middle level managers: Topics by Science.gov

Sample records for middle level managers

Leader behavior and its relationship to senior and middle marketing and production managers in a leading energy resources company

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

Bernheim, S.R.

1985-01-01

This study is an investigation of rated leader behavior at Sun Company, Inc. as it relates to the situational determinants of: (a) managers' level in the authority hierarchy and (b) function of the department. In order to assess if the leadership behaviors of Sun Company, Inc.'s senior - and middle-level managers in the marketing and production functions are distinct, 110 high potential managers were selected to administer Yukl's Managerial Behavior (MBS) to at least 4 of their subordinates who had been reporting to them for 3 months or more. Factor analysis reduced Yukl's 115 questionnaire items to 10 meaningful andmore » reliable components of managerial behavior for the sample. Next, discriminant analysis combined the 10 components of managerial behavior in a way that separated the sample into 4 groups based on different managerial behaviors, including: (a) middle level marketing managers, (b) senior level marketing managers, (c) middle level production managers, and (d) senior level production managers. Analysis of variance determined that middle level production managers trained and coached significantly more than senior level marketing managers, and middle level marketing managers showed a tendency to facilitate cooperation and teamwork more than senior level production managers. In general, the study suggests that Yukl's MBS portrays ab leader behavior taxonomy that, if simplified, can still capture diversity of specific managerial roles and activities.« less
Nurse middle manager ethical dilemmas and moral distress.

PubMed

Ganz, Freda D; Wagner, Nurit; Toren, Orly

2015-02-01

Nurse managers are placed in a unique position within the healthcare system where they greatly impact upon the nursing work environment. Ethical dilemmas and moral distress have been reported for staff nurses but not for nurse middle managers. To describe ethical dilemmas and moral distress among nurse middle managers arising from situations of ethical conflict. The Ethical Dilemmas in Nursing-Middle Manager Questionnaire and a personal characteristics questionnaire were administered to a convenience sample of middle managers from four hospitals in Israel. Middle managers report low to moderate levels of frequency and intensity of ethical dilemmas and moral distress. Highest scores were for administrative dilemmas. Middle managers experience lower levels of ethical dilemmas and moral distress than staff nurses, which are irrespective of their personal characteristics. Interventions should be developed, studied, and then incorporated into institutional frameworks in order to improve this situation. © The Author(s) 2014.
The effect of structural empowerment and perceived organizational support on middle level nurse managers' role satisfaction.

PubMed

Patrick, Allison; Laschinger, Heather K Spence

2006-01-01

The restructuring of Canadian health care organizations during the past decade has reduced the visibility of nursing leadership. This has resulted in job conditions that have disempowered nurse managers and influenced their ability to create positive work environments, mentor potential nurse leaders, and gain satisfaction in the leadership role. These conditions threaten the retention of a cadre of high quality nurse leaders in today's chaotic health care setting. The purpose of this study was to examine the relationship between structural empowerment and perceived organizational support and the effect of these factors on the role satisfaction of middle level nurse managers. A secondary analysis was conducted as part of a larger study of 126 middle level nurse managers working in Canadian acute care hospitals, randomly selected from the Ontario provincial registry. Eighty-four nurse managers responded to a questionnaire mailed to their home addresses. Structural empowerment was positively associated with middle level nurse managers' perceived organizational support. The combination of empowerment and perceptions of organizational support were significant predictors of middle level nurse managers' role satisfaction. The findings support R.M. Kanter's (1977, 1993; Men and Women of the Corporation. Basic Books, New York) contention that empowering work conditions have an impact on employees' feelings of support and sense of accomplishment at work. Positive perceptions of organizational support may play an important role in retaining current middle managers, and possibly attracting future leaders to management positions.
What makes a hospital manager competent at the middle and senior levels?

PubMed

Liang, Zhanming; Leggat, Sandra G; Howard, Peter F; Koh, Lee

2013-11-01

The purpose of this paper is to confirm the core competencies required for middle to senior level managers in Victorian public hospitals in both metropolitan and regional/rural areas. This exploratory mixed-methods study used a three-step approach which included position description content analysis, focus group discussions and online competency verification and identification survey. The study validated a number of key tasks required for senior and middle level hospital managers (levels II, III and IV) and identified and confirmed the essential competencies for completing these key tasks effectively. As a result, six core competencies have been confirmed as common to the II, III and IV management levels in both the Melbourne metropolitan and regional/rural areas. Six core competencies are required for middle to senior level managers in public hospitals which provide guidance to the further development of the competency-based educational approach for training the current management workforce and preparing future health service managers. With the detailed descriptions of the six core competencies, healthcare organisations and training institutions will be able to assess the competency gaps and managerial training needs of current health service managers and develop training programs accordingly.
Leading in Middle Management in Higher Education

ERIC Educational Resources Information Center

Pepper, Coral; Giles, Wendy

2015-01-01

In this article we discuss the experiences of academics who occupy middle-level leadership roles in higher education. We use the term middle management to describe personnel occupying positions below the level of dean and often referred to as associate deans or heads of school. Practitioners rarely turn their attention to their own organizations,…
Key Words for New Managers.

ERIC Educational Resources Information Center

Kim, Taeock; Isaac, Frederick

This paper briefly describes the effects of changes instituted by new library administrators and discusses the roles of both upper and middle level library managers in the process of adapting to change. Suggestions based on the experience of the authors as new middle level managers at a time when extensive changes were occurring in a university…
Leadership Provided by Non-Academic Middle-Level Managers in the Australian Higher Education Sector: The Enablers

ERIC Educational Resources Information Center

Vilkinas, Tricia

2014-01-01

This study seeks to identify the leadership behaviours displayed by non-academic middle-level managers in the Australian higher education sector. The study also identifies the importance of these leadership behaviours and the leadership effectiveness of these managers. The integrated competing values framework was used to measure leadership…
Middle-Level Academic Management: A Case Study on the Roles of the Heads of Department at a Vietnamese University

ERIC Educational Resources Information Center

Nguyen, Thi Lan Huong

2013-01-01

Middle-level academic managers play a central role in university management; however, their roles are not always clear and straightforward. Although this research subject has been comprehensively investigated in the last 40 years, most studies are western-biased. This study examines the roles of Heads of Department in a newly established…
The impact of middle manager affective commitment on perceived improvement program implementation success.

PubMed

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

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

ERIC Educational Resources Information Center

Beresford, Richard; Michels, Nicolette

2014-01-01

This article assesses the role that middle managers play in creating and sustaining entrepreneurial institutions. To date little is known about this role, with attention favouring a more macro-level, top-down focus on institutional leaders, and/or a micro-level, bottom-up focus on individual enterprise champions. This focus on unