecological and socioeconomic impacts in their novel ranges and so effective management actions are needed. However, management can be contentious and create conflicts, especially when stakeholders who benefit from alien species are different from those who incur costs. Such conflicts of interests mean that management strategies can often not be implemented. There is, therefore, increasing interest in engaging stakeholders affected by alien species or by their management. Through a facilitated workshop and consultation process including academics and managers working on a variety of organisms and in different areas (urban and rural) and ecosystems (terrestrial and aquatic), we developed a framework for engaging stakeholders in the management of alien species. The proposed framework for stakeholder engagement consists of 12 steps: (1) identify stakeholders; (2) select key stakeholders for engagement; (3) explore key stakeholders' perceptions and develop initial aims for management; (4) engage key stakeholders in the development of a draft management strategy; (5) re-explore key stakeholders' perceptions and revise the aims of the strategy; (6) co-design general aims, management objectives and time frames with key stakeholders; (7) co-design a management strategy; (8) facilitate stakeholders' ownership of the strategy and adapt as required; and (9) implement the strategy and monitor management actions to evaluate the need for additional or future actions. In case additional management is needed after these actions take place, some extra steps should be taken: (10) identify any new stakeholders, benefits, and costs; (11) monitor engagement; and (12) revise management strategy. Overall, we believe that our framework provides an effective approach to minimize the impact of conflicts created by alien species management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Utilising Planning and Financing Strategies in the Management of Community Development Projects in Enugu State, Nigeria

ERIC Educational Resources Information Center

Obetta, Chukwuemeka K.; Oreh, Catherine I.

2017-01-01

Utilisation of community management strategies is an approach to governance that is based on community and organisational involvement. Communities with development projects have formed community projects management committees (CPMCs) that are encouraged to adopt the community management strategy in the planning and financing of community…

Using the Integrated Vehicle Health Management Research Test and Integration Plan Wiki to Identify Synergistic Test Opportunities

NASA Technical Reports Server (NTRS)

Koelfgen, Syri J.; Faber, James J.

2010-01-01

The National Aeronautics and Space Administration (NASA) and the aviation industry have recognized a need for developing a method to identify and combine resources to carry out research and testing more efficiently. The Integrated Vehicle Health Management (IVHM) Research Test and Integration Plan (RTIP) Wiki is a tool that is used to visualize, plan, and accomplish collaborative research and testing. Synergistic test opportunities are developed using the RTIP Wiki, and include potential common resource testing that combines assets and personnel from NASA, industry, academia, and other government agencies. A research scenario is linked to the appropriate IVHM milestones and resources detailed in the wiki, reviewed by the research team members, and integrated into a collaborative test strategy. The scenario is then implemented by creating a test plan when appropriate and the research is performed. The benefits of performing collaborative research and testing are achieving higher Technology Readiness Level (TRL) test opportunities with little or no additional cost, improved quality of research, and increased communication among researchers. In addition to a description of the method of creating these joint research scenarios, examples of the successful development and implementation of cooperative research using the IVHM RTIP Wiki are given.

Applying the Analytic Hierarchy Process to Oil Sands Environmental Compliance Risk Management

NASA Astrophysics Data System (ADS)

Roux, Izak Johannes, III

Oil companies in Alberta, Canada, invested $32 billion on new oil sands projects in 2013. Despite the size of this investment, there is a demonstrable deficiency in the uniformity and understanding of environmental legislation requirements that manifest into increased project compliance risks. This descriptive study developed 2 prioritized lists of environmental regulatory compliance risks and mitigation strategies and used multi-criteria decision theory for its theoretical framework. Information from compiled lists of environmental compliance risks and mitigation strategies was used to generate a specialized pairwise survey, which was piloted by 5 subject matter experts (SMEs). The survey was validated by a sample of 16 SMEs, after which the Analytic Hierarchy Process (AHP) was used to rank a total of 33 compliance risks and 12 mitigation strategy criteria. A key finding was that the AHP is a suitable tool for ranking of compliance risks and mitigation strategies. Several working hypotheses were also tested regarding how SMEs prioritized 1 compliance risk or mitigation strategy compared to another. The AHP showed that regulatory compliance, company reputation, environmental compliance, and economics ranked the highest and that a multi criteria mitigation strategy for environmental compliance ranked the highest. The study results will inform Alberta oil sands industry leaders about the ranking and utility of specific compliance risks and mitigations strategies, enabling them to focus on actions that will generate legislative and public trust. Oil sands leaders implementing a risk management program using the risks and mitigation strategies identified in this study will contribute to environmental conservation, economic growth, and positive social change.

Airway Problems in Neonates—A Review of the Current Investigation and Management Strategies

PubMed Central

Mok, Quen

2017-01-01

Airway problems in the neonatal population are often life threatening and raise challenging issues in diagnosis and management. The airway problems can result from congenital or acquired lesions and can be broadly classified into those causing obstruction or those due to an abnormal “communication” in the airway. Many different investigations are now available to identify the diagnosis and quantify the severity of the problem, and these tests can be simple or invasive. Bronchography and bronchoscopy are essential to determine the extent and severity of the airway problem and to plan treatment strategy. Further imaging techniques help to delineate other commonly associated abnormalities. Echocardiography is also important to confirm any associated cardiac abnormality. In this review, the merits and disadvantages of the various investigations now available to the clinician will be discussed. The current therapeutic strategies are discussed, and the review will focus on the most challenging conditions that cause the biggest management conundrums, specifically laryngotracheal cleft, congenital tracheal stenosis, and tracheobronchomalacia. Management of acquired stenosis secondary to airway injury from endotracheal intubation will also be discussed as this is a common problem. Slide tracheoplasty is the preferred surgical option for long-segment tracheal stenosis, and results have improved significantly. Stents are occasionally required for residual or recurrent stenosis following surgical repair. There is sufficient evidence that a multidisciplinary team approach for managing complex airway issues provides the best results for the patient. There is ongoing progress in the field with newer diagnostic tools as well as development of innovative management techniques, such as biodegradable stents and stem cell-based tracheal transplants, leading to a much better prognosis for these children in the future. PMID:28424763

Wake Management Strategies for Reduction of Turbomachinery Fan Noise

NASA Technical Reports Server (NTRS)

Waitz, Ian A.

1998-01-01

The primary objective of our work was to evaluate and test several wake management schemes for the reduction of turbomachinery fan noise. Throughout the course of this work we relied on several tools. These include 1) Two-dimensional steady boundary-layer and wake analyses using MISES (a thin-shear layer Navier-Stokes code), 2) Two-dimensional unsteady wake-stator interaction simulations using UNSFLO, 3) Three-dimensional, steady Navier-Stokes rotor simulations using NEWT, 4) Internal blade passage design using quasi-one-dimensional passage flow models developed at MIT, 5) Acoustic modeling using LINSUB, 6) Acoustic modeling using VO72, 7) Experiments in a low-speed cascade wind-tunnel, and 8) ADP fan rig tests in the MIT Blowdown Compressor.

Epidemiological and Economic Evaluation of Alternative On-Farm Management Scenarios for Ovine Footrot in Switzerland

PubMed Central

Zingg, Dana; Steinbach, Sandro; Kuhlgatz, Christian; Rediger, Matthias; Schüpbach-Regula, Gertraud; Aepli, Matteo; Grøneng, Gry M.; Dürr, Salome

2017-01-01

Footrot is a multifactorial infectious disease mostly affecting sheep, caused by the bacteria Dichelobacter nodosus. It causes painful feet lesions resulting in animal welfare issues, weight loss, and reduced wool production, which leads to a considerable economic burden in animal production. In Switzerland, the disease is endemic and mandatory coordinated control programs exist only in some parts of the country. This study aimed to compare two nationwide control strategies and a no intervention scenario with the current situation, and to quantify their net economic effect. This was done by sequential application of a maximum entropy model (MEM), epidemiological simulation, and calculation of net economic effect using the net present value method. Building upon data from a questionnaire, the MEM revealed a nationwide footrot prevalence of 40.2%. Regional prevalence values were used as inputs for the epidemiological model. Under the application of the nationwide coordinated control program without (scenario B) and with (scenario C) improved diagnostics [polymerase chain reaction (PCR) test], the Swiss-wide prevalence decreased within 10 years to 14 and 5%, respectively. Contrary, an increase to 48% prevalence was observed when terminating the current control strategies (scenario D). Management costs included labor and material costs. Management benefits included reduction of fattening time and improved animal welfare, which is valued by Swiss consumers and therefore reduces societal costs. The net economic effect of the alternative scenarios B and C was positive, the one of scenario D was negative and over a period of 17 years quantified at CHF 422.3, 538.3, and −172.3 million (1 CHF = 1.040 US$), respectively. This implies that a systematic Swiss-wide management program under the application of the PCR diagnostic test is the most recommendable strategy for a cost-effective control of footrot in Switzerland. PMID:28560223

Private sector role, readiness and performance for malaria case management in Uganda, 2015.

PubMed

Kaula, Henry; Buyungo, Peter; Opigo, Jimmy

2017-05-25

Several interventions have been put in place to promote access to quality malaria case management services in Uganda's private sector, where most people seek treatment. This paper describes evidence using a mixed-method approach to examine the role, readiness and performance of private providers at a national level in Uganda. These data will be useful to inform strategies and policies for improving malaria case management in the private sector. The ACTwatch national anti-malarial outlet survey was conducted concurrently with a fever case management study. The ACTwatch nationally representative anti-malarial outlet survey was conducted in Uganda between May 18th 2015 and July 2nd 2015. A representative sample of sub-counties was selected in 14 urban and 13 rural clusters with probability proportional to size and a census approach was used to identify outlets. Outlets eligible for the survey met at least one of three criteria: (1) one or more anti-malarials were in stock on the day of the survey; (2) one or more anti-malarials were in stock in the 3 months preceding the survey; and/or (3) malaria blood testing (microscopy or RDT) was available. The fever case management study included observations of provider-patient interactions and patient exit interviews. Data were collected between May 20th and August 3rd, 2015. The fever case management study was implemented in the private sector. Potential outlets were identified during the main outlet survey and included in this sub-sample if they had both artemisinin-based combination therapy (ACT) [artemether-lumefantrine (AL)], in stock on the day of survey as well as diagnostic testing available. A total of 9438 outlets were screened for eligibility in the ACTwatch outlet survey and 4328 outlets were found to be stocking anti-malarials and were interviewed. A total of 9330 patients were screened for the fever case management study and 1273 had a complete patient observation and exit interview. Results from the outlet survey illustrate that the majority of anti-malarials were distributed through the private sector (54.3%), with 31.4% of all anti-malarials distributed through drug stores and 14.4% through private for-profit health facilities. Availability of different anti-malarials and diagnostic testing in the private sector was: ACT (80.7%), quality-assured (QA) ACT (72.0%), sulfadoxine-pyrimethamine (SP) (47.1%), quinine (73.2%) and any malaria blood testing (32.9%). Adult QAACT ($1.62) was three times more expensive than SP ($0.48). The results from the fever case management study found 44.4% of respondents received a malaria test, and among those who tested positive for malaria, 60.0% received an ACT, 48.5% received QAACT; 14.4% a non-artemisinin therapy; 14.9% artemether injection, and 42.5% received an antibiotic. The private sector plays an important role in malaria case management in Uganda. While several private sector initiatives have improved availability of QAACT, there are gaps in malaria diagnosis and distribution of non-artemisinin monotherapies persists. Further private sector strategies, including those focusing on drug stores, are needed to increase coverage of parasitological testing and removal of non-artemisinin therapies from the marketplace.

Improving management of small natural features on private lands by negotiating the science-policy boundary for Maine vernal pools.

PubMed

Calhoun, Aram J K; Jansujwicz, Jessica S; Bell, Kathleen P; Hunter, Malcolm L

2014-07-29

Vernal pools are far more important for providing ecosystem services than one would predict based on their small size. However, prevailing resource-management strategies are not effectively conserving pools and other small natural features on private lands. Solutions are complicated by tensions between private property and societal rights, uncertainties over resource location and function, diverse stakeholders, and fragmented regulatory authority. The development and testing of new conservation approaches that link scientific knowledge, stakeholder decision-making, and conservation outcomes are important responses to this conservation dilemma. Drawing from a 15-y history of vernal pool conservation efforts in Maine, we describe the coevolution of pool conservation and research approaches, focusing on how research-based knowledge was produced and used in support of management decisions. As management shifted from reactive, top-down approaches to proactive and flexible approaches, research shifted from an ecology-focused program to an interdisciplinary program based on social-ecological systems. The most effective strategies for linking scientific knowledge with action changed as the decision-makers, knowledge needs, and context for vernal pool management advanced. Interactions among stakeholders increased the extent to which knowledge was coproduced and shifted the objective of stakeholder engagement from outreach to research collaboration and development of innovative conservation approaches. New conservation strategies were possible because of the flexible, solutions-oriented collaborations and trust between scientists and decision-makers (fostered over 15 y) and interdisciplinary, engaged research. Solutions to the dilemma of conserving small natural features on private lands, and analogous sustainability science challenges, will benefit from repeated negotiations of the science-policy boundary.

A prescription for old-growth-like characteristics in southern pines

Treesearch

Don C. Bragg

2004-01-01

Recent interest in adding old-growth reserves confiicts with a projected increase in the demand for forest commodities. However, managing for old-growthlike characteristics may permit timber production from stands designed to be similar to primeval forests. A silvicultural strategy based on presettlement forest conditions is being tested on 120 ac of mature loblolly (...

Scaling up from greenhouse resistance to fitness in the field for a host of an emerging forest disease

Treesearch

Katherine J. Hayden; Matteo Garbelotto; Richard Dodd; Jessica W. Wright

2013-01-01

Forest systems are increasingly threatened by emergent, exotic diseases, yet management strategies for forest trees may be hindered by long generation times and scant background knowledge. We tested whether nursery disease resistance and growth traits have predictive value for the conservation of Notholithocarpus densiflorus, the host most...

Increasing Teachers' Use of Evidence-Based Classroom Management Strategies through Consultation: Overview and Case Studies

ERIC Educational Resources Information Center

MacSuga, Ashley S.; Simonsen, Brandi

2011-01-01

Many classroom teachers are faced with challenging student behaviors that impact their ability to facilitate learning in productive, safe environments. At the same time, high-stakes testing, increased emphasis on evidence-based instruction, data-based decision making, and response-to-intervention models have put heavy demands on teacher time and…

Impact of the Good Behavior Game on Special Education Teachers

ERIC Educational Resources Information Center

Hopman, Juliette A. B.; van Lier, Pol A. C.; van der Ende, Jan; Struiksma, Chris; Wubbels, Theo; Verhulst, Frank C.; Maras, Athanasios; Breeman, Linda D.; Tick, Nouchka T.

2018-01-01

This study tested effects of a program that offers teachers universal classroom management strategies, on teachers' burnout symptoms and self-efficacy, and their teaching behaviors. Data were collected from 147 teachers (mean age = 38.4 years, SD = 10.8) in 15 special secondary education schools for students with emotional and behavioral problems,…

Anthropogenic disturbance and the risk of flea-borne disease transmission

Treesearch

Megan M. Friggens; Paul Beier

2010-01-01

Anthropogenic disturbance may lead to the spread of vector-borne diseases through effects on pathogens, vectors, and hosts. Identifying the type and extent of vector response to habitat change will enable better and more accurate management strategies for anthropogenic disease spread. We compiled and analyzed data from published empirical studies to test for patterns...

Similarities and Differences in the Organizational Characteristics of Charter Schools: A Test of Institutional Isomorphism and Strategy Positioning Theories

ERIC Educational Resources Information Center

Sweet, Thomas

2013-01-01

Charter schools, independent public schools which operate through a system of contracts with public agencies, are heavily promoted as a means of improving the nation's traditional public education system. Managed as private enterprises, these schools compete for students through the implementation of market-style practices. Popularly viewed as…

Goals and strategies for estimating trends in landbird abundance

Treesearch

Jonathan Bart; Kenneth P. Burnham; Erica H. Dunn; Charles M. Francis; C. John Ralph

2004-01-01

Reliable estimates of trends in population size are critical to effective management of landbirds. We propose a standard for considering that landbird populations are adequately monitored: 80% power to detect a 50% decline occurring within 20 years, using a 2-tailed test and a significance level of 0.10, and incorporating effects of potential bias. Our standard also...

Long-Term Management Strategy for Dredged Material Disposal for Naval Facilities at Pearl Harbor, Hawaii. Phase II - Evaulation of Alternatives

DTIC Science & Technology

2000-03-01

26 Leachate Pathway.................................... 31 Plant Uptake Pathway.................................. 35 Volatization and Odor...Bi13 Appendix C - Surface Runoff Testing............................Cl Appendix D - Leachate Evaluation..............................D1 Appendix E...Oxidized Dredged Material..........................29 Table 7. Mixing Zone Requirement for Runoff Discharges............ 30 Table 8. Leachate Quality

Nurse managers' strategies for feeling less drained by their work: an action research and reflection project for developing emotional intelligence.

PubMed

Taylor, Bev; Roberts, Sue; Smyth, Therese; Tulloch, Moira

2015-10-01

To raise nurse managers' critical awareness of practice problems; uncover practice constraints and improve work effectiveness. Nurse management requires skills and knowledge, underscored by emotional intelligence. The research improved participants' practice and personal insights. Purposive sampling targeted nurse managers interested in improving their practice. Three experienced female nurse managers met fortnightly in a group, for 1 hour, for 10 meetings. The methods included: writing and sharing de-identified journal reflections; critically analysing practice stories; identifying a thematic concern; generating action strategies; and instituting and revising the action plan. Phase One resulted in the identification of the issue of 'being drained by the intensity of nurse managers' work'. The participants adopted five strategies: debriefing problematic situations; deflecting multiple requests; diffusing issues; naming dysfunctional behaviours; and regrouping. In Phase Two, participants implemented and revised the action plan strategies, which resulted in them feeling less drained by their work. Strategies can lessen nurse managers' sense of personal depletion. However, strategies cannot guarantee success every time because the emotional intelligence is integral to nurse management. Action research and reflection assist nurse managers to improve their practice and develop their emotional intelligence. © 2014 John Wiley & Sons Ltd.

Energy Conservation in the Acquisition Process

DTIC Science & Technology

1980-10-01

National Energy Strategies Project," S. H. Schurr, J. Darmstradter, W. Ramsey , H. Perry, M. Russell, The John Hopkins University Press, Baltimore, MD...1.8% 1990-1995 0 to 4.8% 2.1% 3.1% - 1995-2000 0 to 1.5% 1.2% 3.0% Source: Federal Register, 23 June 1980, p. 42193. should be tested for the effect...34Economic Analysis and Program Evaluation for Program Management" 18 Oct., 1972 calls for "a test of the sensitivity of the results of any factor

System Risk Balancing Profiles: Software Component

NASA Technical Reports Server (NTRS)

Kelly, John C.; Sigal, Burton C.; Gindorf, Tom

2000-01-01

The Software QA / V&V guide will be reviewed and updated based on feedback from NASA organizations and others with a vested interest in this area. Hardware, EEE Parts, Reliability, and Systems Safety are a sample of the future guides that will be developed. Cost Estimates, Lessons Learned, Probability of Failure and PACTS (Prevention, Avoidance, Control or Test) are needed to provide a more complete risk management strategy. This approach to risk management is designed to help balance the resources and program content for risk reduction for NASA's changing environment.

Human immunodeficiency virus prevalence, incidence, and residual transmission risk in first-time and repeat blood donations in Zimbabwe: implications on blood safety.

PubMed

Mapako, Tonderai; Mvere, David A; Chitiyo, McLeod E; Rusakaniko, Simbarashe; Postma, Maarten J; van Hulst, Marinus

2013-10-01

National Blood Service Zimbabwe human immunodeficiency virus (HIV) risk management strategy includes screening and discarding of first-time donations, which are collected in blood packs without an anticoagulant (dry pack). To evaluate the impact of discarding first-time donations on blood safety the HIV prevalence, incidence, and residual risk in first-time and repeat donations (wet packs) were compared. Donor data from 2002 to 2010 were retrieved from a centralized national electronic donor database and retrospectively analyzed. Chi-square test was used to compare HIV prevalence with relative risk (RR), and the RR point estimates and 95% confidence interval (CI) are reported. Trend analysis was done using Cochran-Armitage trend test. HIV residual risk estimates were determined using published residual risk estimation models. Over the 9 years the overall HIV prevalence estimates are 1.29% (n = 116,058) and 0.42% (n = 434,695) for first-time and repeat donations, respectively. The overall RR was 3.1 (95% CI, 2.9-3.3; p < 0.0001). The overall mean residual transmission risk of HIV window phase donations in first-time was 1:7384 (range, 1:11,308-1:5356) and in repeat donors it was 1:5496 (range, 1:9943-1:3347). The significantly high HIV prevalence estimates recorded in first-time over repeat donations is indicative of the effectiveness of the HIV risk management strategy. However, comparable residual transmission risk estimates in first-time and repeat donors point to the need to further review the risk management strategies. Given the potential wastage of valuable resources, future studies should focus on the cost-effectiveness and utility of screening and discarding first-time donations. © 2013 American Association of Blood Banks.

Usability and feasibility of health IT interventions to enhance Self-Care for Lymphedema Symptom Management in breast cancer survivors.

PubMed

Fu, Mei R; Axelrod, Deborah; Guth, Amber A; Wang, Yao; Scagliola, Joan; Hiotis, Karen; Rampertaap, Kavita; El-Shammaa, Nardin

2016-09-01

The-Optimal-Lymph-Flow health IT system (TOLF) is a patient-centered, web-and-mobile-based educational and behavioral health IT system focusing on safe, innovative, and pragmatic self-care strategies for lymphedema symptom management. The purpose of this study was to evaluate usability, feasibility, and acceptability of TOLF among the end-user of breast cancer survivors. Two types of usability testing were completed with 30 breast cancer survivors: heuristic evaluation and end-user testing. Each participant was asked to think aloud while completing a set of specified tasks designed to explicate and freely explore the system features. A heuristic evaluation checklist, the Perceived Ease of Use and Usefulness Questionnaire, and The Post Study System Usability Questionnaire were used to evaluate usability of the system. Open-ended questions were used to gather qualitative data. Quantitative data were analyzed using descriptive statistics and qualitative data were summarized thematically. Breast cancer survivors were very satisfied with the system: 90% (n = 27) rated the system having no usability problems; 10% (n = 3) noted minor cosmetic problems: spelling errors or text font size. The majority of participants 96.6% (n = 29) strongly agreed that the system was easy to use and effective in helping to learn about lymphedema, symptoms and self-care strategies. Themes from the qualitative data included empowerment, high quality information, loving avatar simulation videos, easy accessibility, and user-friendliness. This usability study provided evidence on breast cancer survivor's acceptance and highly positive evaluation of TOLF's usability as well as feasibility of using technologically-driven delivery model to enhance self-care strategies for lymphedema symptom management.

Value of the "Test & Treat" Strategy for Uninvestigated Dyspepsia at Low Prevalence Rates of Helicobacter pylori in the Population.

PubMed

Agréus, Lars; Talley, Nicholas J; Jones, Michael

2016-06-01

In populations with a low prevalence rate of Helicobacter pylori (H. pylori) infection from Western countries, guidelines for the management of uninvestigated dyspepsia generally recommend that the "test and treat" strategy should be avoided in favor of empiric proton-pump inhibitor therapy in younger patients (on average < 50 years of age) without alarm symptoms and signs. The prevalence of H. pylori infection has fallen from about 30% to about 10% in Sweden and other countries. We aimed to explore whether the rationale for test and treat is relevant in contemporary clinical practice. In settings with an infection rate in the adult population of 30% and 10%, we modeled the positive and negative predictive values for indirect (nonendoscopy) tests on current H. pylori infection with a presumed sensitivity and specificity of 95%. We then calculated the difference in false-negative and false-positive test outcome, and eradication prescription rates in the two scenarios. While the positive predictive value for the test decreased from 0.89 to 0.68 when the prevalence of H. pylori fell from 30% to 10%, there were only 1% more false-negative tests and 1% less false-positive tests. The eradication prescription rate would decrease by 18% with a 10% prevalence rate. The recommendation to stop applying "test and treat" at lower prevalence rates of H. pylori should be reconsidered. The test and treat strategy is the preferred approach for most patients who present with dyspepsia. © 2015 John Wiley & Sons Ltd.

Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial.

PubMed

Garner, Bryan R; Zehner, Mark; Roosa, Mathew R; Martino, Steve; Gotham, Heather J; Ball, Elizabeth L; Stilen, Patricia; Speck, Kathryn; Vandersloot, Denna; Rieckmann, Traci R; Chaple, Michael; Martin, Erika G; Kaiser, David; Ford, James H

2017-11-17

Improving the extent to which evidence-based practices (EBPs)-treatments that have been empirically shown to be efficacious or effective-are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness-implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS service organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. Using a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition) or the ATTC + ISF strategy (experimental condition). The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation). The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change). Building upon the exploration-preparation-implementation-sustainment (EPIS) framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1) time-to-proficiency (i.e., preparation phase outcome), (2) implementation effectiveness (i.e., implementation phase outcome), and (3) level of sustainment (i.e., sustainment phase outcome). Although not without limitations, the ISF experiment has several strengths: a highly rigorous design (randomized, hypothesis-driven), high-need setting (ASOs), large sample size (39 ASOs), large geographic representation (23 states and the District of Columbia), and testing along multiple phases of the EPIS continuum (preparation, implementation, and sustainment). Thus, study findings will significantly improve generalizable knowledge regarding the best preparation, implementation, and sustainment strategies for advancing EBPs along the EPIS continuum. Moreover, increasing ASO's capacity to address substance use may improve the HIV Care Continuum. Trial registration ClinicalTrials.gov: NCT03120598.

Systematic review of management strategies to control chronic wasting disease in wild deer populations in North America.

PubMed

Uehlinger, F D; Johnston, A C; Bollinger, T K; Waldner, C L

2016-08-22

Chronic wasting disease (CWD) is a contagious, fatal prion disease affecting cervids in a growing number of regions across North America. Projected deer population declines and concern about potential spread of CWD to other species warrant strategies to manage this disease. Control efforts to date have been largely unsuccessful, resulting in continuing spread and increasing prevalence. This systematic review summarizes peer-reviewed published reports describing field-applicable CWD control strategies in wild deer populations in North America using systematic review methods. Ten databases were searched for peer-reviewed literature. Following deduplication, relevance screening, full-text appraisal, subject matter expert review and qualitative data extraction, nine references were included describing four distinct management strategies. Six of the nine studies used predictive modeling to evaluate control strategies. All six demonstrated one or more interventions to be effective but results were dependant on parameters and assumptions used in the model. Three found preferential removal of CWD infected deer to be effective in reducing CWD prevalence; one model evaluated a test and slaughter strategy, the other selective removal of infected deer by predators and the third evaluated increased harvest of the sex with highest prevalence (males). Three models evaluated non-selective harvest of deer. There were only three reports that examined primary data collected as part of observational studies. Two of these studies supported the effectiveness of intensive non-selective culling; the third study did not find a difference between areas that were subjected to culling and those that were not. Seven of the nine studies were conducted in the United States. This review highlights the paucity of evaluated, field-applicable control strategies for CWD in wild deer populations. Knowledge gaps in the complex epidemiology of CWD and the intricacies inherent to prion diseases currently pose significant challenges to effective control of this disease in wild deer in North America.

Effects of a self-management educational program for the control of childhood asthma.

PubMed

Pérez, M G; Feldman, L; Caballero, F

1999-01-01

The objective of the present study was to evaluate the effects of a self-management educational program on 29 children between 6 and 14 years old and their parents implemented in an office setting in Venezuela. Children were randomly assigned to experimental and control group. Children's asthma knowledge, self-management abilities, index morbidity, parents' asthma knowledge and management abilities were measured. The program consisted of six sessions of information giving and cognitive-behavioral strategies for the children, and two talks and an informative brochure for the parents. Results of t tests indicate that the experimental group experienced a statistical significant effects on children's asthma knowledge (P < 0.001) and practice of self-management abilities (P < 0.000) and in parents' knowledge (P < 0.008) compared to the control group. The educational Self-management program had a significant impact on the Morbidity Index of the study group at post-test (P < 0.05). Younger children benefited more from the program compared to older ones (P < 0.09). Children's age is highlighted as a critical variable in designing asthma educational programs. Results suggest the effectiveness on these programs independently of the cultural context.

A training program to enhance recognition of depression in nursing homes, assisted living, and other long-term care settings: Description and evaluation.

PubMed

Abrams, Robert C; Nathanson, Mark; Silver, Stephanie; Ramirez, Mildred; Toner, John A; Teresi, Jeanne A

2017-01-01

Low levels of symptom recognition by staff have been "gateway" barriers to the management of depression in long-term care. The study aims were to refine a depression training program for front-line staff in long-term care and provide evaluative knowledge outcome data. Three primary training modules provide an overview of depression symptoms; a review of causes and situational and environmental contributing factors; and communication strategies, medications, and clinical treatment strategies. McNemar's chi-square tests and paired t-tests were used to examine change in knowledge. Data were analyzed for up to 143 staff members, the majority from nursing. Significant changes (p < .001) in knowledge were observed for all modules, with an average change of between 2 and 3 points. Evidence was provided that participants acquired desired information in the recognition, detection, and differential diagnosis and treatment strategies for those persons at significant risk for a depressive disorder.

The Integrated Rangeland Fire Management Strategy Actionable Science Plan: U.S. Department of the Interior, Washington D.C.

Treesearch

Integrated Rangeland Fire Management Strategy Actionable Science Plan Team

2016-01-01

The Integrated Rangeland Fire Management Strategy (hereafter Strategy, DOI 2015) outlined the need for coordinated, science-based adaptive management to achieve long-term protection, conservation, and restoration of the sagebrush (Artemisia spp.) ecosystem. A key component of this management approach is the identification of knowledge gaps that limit...

Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials

PubMed Central

Straus, Sharon E.

2008-01-01

BACKGROUND Studies indicate a gap between evidence and clinical practice in osteoporosis management. Tools that facilitate clinical decision making at the point of care are promising strategies for closing these practice gaps. OBJECTIVE To systematically review the literature to identify and describe the effectiveness of tools that support clinical decision making in osteoporosis disease management. DATA SOURCES Medline, EMBASE, CINAHL, and EBM Reviews (CDSR, DARE, CCTR, and ACP J Club), and contact with experts in the field. REVIEW METHODS Randomized controlled trials (RCTs) in any language from 1966 to July 2006 investigating disease management interventions in patients at risk for osteoporosis. Outcomes included fractures and bone mineral density (BMD) testing. Two investigators independently assessed articles for relevance and study quality, and extracted data using standardized forms. RESULTS Of 1,246 citations that were screened for relevance, 13 RCTs met the inclusion criteria. Reported study quality was generally poor. Meta-analysis was not done because of methodological and clinical heterogeneity; 77% of studies included a reminder or education as a component of their intervention. Three studies of reminders plus education targeted to physicians and patients showed increased BMD testing (RR range 1.43 to 8.67) and osteoporosis medication use (RR range 1.60 to 8.67). A physician reminder plus a patient risk assessment strategy found reduced fractures [RR 0.58, 95% confidence interval (CI) 0.37 to 0.90] and increased osteoporosis therapy (RR 2.44, CI 1.43 to 4.17). CONCLUSION Multi-component tools that are targeted to physicians and patients may be effective for supporting clinical decision making in osteoporosis disease management. Electronic supplementary material The online version of this article (doi:10.1007/s11606-008-0812-9) contains supplementary material, which is available to authorized users. PMID:18836782

A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care.

PubMed

Comino, Elizabeth Jean; Davies, Gawaine Powell; Krastev, Yordanka; Haas, Marion; Christl, Bettina; Furler, John; Raymont, Anthony; Harris, Mark F

2012-11-21

Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care. An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions). The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n = 45), episodic care (n = 19), and chronic disease management (n = 11). They were undertaken in a number of countries including Australia (n = 25), USA (n = 25), and UK (n = 15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n = 46 studies) or as a combination of two (n = 20) or more strategies (n = 9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n = 43 studies), patient support (n = 29), provision of new services (n = 19), workforce development (n = 11), and financial incentives (n = 9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results. This review suggests that multiple, linked strategies targeting different levels of the health care system are most likely to improve access to best practice PHC. The proposed changes in the structure of PHC in Australia may provide opportunities to investigate the factors that influence access to best practice PHC and to develop and implement effective, evidence based strategies to address these.

The current state of knowledge on the interaction of Escherichia coli within vegetative filter strips as a sustainable best management practice to reduce fecal pathogen loading into surface waters

PubMed Central

Olilo, Casianes Owino; Muia, Anastasia Wairimu; Moturi, Wilkister Nyaora; Onyando, Japhet Ogalo; Amber, Ford Roegner

2016-01-01

Agro-pastoral operations have the potential to threaten public health with loading of diverse pathogens into surface waters through overland flow; increasing awareness of the limitations of fecal indicators has led to development of a number of advancements in detection, source tracking and predictive modeling of public health risk. These tools and techniques are beginning to be integrated into management strategies. The objective of this review was to determine the status of current knowledge and challenges of the fate and transport of Escherichia coli in overland flow and their interaction within vegetative filter strip (VFS) as one of these implemented best management practices and to critically evaluate its use in that setting as an indicator organism. With few studies directly focusing on VFS removal of E. coli from overland flow, we critically evaluated the available data on movement of E. coil from fecal source loading to retention and decay or re-release for potential contamination of water ways and pointed out potential limitations in both pathogen-specific removal and its use as an indicator organisms within overland flow and VFS. Critical areas of focus for future studies to reduce gaps in knowledge were identified, and the integration of newer approaches in source tracking, alternative indicators and the use of non-pathogenic surrogates for field testing of existing VFS models was encouraged. With VFS as a growing field of interest as an economical conservation practice and as an avenue for conservation of resources for small-scale agro-pastoral operations, management strategies to reduce initial fecal load from either applied manure constituents or shedding from free-range animals will continue to test the limits in the applications of models to overland flow and VFS management strategies. Further studies at the microscale in understanding discrepancies between low and high pathogenicity strains of E. coil and between E. coil and other fecal pathogens in the context of VFS will be critical. However, nuanced studies are needed to understand either biological or environmental differences in the fate and transport of the diverse types of fecal pathogens within these settings PMID:28042601

Towards a theory of tiered testing.

PubMed

Hansson, Sven Ove; Rudén, Christina

2007-06-01

Tiered testing is an essential part of any resource-efficient strategy for the toxicity testing of a large number of chemicals, which is required for instance in the risk management of general (industrial) chemicals, In spite of this, no general theory seems to be available for the combination of single tests into efficient tiered testing systems. A first outline of such a theory is developed. It is argued that chemical, toxicological, and decision-theoretical knowledge should be combined in the construction of such a theory. A decision-theoretical approach for the optimization of test systems is introduced. It is based on expected utility maximization with simplified assumptions covering factual and value-related information that is usually missing in the development of test systems.

New trends in the prevention and management of community-acquired pneumonia.

PubMed

Postma, D F; van Werkhoven, C H; Huijts, S M; Bolkenbaas, M; Oosterheert, J J; Bonten, M J M

2012-10-01

Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This review summarises current trends and knowledge gaps in CAP management and prevention. Although Streptococcus pneumoniae is the most frequent cause of CAP, identification of the microbial cause of infection remains unsuccessful in most episodes, and little is known about the aetiology of CAP in immunocompromised patients. Urinary antigen testing has become standard care for diagnosing Legionella infection, and pneumococcal urinary antigen testing is now recommended in the Dutch guidelines to streamline antibiotic therapy in patients hospitalised with CAP. In primary care C-reactive protein determination is recommended to improve antibiotic prescription for lower respiratory tract infections. In patients hospitalised with CAP, three strategies are considered equally effective for choosing empirical antibiotic treatment. Yet, more (and better designed) studies are needed to determine the best strategy, as well as to determine optimal (which usually means the minimum) duration of antibiotic therapy and the role of adjuvant treatment with corticosteroids. The effectiveness of the 23-valent pneumococcal polysaccharide vaccine in preventing invasive pneumococcal disease and pneumococcal CAP remains debated, and whether the newer conjugate vaccines are more effective remains to be determined. Many of these questions are currently being addressed in large-scaled trials in the Netherlands, and their results may allow evidence-based decisions in CAP management and prevention.

A cost-effective interdisciplinary approach to microbiologic send-out test use.

PubMed

Aesif, Scott W; Parenti, David M; Lesky, Linda; Keiser, John F

2015-02-01

Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine. To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing. The George Washington University Hospital is a 370-bed academic hospital in Washington, DC. In 2012 all requisitions for microbiologic send-out tests were screened by the clinical pathology house staff prior to final dispensation. Tests with questionable utility were brought to the attention of ordering clinicians through the use of interdisciplinary rounds and direct face-to-face consultation. Screening resulted in a cancellation rate of 38% of send-out tests, with proportional cost savings. Nucleic acid tests represented most of the tests screened and the largest percentage of cost saved through screening. Following consultation, requested send-out tests were most often canceled because of a lack of clinical indication. Direct face-to-face consultation with ordering physicians is an effective, interdisciplinary approach to managing the use of send-out testing in the microbiology laboratory.

Science Framework for the Conservation and Restoration Strategy of the Department of the Interior, Secretarial Order 3336: Using resilience and resistance concepts to assess threats to sagebrush ecosystems and sage-grouse, prioritize conservation and restoration actions, and inform management strategies

Treesearch

Jeanne C. Chambers; Jeffrey L. Beck; Steve Campbell; John Carlson; Thomas J. Christiansen; Karen J. Clause; Michele R. Crist; Jonathan B. Dinkins; Kevin E. Doherty; Shawn Espinosa; Kathleen A. Griffin; Steven E. Hanser; Douglas W. Havlina; Kenneth F. Henke; Jacob D. Hennig; Laurie L. Kurth; Jeremy D. Maestas; Mary Manning; Kenneth E. Mayer; Brian A. Mealor; Clinton McCarthy; Mike Pellant; Marco A. Perea; Karen L. Prentice; David A. Pyke; Lief A. Wiechman; Amarina Wuenschel

2016-01-01

The Science Framework for the Conservation and Restoration Strategy of the Department of the Interior, Secretarial Order 3336 (SO 3336), Rangeland Fire Prevention, Management and Restoration, provides a strategic, multiscale approach for prioritizing areas for management and determining effective management strategies across the sagebrush biome. The emphasis of this...

Western Juniper Management: Assessing Strategies for Improving Greater Sage-grouse Habitat and Rangeland Productivity

NASA Astrophysics Data System (ADS)

Farzan, Shahla; Young, Derek J. N.; Dedrick, Allison G.; Hamilton, Matthew; Porse, Erik C.; Coates, Peter S.; Sampson, Gabriel

2015-09-01

Western juniper ( Juniperus occidentalis subsp. occidentalis) range expansion into sagebrush steppe ecosystems has affected both native wildlife and economic livelihoods across western North America. The potential listing of the greater sage-grouse ( Centrocercus urophasianus) under the U.S. Endangered Species Act has spurred a decade of juniper removal efforts, yet limited research has evaluated program effectiveness. We used a multi-objective spatially explicit model to identify optimal juniper removal sites in Northeastern California across weighted goals for ecological (sage-grouse habitat) and economic (cattle forage production) benefits. We also extended the analysis through alternative case scenarios that tested the effects of coordination among federal agencies, budgetary constraints, and the use of fire as a juniper treatment method. We found that sage-grouse conservation and forage production goals are somewhat complementary, but the extent of complementary benefits strongly depends on spatial factors and management approaches. Certain management actions substantially increase achievable benefits, including agency coordination and the use of prescribed burns to remove juniper. Critically, our results indicate that juniper management strategies designed to increase cattle forage do not necessarily achieve measurable sage-grouse benefits, underscoring the need for program evaluation and monitoring.

Western juniper management: assessing strategies for improving greater sage-grouse habitat and rangeland productivity

USGS Publications Warehouse

Farzan, Shahla; Young, Derek J.N.; Dedrick, Allison G.; Hamilton, Mattew; Porse, Erik C.; Coates, Peter S.; Sampson, Gabriel

2015-01-01

Western juniper (Juniperus occidentalis subsp. occidentalis) range expansion into sagebrush steppe ecosystems has affected both native wildlife and economic livelihoods across western North America. The potential listing of the greater sage-grouse (Centrocercus urophasianus) under the U.S. Endangered Species Act has spurred a decade of juniper removal efforts, yet limited research has evaluated program effectiveness. We used a multi-objective spatially explicit model to identify optimal juniper removal sites in Northeastern California across weighted goals for ecological (sage-grouse habitat) and economic (cattle forage production) benefits. We also extended the analysis through alternative case scenarios that tested the effects of coordination among federal agencies, budgetary constraints, and the use of fire as a juniper treatment method. We found that sage-grouse conservation and forage production goals are somewhat complementary, but the extent of complementary benefits strongly depends on spatial factors and management approaches. Certain management actions substantially increase achievable benefits, including agency coordination and the use of prescribed burns to remove juniper. Critically, our results indicate that juniper management strategies designed to increase cattle forage do not necessarily achieve measurable sage-grouse benefits, underscoring the need for program evaluation and monitoring.

Selective breeding: the future of TB management in African buffalo?

PubMed

le Roex, N; Berrington, C M; Hoal, E G; van Helden, P D

2015-09-01

The high prevalence of bovine tuberculosis (BTB) in African buffalo (Syncerus caffer) in regions of southern African has a negative economic impact on the trade of animals and animal products, represents an ecological threat to biodiversity, and poses a health risk to local communities through the wildlife-cattle-human interface. Test and cull methods may not be logistically feasible in many free-range wildlife systems, and with the presence of co-existing BTB hosts and the limited effectiveness of the BCG vaccine in buffalo, there is a need for alternative methods of BTB management. Selective breeding for increased resistance to BTB in buffalo may be a viable method of BTB management in the future, particularly if genetic information can be incorporated into these schemes. To explore this possibility, we discuss the different strategies that can be employed in selective breeding programmes, and consider the implementation of genetic improvement schemes. We reflect on the suitability of applying this strategy for enhanced BTB resistance in African buffalo, and address the challenges of this approach that must be taken into account. Conclusions and the implications for management are presented. Copyright © 2015 Elsevier B.V. All rights reserved.

Western Juniper Management: Assessing Strategies for Improving Greater Sage-grouse Habitat and Rangeland Productivity.

PubMed

Farzan, Shahla; Young, Derek J N; Dedrick, Allison G; Hamilton, Matthew; Porse, Erik C; Coates, Peter S; Sampson, Gabriel

2015-09-01

Western juniper (Juniperus occidentalis subsp. occidentalis) range expansion into sagebrush steppe ecosystems has affected both native wildlife and economic livelihoods across western North America. The potential listing of the greater sage-grouse (Centrocercus urophasianus) under the U.S. Endangered Species Act has spurred a decade of juniper removal efforts, yet limited research has evaluated program effectiveness. We used a multi-objective spatially explicit model to identify optimal juniper removal sites in Northeastern California across weighted goals for ecological (sage-grouse habitat) and economic (cattle forage production) benefits. We also extended the analysis through alternative case scenarios that tested the effects of coordination among federal agencies, budgetary constraints, and the use of fire as a juniper treatment method. We found that sage-grouse conservation and forage production goals are somewhat complementary, but the extent of complementary benefits strongly depends on spatial factors and management approaches. Certain management actions substantially increase achievable benefits, including agency coordination and the use of prescribed burns to remove juniper. Critically, our results indicate that juniper management strategies designed to increase cattle forage do not necessarily achieve measurable sage-grouse benefits, underscoring the need for program evaluation and monitoring.

Cost-effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary.

PubMed

Hannouf, M B; Winquist, E; Mahmud, S M; Brackstone, M; Sarma, S; Rodrigues, G; Rogan, P; Hoch, J S; Zaric, G S

2017-06-01

We aimed to investigate the cost-effectiveness of a 2000-gene-expression profiling (GEP) test to help identify the primary tumor site when clinicopathological diagnostic evaluation was inconclusive in patients with cancer of unknown primary (CUP). We built a decision-analytic-model to project the lifetime clinical and economic consequences of different clinical management strategies for CUP. The model was parameterized using follow-up data from the Manitoba Cancer Registry, cost data from Manitoba Health administrative databases and secondary sources. The 2000-GEP-based strategy compared to current clinical practice resulted in an incremental cost-effectiveness ratio (ICER) of $44,151 per quality-adjusted life years (QALY) gained. The total annual-budget impact was $36.2 million per year. A value-of-information analysis revealed that the expected value of perfect information about the test's clinical impact was $4.2 million per year. The 2000-GEP test should be considered for adoption in CUP. Field evaluations of the test are associated with a large societal benefit.

Establishing ecological reference conditions and tracking post-application effectiveness of lanthanum-saturated bentonite clay (Phoslock®) for reducing phosphorus in aquatic systems: an applied paleolimnological approach.

PubMed

Moos, M T; Taffs, K H; Longstaff, B J; Ginn, B K

2014-08-01

Innovative management strategies for nutrient enrichment of freshwater are important in the face of this increasing global problem, however many strategies are not assessed over long enough time periods to establish effectiveness. Paleolimnological techniques using diatoms as biological indicators were utilized to establish ecological reference conditions, environmental variation, and the effectiveness of lanthanum-saturated bentonite clay (brand name: Phoslock(®)) applied to reduce water column phosphorus (P) concentrations in four waterbodies in Ontario, Canada, and eastern Australia. In sediment cores from the two Canadian sites, there were short-lived changes to diatom assemblages, relative to inferred background conditions, and a temporary reduction in both measured and diatom-inferred total phosphorus (TP) before returning to pre-application conditions (particularly in the urban stormwater management pond which has a high flushing rate and responds rapidly to precipitation and surface run-off). The two Australian sites (a sewage treatment pond and a shallow recreational lake), recorded no reduction in diatom-inferred TP. Based on our pre-application environmental reconstruction, changes to the diatom assemblages and diatom-inferred TP appeared to be driven by larger, climatic factors. While laboratory tests involving this product showed sharp reductions in water column TP, management strategies require detailed information on pre-application environmental conditions and variations in order to accurately assess the effectiveness of new technologies for lake management. Copyright © 2014 Elsevier Ltd. All rights reserved.

Teachers' views and beliefs about bullying: influences on classroom management strategies and students' coping with peer victimization.

PubMed

Kochenderfer-Ladd, Becky; Pelletier, Marie E

2008-08-01

A multilevel design was used to test a model in which teachers' attitudes (beliefs) about bullying (e.g., it is normative; assertive children do not get bullied; children wouldn't be bullied if they avoided mean kids) were hypothesized to influence if and how they intervene in bullying interactions. In turn, it was hypothesized that teachers' strategies would influence how their students cope with victimization and the frequency of victimization reported by their students. Data were gathered on 34 2nd and 4th grade teachers and 363 ethnically-diverse students (188 boys; 175 girls; M age=9 years 2 months). Results indicated that teachers were not likely to intervene if they viewed bullying as normative behavior, but were more likely to intervene if they held either assertion or avoidant beliefs. Moreover, avoidant beliefs were predictive of separating students which was then associated both directly and indirectly (via reduced revenge seeking) with lower levels of peer victimization. No grade differences emerged for teachers' views or management strategies; however, minor sex differences were detected which will be discussed.

Optimization based on benefit of regional energy suppliers of distributed generation in active distribution network

NASA Astrophysics Data System (ADS)

Huo, Xianxu; Li, Guodong; Jiang, Ling; Wang, Xudong

2017-08-01

With the development of electricity market, distributed generation (DG) technology and related policies, regional energy suppliers are encouraged to build DG. Under this background, the concept of active distribution network (ADN) is put forward. In this paper, a bi-level model of intermittent DG considering benefit of regional energy suppliers is proposed. The objective of the upper level is the maximization of benefit of regional energy suppliers. On this basis, the lower level is optimized for each scene. The uncertainties of DG output and load of users, as well as four active management measures, which include demand-side management, curtailing the output power of DG, regulating reactive power compensation capacity and regulating the on-load tap changer, are considered. Harmony search algorithm and particle swarm optimization are combined as a hybrid strategy to solve the model. This model and strategy are tested with IEEE-33 node system, and results of case study indicate that the model and strategy successfully increase the capacity of DG and benefit of regional energy suppliers.

An investigation of lithium-ion battery thermal management using paraffin/porous-graphite-matrix composite

NASA Astrophysics Data System (ADS)

Greco, Angelo; Jiang, Xi; Cao, Dongpu

2015-03-01

The thermal management of a cylindrical battery cell by a phase change material (PCM)/compressed expanded natural graphite (CENG) is investigated in this study. The transient thermal behaviour of both the battery and the PCM/CENG is described with a simplified one-dimensional model taking into account the physical and phase change properties of the PCM/CENG composite. The 1D analytical/computational model yielded nearly identical results to the three-dimensional simulation results for various cooling strategies. Therefore, the 1D model is sufficient to describe the transient behaviour of the battery cooled by a PCM/CENG composite. Moreover, the maximum temperature reached by the PCM/CENG cooling strategy is much lower than that by the forced convection in the same configuration. In the test case studied, the PCM showed superior transient characteristics to forced convection cooling. The PCM cooling is able to maintain a lower maximum temperature during the melting process and to extend the transient time for temperature rise. Furthermore, the graphite-matrix bulk density is identified as an important parameter for optimising the PCM/CENG cooling strategy.

Workaholism and daily energy management at work: associations with self-reported health and emotional exhaustion

PubMed Central

SCHULZ, Anika Susanne; BLOOM, Jessica; KINNUNEN, Ulla

2017-01-01

Adequate energy management during the working day is essential for employees to remain healthy and vital. Research has investigated which energy management strategies are frequently used and which are most beneficial, but the results are inconclusive and research is still scarce. We aim to extend the current knowledge by considering individual differences in terms of working compulsively (as key feature of workaholism) with regard to energy management. Data were collected with an online survey in 1,253 employees from 12 different organizations. Employees’ levels of compulsiveness were expected to relate to 1) employees’ choice of which energy management strategies to use, and 2) the benefits (improved health and alleviated emotional exhaustion) of the chosen strategy. The results partly supported the hypotheses in that compulsiveness was associated with more frequent use of work-related energy management strategies. However, compulsiveness was not related to less frequent use of micro-breaks. Energy management (particularly work-related and physical micro-break strategies) improved health and alleviated emotional exhaustion regardless of compulsiveness levels, whereas private micro-break strategies were only beneficial for employees high in compulsiveness. PMID:28123137

Behavior Management of Special Needs Learners: Positive Approaches.

ERIC Educational Resources Information Center

Missouri Univ., Columbia. Missouri LINC.

The paper addresses behavior management strategies for developing new behaviors in special needs learners, strategies for changing existing behaviors, and strategies for developing behavioral generalization. An introductory overview identifies five basic principles of behavior management. Fourteen behavioral terms are then defined (e.g.,…

The role of goal management for successful adaptation to arthritis.

PubMed

Arends, Roos Y; Bode, Christina; Taal, Erik; Van de Laar, Mart A F J

2013-10-01

Persons with polyarthritis often experience difficulties in attaining personal goals due to disease symptoms such as pain, fatigue and reduced mobility. This study examines the relationship of goal management strategies - goal maintenance, goal adjustment, goal disengagement, goal reengagement - with indicators of adaptation to polyarthritis, namely, depression, anxiety, purpose in life, positive affect, participation, and work participation. 305 patients diagnosed with polyarthritis participated in a questionnaire study (62% female, 29% employed, mean age: 62 years). Hierarchical multiple-regression-analyses were conducted to examine the relative importance of the goal management strategies for adaptation. Self-efficacy in relation to goal management was also studied. For all adaptation indicators, the goal management strategies added substantial explained variance to the models (R(2): .07-.27). Goal maintenance and goal adjustment were significant predictors of adaptation to polyarthritis. Self-efficacy partly mediated the influence of goal management strategies. Goal management strategies were found to be important predictors of successful adaptation to polyarthritis. Overall, adjusting goals to personal ability and circumstances and striving for goals proved to be the most beneficial strategies. Designing interventions that focus on the effective management of goals may help people to adapt to polyarthritis. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Instructional and behavior management practices implemented by elementary general education teachers.

PubMed

Reddy, Linda A; Fabiano, Gregory A; Dudek, Christopher M; Hsu, Louis

2013-12-01

This investigation examined 317 general education kindergarten through fifth-grade teachers' use of instructional and behavioral management strategies as measured by the Classroom Strategy Scale (CSS)-Observer Form, a multidimensional tool for assessing classroom practices. The CSS generates frequency of strategy use and discrepancy scores reflecting the difference between recommended and actual frequencies of strategy use. Hierarchical linear models (HLMs) suggested that teachers' grade-level assignment was related to their frequency of using instructional and behavioral management strategies: Lower grade teachers utilized more clear 1 to 2 step commands, praise statements, and behavioral corrective feedback strategies than upper grade teachers, whereas upper grade teachers utilized more academic monitoring and feedback strategies, content/concept summaries, student focused learning and engagement, and student thinking strategies than lower grade teachers. Except for the use of praise statements, teachers' usage of instructional and behavioral management strategies was not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. HLMs suggested that teachers' grade level was related to their discrepancy scores of some instructional and behavioral management strategies: Upper grade teachers had higher discrepancy scores in academic performance feedback, behavioral feedback, and praise than lower grade teachers. Teachers' discrepancy scores of instructional and behavioral management strategies were not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. Implications of results for school psychology practice are outlined. © 2013.

Optimization of European call options considering physical delivery network and reservoir operation rules

NASA Astrophysics Data System (ADS)

Cheng, Wei-Chen; Hsu, Nien-Sheng; Cheng, Wen-Ming; Yeh, William W.-G.

2011-10-01

This paper develops alternative strategies for European call options for water purchase under hydrological uncertainties that can be used by water resources managers for decision making. Each alternative strategy maximizes its own objective over a selected sequence of future hydrology that is characterized by exceedance probability. Water trade provides flexibility and enhances water distribution system reliability. However, water trade between two parties in a regional water distribution system involves many issues, such as delivery network, reservoir operation rules, storage space, demand, water availability, uncertainty, and any existing contracts. An option is a security giving the right to buy or sell an asset; in our case, the asset is water. We extend a flow path-based water distribution model to include reservoir operation rules. The model simultaneously considers both the physical distribution network as well as the relationships between water sellers and buyers. We first test the model extension. Then we apply the proposed optimization model for European call options to the Tainan water distribution system in southern Taiwan. The formulation lends itself to a mixed integer linear programming model. We use the weighing method to formulate a composite function for a multiobjective problem. The proposed methodology provides water resources managers with an overall picture of water trade strategies and the consequence of each strategy. The results from the case study indicate that the strategy associated with a streamflow exceedence probability of 50% or smaller should be adopted as the reference strategy for the Tainan water distribution system.

Feasibility of using the Omaha System to represent public health nurse manager interventions.

PubMed

Monsen, Karen A; Newsom, Eric T

2011-01-01

To test the feasibility of representing public health nurse (PHN) manager interventions using a recognized standardized nursing terminology. A nurse manager in a Midwest local public health agency documented nurse manager interventions using the Omaha System for 5 months. ANALYTIC STRATEGY: The data were analyzed and the results were compared with the results from a parallel analysis of existing PHN intervention data. Interventions for 79 "clients" (projects, teams, or individuals) captured 76% of recorded work hours, and addressed 43% of Omaha System problems. Most problems were addressed at the "community" level (87.1%) versus the "individual" level (12.9%). Nursing practice differed between the 2 knowledge domains of public health family home visiting nursing and public health nursing management. Standardized nursing terminologies have the potential to represent, describe, and quantify nurse manager interventions for future evaluation and research. © 2011 Wiley Periodicals, Inc.

Habitat Management to Suppress Pest Populations: Progress and Prospects.

PubMed

Gurr, Geoff M; Wratten, Steve D; Landis, Douglas A; You, Minsheng

2017-01-31

Habitat management involving manipulation of farmland vegetation can exert direct suppressive effects on pests and promote natural enemies. Advances in theory and practical techniques have allowed habitat management to become an important subdiscipline of pest management. Improved understanding of biodiversity-ecosystem function relationships means that researchers now have a firmer theoretical foundation on which to design habitat management strategies for pest suppression in agricultural systems, including landscape-scale effects. Supporting natural enemies with shelter, nectar, alternative prey/hosts, and pollen (SNAP) has emerged as a major research topic and applied tactic with field tests and adoption often preceded by rigorous laboratory experimentation. As a result, the promise of habitat management is increasingly being realized in the form of practical worldwide implementation. Uptake is facilitated by farmer participation in research and is made more likely by the simultaneous delivery of ecosystem services other than pest suppression.

Knowledge-based system for flight information management. Thesis

NASA Technical Reports Server (NTRS)

Ricks, Wendell R.

1990-01-01

The use of knowledge-based system (KBS) architectures to manage information on the primary flight display (PFD) of commercial aircraft is described. The PFD information management strategy used tailored the information on the PFD to the tasks the pilot performed. The KBS design and implementation of the task-tailored PFD information management application is described. The knowledge acquisition and subsequent system design of a flight-phase-detection KBS is also described. The flight-phase output of this KBS was used as input to the task-tailored PFD information management KBS. The implementation and integration of this KBS with existing aircraft systems and the other KBS is described. The flight tests are examined of both KBS's, collectively called the Task-Tailored Flight Information Manager (TTFIM), which verified their implementation and integration, and validated the software engineering advantages of the KBS approach in an operational environment.

Using food-web theory to conserve ecosystems

PubMed Central

McDonald-Madden, E.; Sabbadin, R.; Game, E. T.; Baxter, P. W. J.; Chadès, I.; Possingham, H. P.

2016-01-01

Food-web theory can be a powerful guide to the management of complex ecosystems. However, we show that indices of species importance common in food-web and network theory can be a poor guide to ecosystem management, resulting in significantly more extinctions than necessary. We use Bayesian Networks and Constrained Combinatorial Optimization to find optimal management strategies for a wide range of real and hypothetical food webs. This Artificial Intelligence approach provides the ability to test the performance of any index for prioritizing species management in a network. While no single network theory index provides an appropriate guide to management for all food webs, a modified version of the Google PageRank algorithm reliably minimizes the chance and severity of negative outcomes. Our analysis shows that by prioritizing ecosystem management based on the network-wide impact of species protection rather than species loss, we can substantially improve conservation outcomes. PMID:26776253

Psychometric properties of the Polish language version of the chronic pain coping inventory-42 for patients treated surgically due to herniated lumbar discs and spondylotic changes.

PubMed

Misterska, Ewa; Jankowski, Roman; Głowacki, Maciej

2014-05-14

The development of a pain-management program tailored to the specific needs of patients with chronic low back pain (CLBP) requires the proper assessment of psychosocial factors affecting each individual. The Chronic Pain Coping Inventory-42 (CPCI-42) refers to coping strategies, which are commonly defined as the cognitive and behavioral techniques an individual may resort to in stressful or demanding situations. Evidence from a number of sources suggests that differences in pain coping strategies may significantly affect how an individual deals with chronic pain. We aimed to adapt the CPCI-42 to Polish cultural conditions (PL-CPCI-42) and then verify its psychometric properties based on a group of patients treated surgically due to herniated lumbar discs and coexisting spondylotic changes. The average age of the study participants (n=90) was 43.47 years (SD 10.21). The average duration of chronic low back pain (CLBP) was 49.37 months (SD 64.71). Lumbosacral spine X-rays and magnetic resonance imaging scans were performed and all patients completed the PL-CPCI-42 and the Polish versions of the Numeric Pain Rating Scale (NPRS-PL) twice. Internal consistency of the PL-CPCI-42, floor and ceiling effects, test-retest reliability, and criterion validity were analyzed. Resting, guarding, and coping self-statements were frequently used as coping strategies both in the test and in the retest, in contrast to relaxation and exercise/stretch. The NPRS-PL result was 5.70 cm in the test and 5.66 in the retest. Cronbach's alpha values were recorded for the asking for assistance, coping self-statements, and seeking social support domains (0.83, 0.80, 0.83, respectively). Test-retest reliability of the PL-CPCI-42 varied from 0.53 (relaxation domain) to 0.84 (asking for assistance and coping self-statements domains). The present study provides evidence of the validity of the PL-CPCI-42 and supports its usefulness in assessing chronic pain coping strategies, which are especially important to pain adjustment and in the creation of multidisciplinary pain management programs for patients with severe CLBP.

23 CFR 450.320 - Congestion management process in transportation management areas.

Code of Federal Regulations, 2010 CFR

2010-04-01

... travel demand reduction and operational management strategies. (b) The development of a congestion... appropriate analysis of reasonable (including multimodal) travel demand reduction and operational management... the analysis demonstrates that travel demand reduction and operational management strategies cannot...

Strategies Used by Families to Simplify Tasks for Individuals with Alzheimer's Disease and Related Disorders: Psychometric Analysis of the Task Management Strategy Index (TMSI)

ERIC Educational Resources Information Center

Gitlin, Laura N.; Winter, Laraine; Dennis, Marie P.; Corcoran, Mary; Schinfeld, Sandy; Hauck, Walter W.

2002-01-01

Purpose: Little is known about the specific behavioral strategies used by families to manage the physical dependency of persons with Alzheimer's disease and related disorders (ADRD). This study reports the psychometric properties of the Task Management Strategy Index (TMSI), a measure designed to identify actions taken by caregivers to simplify…

Teacher coaching supported by formative assessment for improving classroom practices.

PubMed

Fabiano, Gregory A; Reddy, Linda A; Dudek, Christopher M

2018-06-01

The present study is a wait-list controlled, randomized study investigating a teacher coaching approach that emphasizes formative assessment and visual performance feedback to enhance elementary school teachers' classroom practices. The coaching model targeted instructional and behavioral management practices as measured by the Classroom Strategies Assessment System (CSAS) Observer and Teacher Forms. The sample included 89 general education teachers, stratified by grade level, and randomly assigned to 1 of 2 conditions: (a) immediate coaching, or (b) waitlist control. Results indicated that, relative to the waitlist control, teachers in immediate coaching demonstrated significantly greater improvements in observations of behavior management strategy use but not for observations of instructional strategy use. Observer- and teacher-completed ratings of behavioral management strategy use at postassessment were significantly improved by both raters; ratings of instructional strategy use were significantly improved for teacher but not observer ratings. A brief coaching intervention improved teachers' use of observed behavior management strategies and self-reported use of behavior management and instructional strategies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Hospital choice factors: a case study in Turkey.

PubMed

Akinci, Fevzi; Esatoğlu, A Ezel; Tengilimoglu, Dilaver; Parsons, Amy

2004-01-01

In an attempt to test the robustness of the numerous American findings related to hospital choice in the context of another country, this study examines the factors affecting hospital choice decisions of 869 patients in three public and one private hospital policlinics in Ankara, Turkey and attempts to determine their importance levels. Identification of these factors and determining their effect levels is important in concentrating management efforts on these key areas and in formulating effective marketing strategies to retain and expand hospital patient bases in the future. Our findings highlight the importance of accessibility of hospital services to consumers in hospital choice as well as the role of hospital's image, its physical appearance, and technological capabilities in informing such choices. American health care managers can use these findings to further understand how patients make choices related to health care facilities and to develop marketing strategies that may more effectively market their facilities.

Safety Challenges and Improvement Strategies of Ethnic Minority Construction Workers: A Case Study in Hong Kong.

PubMed

Wu, Chunlin; Luo, Xiaowei; Wang, Tao; Wang, Yue; Sapkota, Bibek

2018-04-18

Due to cultural differences, ethnic minority construction workers are more difficult to manage and more vulnerable to accidents. This study aims to identify the major barriers faced by ethnic minority workers from their own perspectives and determine potential strategies to enhance safety climate of construction projects, thus ultimately improve their safety performance. A survey with modified Nordic safety climate questionnaire was conducted in a certain sub-contractor in Hong Kong. In-depth interviews, status quo description, major challenge investigation and safety knowledge tests were carried as well. The top three most important safety challenges identified are improper stereotypes from the whole industry, lack of opportunities for job assignment, and language barriers. To improve the safety performance, employers should allocate sufficient personal protective equipment and governments should organize unannounced site visits more frequently. Besides, the higher-level management should avoid giving contradictory instructions to foremen against to the standards of supervisors.

Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections.

PubMed

Fajardo-Bernal, Luisa; Aponte-Gonzalez, Johanna; Vigil, Patrick; Angel-Müller, Edith; Rincon, Carlos; Gaitán, Hernando G; Low, Nicola

2015-09-29

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most frequent causes of bacterial sexually transmitted infections (STIs). Management strategies that reduce losses in the clinical pathway from infection to cure might improve STI control and reduce complications resulting from lack of, or inadequate, treatment. To assess the effectiveness and safety of home-based specimen collection as part of the management strategy for Chlamydia trachomatis and Neisseria gonorrhoeae infections compared with clinic-based specimen collection in sexually-active people. We searched the Cochrane Sexually Transmitted Infections Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS on 27 May 2015, together with the World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. Randomized controlled trials (RCTs) of home-based compared with clinic-based specimen collection in the management of C. trachomatis and N. gonorrhoeae infections. Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We contacted study authors for additional information. We resolved any disagreements through consensus. We used standard methodological procedures recommended by Cochrane. The primary outcome was index case management, defined as the number of participants tested, diagnosed and treated, if test positive. Ten trials involving 10,479 participants were included. There was inconclusive evidence of an effect on the proportion of participants with index case management (defined as individuals tested, diagnosed and treated for CT or NG, or both) in the group with home-based (45/778, 5.8%) compared with clinic-based (51/788, 6.5%) specimen collection (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.60 to 1.29; 3 trials, I² = 0%, 1566 participants, moderate quality). Harms of home-based specimen collection were not evaluated in any trial. All 10 trials compared the proportions of individuals tested. The results for the proportion of participants completing testing had high heterogeneity (I² = 100%) and were not pooled. We could not combine data from individual studies looking at the number of participants tested because the proportions varied widely across the studies, ranging from 30% to 96% in home group and 6% to 97% in clinic group (low-quality evidence). The number of participants with positive test was lower in the home-based specimen collection group (240/2074, 11.6%) compared with the clinic-based group (179/967, 18.5%) (RR 0.72, 95% CI 0.61 to 0.86; 9 trials, I² = 0%, 3041 participants, moderate quality). Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection. Increases in the proportion of individuals tested as a result of home-based, compared with clinic-based, specimen collection are offset by a lower proportion of positive results. The harms of home-based specimen collection compared with clinic-based specimen collection have not been evaluated. Future RCTs to assess the effectiveness of home-based specimen collection should be designed to measure biological outcomes of STI case management, such as proportion of participants with negative tests for the relevant STI at follow-up.

Spatial strategies for managing visitor impacts in National Parks

USGS Publications Warehouse

Leung, Y.-F.; Marion, J.L.

1999-01-01

Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or effective in minimizing resource impacts. Spatial configuration was only minimally evaluated, as it was not included in the survey. The proposed typology of spatial strategies offers a useful means of organizing and understanding the wide variety of management strategies and actions applied in managing visitor impacts in parks and protected areas. Examples from U.S. national parks demonstrate the diversity of these basic strategies and their flexibility in implementation at various spatial scales. Documentation of these examples helps illustrate their application and inform managers of the multitude of options. Further analysis from the spatial perspective is needed Io extend the applicability of this typology to other recreational activities and management issues.

Demand management and case management: a conservation strategy.

PubMed

Bryant, C D R Anna K

2007-01-01

This article reviews the history and development of managed competition, and explores the possibilities of a new demand management strategy in the context of nurse case management to offer less costly, higher quality care for a greater number of patients. The article examines the history and principles of healthcare demand management, its implementation in the hospital and clinical practices of nurse case managers, and its impacts in reducing costs while maintaining care levels. The article develops and analyzes the conflicts and common ground between demand management and case management. First, demand-side strategies can be effective in reducing costs while maintaining quality of nursing care; second, nurse case managers should employ patient education, self-care, and staffing solutions to manage demand. Nurse case managers must apply demand management principles carefully. Their goal is not to restrict care, but to maintain the highest levels of care possible within the limits of their practice's resources and staffing. Two critical themes emerge: (1) demand management is a potential alternative to market-driven managed competition and (2) nursing case management can affect an effective form of demand management. However, the long-term implications of these nursing case management strategies on healthcare staffing need further exploration.

The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.

PubMed

Evans, Catrin; Nalubega, Sylivia; McLuskey, John; Darlington, Nicola; Croston, Michelle; Bath-Hextall, Fiona

2016-01-15

Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. This review included 21 publications from 18 research studies, representing a wide range of countries and healthcare settings. There were 245 findings which were aggregated into 12 categories and five synthesized findings. 1. Nurses/midwives are supportive of provider-initiated HIV testing and counseling if it is perceived to enhance patient care and to align with perceived professional roles. 2. Nurses'/midwives' ability to perform provider-initiated HIV testing and counseling well requires an appropriate infrastructure and adequate human and material resources. 3. At the organizational level, nurses'/midwives' engagement with provider-initiated HIV testing and counseling is facilitated by an inclusive management structure, alongside the provision of ongoing training and clinical supervision. Provider-initiated HIV testing and counseling is hindered by difficulties in fitting it into existing workloads and routines. 4. Nurses/midwives perceive that good quality care in provider-initiated HIV testing and counseling involves finding a balance between public health needs and individual patient needs. Good care requires time and the ability to apply a patient centred approach. 5. The emotional work involved in provider-initiated HIV testing and counseling can be stressful. Nurses/Midwives may require support to deal with complex moral and ethical issues. This review shows that provider-initiated HIV testing and counseling is supported by nurses/midwives who strive to implement it according to principles of good care and a patient centered approach. Nurses/midwives face multiple operational, infra-structural, resource and ethical challenges in the implementation of provider-initiated HIV testing and counseling. The implementation process for provider-initiated HIV testing and counseling would benefit from using a quality improvement framework. Nurses/midwives undertaking provider-initiated HIV testing and counseling require management support, ongoing training and adequate infrastructure/resources. Additional guidance is required on legal/ethical issues in testing of children and in third party disclosure. Operational research is required to determine an optimal skill mix and optimal methods of integrating provider-initiated HIV testing and counseling into existing work routines. The Joanna Briggs Institute.

Can Land Managers Control Japanese Knotweed? Lessons from Control Tests in Belgium

NASA Astrophysics Data System (ADS)

Delbart, Emmanuel; Mahy, Grégory; Weickmans, Bernard; Henriet, François; Crémer, Sébastien; Pieret, Nora; Vanderhoeven, Sonia; Monty, Arnaud

2012-12-01

Japanese knotweed Fallopia japonica is an extremely abundant invasive plant in Belgium and surrounding countries. To date, no eradication method is available for land managers facing the invasion of this rhizomatous plant. We tested different chemical herbicides with two application methods (spraying and stem injection), as well as mechanical treatments, on knotweed clones throughout southern Belgium. The tested control methods were selected to be potentially usable by managers, e.g., using legally accepted rates for herbicides. Stem volume, height and density reduction were assessed after one or two years, depending on the control method. Labor estimations were made for each control method. No tested control method completely eradicated the clones. Stem injection with glyphosate-based herbicide (3.6 kg ha-1 of acid equivalent glyphosate) caused the most damage, i.e., no sprouting shoots were observed the year following the injection. The following year, though, stunted shoots appeared. Among the mechanical control methods, repeated cuts combined with native tree transplanting most appreciably reduced knotweed development. The most efficient methods we tested could curb knotweed invasion, but are not likely to be effective in eradicating the species. As such, they should be included in a more integrated restoration strategy, together with prevention and public awareness campaigns.

Monitoring System for Storm Readiness and Recovery of Test Facilities: Integrated System Health Management (ISHM) Approach

NASA Technical Reports Server (NTRS)

Figueroa, Fernando; Morris, Jon; Turowski, Mark; Franzl, Richard; Walker, Mark; Kapadia, Ravi; Venkatesh, Meera; Schmalzel, John

2010-01-01

Severe weather events are likely occurrences on the Mississippi Gulf Coast. It is important to rapidly diagnose and mitigate the effects of storms on Stennis Space Center's rocket engine test complex to avoid delays to critical test article programs, reduce costs, and maintain safety. An Integrated Systems Health Management (ISHM) approach and technologies are employed to integrate environmental (weather) monitoring, structural modeling, and the suite of available facility instrumentation to provide information for readiness before storms, rapid initial damage assessment to guide mitigation planning, and then support on-going assurance as repairs are effected and finally support recertification. The system is denominated Katrina Storm Monitoring System (KStorMS). Integrated Systems Health Management (ISHM) describes a comprehensive set of capabilities that provide insight into the behavior the health of a system. Knowing the status of a system allows decision makers to effectively plan and execute their mission. For example, early insight into component degradation and impending failures provides more time to develop work around strategies and more effectively plan for maintenance. Failures of system elements generally occur over time. Information extracted from sensor data, combined with system-wide knowledge bases and methods for information extraction and fusion, inference, and decision making, can be used to detect incipient failures. If failures do occur, it is critical to detect and isolate them, and suggest an appropriate course of action. ISHM enables determining the condition (health) of every element in a complex system-of-systems or SoS (detect anomalies, diagnose causes, predict future anomalies), and provide data, information, and knowledge (DIaK) to control systems for safe and effective operation. ISHM capability is achieved by using a wide range of technologies that enable anomaly detection, diagnostics, prognostics, and advise for control: (1) anomaly detection algorithms and strategies, (2) fusion of DIaK for anomaly detection (model-based, numerical, statistical, empirical, expert-based, qualitative, etc.), (3) diagnostics/prognostics strategies and methods, (4) user interface, (5) advanced control strategies, (6) integration architectures/frameworks, (7) embedding of intelligence. Many of these technologies are mature, and they are being used in the KStorMS. The paper will describe the design, implementation, and operation of the KStorMS; and discuss further evolution to support other needs such as condition-based maintenance (CBM).

Responses to professional identity threat: Identity management strategies in incident narratives of health care professionals.

PubMed

van Os, Annemiek; de Gilder, Dick; van Dyck, Cathy; Groenewegen, Peter

2015-01-01

The purpose of this paper is to explore sensemaking of incidents by health care professionals through an analysis of the role of professional identity in narratives of incidents. Using insights from social identity theory, the authors argue that incidents may create a threat of professional identity, and that professionals make use of identity management strategies in response to this identity threat. The paper draws on a qualitative analysis of incident narratives in 14 semi-structured interviews with physicians, nurses, and residents at a Dutch specialist hospital. The authors used an existing framework of identity management strategies to categorize the narratives. The analysis yielded two main results. First, nurses and residents employed multiple types of identity management strategies simultaneously, which points to the possible benefit of combining different strategies. Second, physicians used the strategy of patronization of other professional groups, a specific form of downward comparison. The authors discuss the implications of the findings in terms of the impact of identity management strategies on the perpetuation of hierarchical differences in health care. The authors argue that efforts to manage incident handling may profit from considering social identity processes in sensemaking of incidents. This is the first study that systematically explores how health care professionals use identity management strategies to maintain a positive professional identity in the face of incidents. This study contributes to research on interdisciplinary cooperation in health care.

Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study.

PubMed

Athié, Karen; Menezes, Alice Lopes do Amaral; da Silva, Angela Machado; Campos, Monica; Delgado, Pedro Gabriel; Fortes, Sandra; Dowrick, Christopher

2016-09-30

Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health. In this mixed-method study 18 health managers and 24 professionals were interviewed from different primary and mental health care services in Rio de Janeiro. A semi-structured survey was conducted with 185 closed questions ranging from 1 to 5 and one open-ended question, to evaluate: access, gateway, trust, family focus, primary mental health interventions, mental health records, mental health problems, team collaboration, integration with community resources and primary mental health education. Two comparisons were made: health managers and professionals' (Mann-Whitney non-parametric test) and health managers' perceptions (Kruskall-Wallis non parametric-test) in 4 service designs (General Traditional Outpatients, Mental Health Specialised Outpatients, Psychosocial Community Centre and Family Health Strategy)(SPSS version 17.0). Qualitative data were subjected to Framework Analysis. Firstly, health managers and professionals' perceptions converged in all components, except the health record system. Secondly, managers' perceptions in traditional services contrasted with managers' perceptions in community-based services in components such as mental health interventions and team collaboration, and converged in gateway, trust, record system and primary mental health education. Qualitative data revealed an acceptance of mental health and primary care integration, but a lack of communication between institutions. The Mixed Method demonstrated that interviewees consider mental health and primary care integration as a requirement of the system, while their perceptions and the model of work produced by the institutional culture are inextricably linked. There is a gap between health managers' and professionals' understanding of community-based primary mental health care. The integration of different processes of work entails both rethinking workforce actions and institutional support to help make changes.

Hybrid-optimization algorithm for the management of a conjunctive-use project and well field design

USGS Publications Warehouse

Chiu, Yung-Chia; Nishikawa, Tracy; Martin, Peter

2012-01-01

Hi‐Desert Water District (HDWD), the primary water‐management agency in the Warren Groundwater Basin, California, plans to construct a waste water treatment plant to reduce future septic‐tank effluent from reaching the groundwater system. The treated waste water will be reclaimed by recharging the groundwater basin via recharge ponds as part of a larger conjunctive‐use strategy. HDWD wishes to identify the least‐cost conjunctive‐use strategies for managing imported surface water, reclaimed water, and local groundwater. As formulated, the mixed‐integer nonlinear programming (MINLP) groundwater‐management problem seeks to minimize water‐delivery costs subject to constraints including potential locations of the new pumping wells, California State regulations, groundwater‐level constraints, water‐supply demand, available imported water, and pump/recharge capacities. In this study, a hybrid‐optimization algorithm, which couples a genetic algorithm and successive‐linear programming, is developed to solve the MINLP problem. The algorithm was tested by comparing results to the enumerative solution for a simplified version of the HDWD groundwater‐management problem. The results indicate that the hybrid‐optimization algorithm can identify the global optimum. The hybrid‐optimization algorithm is then applied to solve a complex groundwater‐management problem. Sensitivity analyses were also performed to assess the impact of varying the new recharge pond orientation, varying the mixing ratio of reclaimed water and pumped water, and varying the amount of imported water available. The developed conjunctive management model can provide HDWD water managers with information that will improve their ability to manage their surface water, reclaimed water, and groundwater resources.

Hybrid-optimization algorithm for the management of a conjunctive-use project and well field design

USGS Publications Warehouse

Chiu, Yung-Chia; Nishikawa, Tracy; Martin, Peter

2012-01-01

Hi-Desert Water District (HDWD), the primary water-management agency in the Warren Groundwater Basin, California, plans to construct a waste water treatment plant to reduce future septic-tank effluent from reaching the groundwater system. The treated waste water will be reclaimed by recharging the groundwater basin via recharge ponds as part of a larger conjunctive-use strategy. HDWD wishes to identify the least-cost conjunctiveuse strategies for managing imported surface water, reclaimed water, and local groundwater. As formulated, the mixed-integer nonlinear programming (MINLP) groundwater-management problem seeks to minimize water delivery costs subject to constraints including potential locations of the new pumping wells, California State regulations, groundwater-level constraints, water-supply demand, available imported water, and pump/recharge capacities. In this study, a hybrid-optimization algorithm, which couples a genetic algorithm and successive-linear programming, is developed to solve the MINLP problem. The algorithm was tested by comparing results to the enumerative solution for a simplified version of the HDWD groundwater-management problem. The results indicate that the hybrid-optimization algorithm can identify the global optimum. The hybrid-optimization algorithm is then applied to solve a complex groundwater-management problem. Sensitivity analyses were also performed to assess the impact of varying the new recharge pond orientation, varying the mixing ratio of reclaimed water and pumped water, and varying the amount of imported water available. The developed conjunctive management model can provide HDWD water managers with information that will improve their ability to manage their surface water, reclaimed water, and groundwater resources.

PORTALS: design of an innovative approach to anticoagulation management through eHealth.

PubMed

Talboom-Kamp, E P W A; Verdijk, N A; Talboom, I J S H; Harmans, L M; Numans, M E; Chavannes, N H

2017-03-16

For the monitoring of International Normalized Ratio (INR) values, venous thromboembolism (VTE) and atrial fibrillation (AF) patients can visit anticoagulation clinics, laboratories, or physicians for venous puncture. Point-of-care testing (POCT) made it possible for patients to monitor INR themselves (self-monitoring) and even self-adjust their medication dosage (self-dosage). Both skills are accepted as forms of self-management. eHealth applications can improve this self-management, resulting in better clinical outcomes. Our study, called PORTALS, aims at identifying the optimal implementation strategy of training to improve self-management and explore factors that enhance good self-management skills. In addition, the relationship between the implementation strategy of training, clinical outcomes, and individual characteristics will be investigated. Of the 247 recruited participants, 110 chose to continue with regular care. 137 patients have been randomly divided in subgroups and compared using a parallel cohort design: one group will be trained and educated by e-learning, and the other group will receive face-to-face group training. More insight in factors that enhance good self-management will help to improve clinical outcomes and patient satisfaction on anticoagulation therapy. Our study will provide practical insights and knowledge of eHealth in daily practice and of the importance of education on the adoption of self-management. We expect the self-management program including training to help patients to better manage their own INR values and medication use, thereby increasing health status and diminishing thromboembolic events and hospitalisation. The Netherlands National Trial Register, number NTR3947 .

The effect of web quest and team-based learning on students’ self-regulation

PubMed Central

BADIYEPEYMAIE JAHROMI, ZOHREH; MOSALANEJAD, LEILI; REZAEE, RITA

2016-01-01

Introduction In this study, the authors aimed to examine the effects of cooperative learning methods using Web Quest and team-based learning on students’ self-direction, self-regulation, and academic achievement. Method This is a comparative study of students taking a course in mental health and psychiatric disorders. In two consecutive years, a group of students were trained using the WebQuest approach as a teaching strategy (n = 38), while the other group was taught using team-based learning (n=39). Data gathering was based on Guglielmino’s self-directed learning readiness scale (SDLRS) and Buford’s self-regulation questionnaire. The data were analyzed by descriptive test using M (IQR), Wilcoxon signed-rank test, and the Mann–Whitney U-test in SPSS software, version 13. p<0.05 was considered as the significance level. Results The results of the Mann–Whitney U test showed that the participants’ self- directed (self-management) and self-regulated learning differed between the two groups (p=0.04 and p=0.01, respectively). Wilcoxon test revealed that self-directed learning indices (self-control and self-management) were differed between the two strategies before and after the intervention. However, the scores related to learning (students’ final scores) were higher in the WebQuest approach than in team-based learning. Conclusion By employing modern educational approaches, students are not only more successful in their studies but also acquire the necessary professional skills for future performance. Further research to compare the effects of new methods of teaching is required. PMID:27104202

Time management strategies for research productivity.

PubMed

Chase, Jo-Ana D; Topp, Robert; Smith, Carol E; Cohen, Marlene Z; Fahrenwald, Nancy; Zerwic, Julie J; Benefield, Lazelle E; Anderson, Cindy M; Conn, Vicki S

2013-02-01

Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

Evaluation of a rural chronic disease self-management program.

PubMed

Stone, Genevieve R; Packer, Tanya L

2010-01-01

Internationally, the prevalence of long-term health conditions is at epidemic proportions. Australia is no exception. The Australian Government's 'Better Health Initiative' has 5 key strategies to build better health care, one of which is the adoption of self-management and self-management support. Self-management allows people to manage their condition and the consequences it brings to their lives in partnership with their health providers. The purpose of this article was to report both the process and patient outcomes following the introduction of the Stanford Chronic Disease Self-Management Program (CDSMP) into an existing service in an Australian rural setting. Implementation processes were evaluated using semi-structured interviews conducted with managers, lay and health professional course leaders and participants about positive and negative aspects of providing the CDSMP. Participant outcomes were evaluated using a modified pre-test, post-test design to evaluate changes in activity participation and self-management knowledge and skills. Both negative and positive aspects of providing the program were represented by two key themes: (1) program content and quality; and (2) logistics of delivery. Throughout the interviews, managers and leaders, and course participants offered recommendations that were thematically grouped into 3 categories: (1) enhancing quality; (2) improving the logistics; and (3) providing resources. Comparison of activity levels with a community sample indicated that participants had significantly decreased participation levels. Scores on the Health Education Impact Questionnaire v2 (heiQ - RETRO) demonstrated statistically better scores at post-test on the domains of 'self monitoring', 'insight' and 'health service navigation' with a trend towards significance on 3 other domains. Future implementation of CDSMPs in rural areas will be encouraged by these patient outcomes, and informed by the qualitative findings from managers, leaders and course participants.

Bereaved adults' evaluations of grief management messages: effects of message person centeredness, recipient individual differences, and contextual factors.

PubMed

Rack, Jessica J; Burleson, Brant R; Bodie, Graham D; Holmstrom, Amanda J; Servaty-Seib, Heather

2008-01-01

This study identifies grief management strategies that bereaved adults evaluate as more and less helpful, assesses whether the person centeredness of these strategies explains their helpfulness, and determines whether strategy helpfulness varies as a function of demographic, personality, and situational factors. Participants (105 bereaved young adults) assessed the helpfulness of 16 grief management strategies; these strategies were coded for their degree of person centeredness. Strategy person centeredness was strongly correlated with helpfulness. Strategy helpfulness varied as a function of participant gender and the disruptiveness of the decedent's death, but not as a function of need for cognition or decedent closeness.

Flight Crew Task Management in Non-Normal Situations

NASA Technical Reports Server (NTRS)

Schutte, Paul C.; Trujillo, Anna C.

1996-01-01

Task management (TM) is always performed on the flight deck, although not always explicitly, consistently, or rigorously. Nowhere is TM as important as it is in dealing with non-normal situations. The objective of this study was to analyze pilot TM behavior for non-normal situations. Specifically, the study observed pilots performance in a full workload environment in order to discern their TM strategies. This study identified four different TM prioritization and allocation strategies: Aviate-Navigate-Communicate-Manage Systems; Perceived Severity; Procedure Based; and Event/Interrupt Driven. Subjects used these strategies to manage their personal workload and to schedule monitoring and assessment of the situation. The Perceived Severity strategy for personal workload management combined with the Aviate-Navigate-Communicate-Manage Systems strategy for monitoring and assessing appeared to be the most effective (fewest errors and fastest response times) in responding to the novel system failure used in this study.

Nursing contributions to chronic disease management in primary care.

PubMed

Lukewich, Julia; Edge, Dana S; VanDenKerkhof, Elizabeth; Tranmer, Joan

2014-02-01

As the prevalence of chronic diseases continues to increase, emphasis is being placed on the development of primary care strategies that enhance healthcare delivery. Innovations include interprofessional healthcare teams and chronic disease management strategies. To determine the roles of nurses working in primary care settings in Ontario and the extent to which chronic disease management strategies have been implemented. We conducted a cross-sectional survey of a random sample of primary care nurses, including registered practical nurses, registered nurses, and nurse practitioners, in Ontario between May and July 2011. Nurses in primary care reported engaging in chronic disease management activities but to different extents depending on their regulatory designation (licensure category). Chronic disease management strategy implementation was not uniform across primary care practices where the nurses worked. There is the potential to optimize and standardize the nursing role within primary care and improve the implementation of chronic disease management strategies.

Heart failure patients' attitudes, beliefs, expectations and experiences of self-management strategies: a qualitative synthesis.

PubMed

Wingham, Jennifer; Harding, Geoff; Britten, Nicky; Dalal, Hayes

2014-06-01

To develop a model of heart failure patients' attitudes, beliefs, expectations, and experiences based on published qualitative research that could influence the development of self-management strategies. A synthesis of 19 qualitative research studies using the method of meta-ethnography. This synthesis offers a conceptual model of the attitudes, beliefs, and expectations of patients with heart failure. Patients experienced a sense of disruption before developing a mental model of heart failure. Patients' reactions included becoming a strategic avoider, a selective denier, a well-intentioned manager, or an advanced self-manager. Patients responded by forming self-management strategies and finally assimilated the strategies into everyday life seeking to feel safe. This conceptual model suggests that there are a range of interplaying factors that facilitate the process of developing self-management strategies. Interventions should take into account patients' concepts of heart failure and their subsequent reactions.

What's your strategy for managing knowledge?

PubMed

Hansen, M T; Nohria, N; Tierney, T

1999-01-01

The rise of the computer and the increasing importance of intellectual assets have compelled executives to examine the knowledge underlying their businesses and how it is used. Because knowledge management as a conscious practice is so young, however, executives have lacked models to use as guides. To help fill that gap, the authors recently studied knowledge management practices at management consulting firms, health care providers, and computer manufacturers. They found two very different knowledge management strategies in place. In companies that sell relatively standardized products that fill common needs, knowledge is carefully codified and stored in databases, where it can be accessed and used--over and over again--by anyone in the organization. The authors call this the codification strategy. In companies that provide highly customized solutions to unique problems, knowledge is shared mainly through person-to-person contacts; the chief purpose of computers is to help people communicate. They call this the personalization strategy. A company's choice of knowledge management strategy is not arbitrary--it must be driven by the company's competitive strategy. Emphasizing the wrong approach or trying to pursue both can quickly undermine a business. The authors warn that knowledge management should not be isolated in a functional department like HR or IT. They emphasize that the benefits are greatest--to both the company and its customers--when a CEO and other general managers actively choose one of the approaches as a primary strategy.

The English Teacher's Survival Guide: Ready-To-Use Techniques & Materials for Grades 7-12. 2nd Edition

ERIC Educational Resources Information Center

Brandvik, Mary Lou; McKnight, Katherine S.

2011-01-01

This unique time-saving book is packed with tested techniques and materials to assist new and experienced English teachers with virtually every phase of their job from lesson planning to effective discipline techniques. The book includes 175 easy-to-understand strategies, lessons, checklists, and forms for effective classroom management and over…

Talking to Score: Impression Management in L2 Oral Assessment and the Co-Construction of a Test Discourse Genre

ERIC Educational Resources Information Center

Luk, Jasmine

2010-01-01

In recent years, the emphasis in second language (L2) oral proficiency assessment has shifted from linguistic accuracy to discourse strategies such as the ability to initiate, respond, and negotiate meaning. This has resulted in a growing interest in the discourse analysis of students' performance in different oral proficiency assessment formats.…

Thinning effects on foliar elements in eastern hemlock: implications for managing the spread of the hemlock woolly adelgid

Treesearch

Kathryn B. Piatek; Mary Ann Fajvan; Richard M. Turcotte

2017-01-01

Stand thinning is being tested as a means to limit the impacts of the invasive hemlock woolly adelgid (HWA; Adelges tsugae Annand) on eastern hemlock (Tsuga canadensis (L.) Carriere). The efficacy of this strategy may be reduced if thinning increases hemlock foliar nutrients because HWA densities are correlated with foliar...

Teaching a Cognitive Behavioral Strategy to Manage Emotions Rational Emotive Behavior Therapy in an Educational Setting

ERIC Educational Resources Information Center

Banks, Tachelle; Zionts, Paul

2009-01-01

The academic and social challenges facing public schools are enormous. For example, the pressure to meet the demands of the current high-stakes testing environment and reach adequate yearly progress (AYP) goals has arguably never been greater (Luna & Turner, 2001; Sanders, 2003). The energy devoted to academics has supplanted the little time spent…

A Global Space Control Strategy

DTIC Science & Technology

2014-12-01

ASAT testing and development before significant pushback is enacted. Further, a growing body of literature suggests that space-based intelligence...management process must be the foundation of plan- ning space operations and responses. Second, we must realize that in order to conduct effective space...end state where commanders considering multiple courses of action have a sensor architecture and a tasking, collection, processing , exploitation, and

Using Computers in the Classroom To Promote Generative Strategies for Reading Comprehension.

ERIC Educational Resources Information Center

Brown, Carol A.

Reading management programs have become very popular in elementary schools. Students select a title from a prescribed reading list, then are tested for recall of facts and events in the story. Students are motivated to read as many titles as possible since they must achieve a certain score to win prizes. Although there have been reports that this…

Prevalence of self-management versus formal service use for common mental disorders in Australia: findings from the 2007 National Survey of Mental Health and Wellbeing.

PubMed

Olesen, Sarah C; Butterworth, Peter; Leach, Liana

2010-09-01

To determine the proportion of Australian adults who use non-practitioner led support services and self-management strategies for common mental disorders. Data were drawn from the 2007 National Survey of Mental Health and Wellbeing, a representative survey of 8841 Australian adults aged 16 to 85 years. This survey included the Composite International Diagnostic Instrument to obtain diagnosis of International Classification of Diseases (Version 10; ICD-10) mental disorders. Information about consultations with health professionals for mental health problems and the use of support services and self-management strategies was also collected. Half of all adults who met the criteria for an affective or anxiety disorder in the last 12 months reported using non-practitioner led support services and/or self-management strategies for their mental health problems. Six per cent used support services, including Internet and non-online support groups and telephone counselling, and 51.9% used self-management strategies such as doing 'more of the things you enjoy' to 'help deal with' their mental health problems. Of people with a 12-month common mental disorder, 24% used support services and/or self-management strategies without additional formal services; 29.3% used both. Of adults with a 12-month affective or anxiety disorder, 37% used neither formal services nor self-management strategies. A substantial proportion of people who reported using self-management strategies for their mental health did not have a diagnosable affective or anxiety disorder. The use of non-practitioner led support services and self-management strategies for mental health problems, with and without adjunct use of formal health services, is widespread in Australia. Future research is needed to investigate why people may select these strategies over formal services, or whether self-management reflects the presence of barriers to use of formal services.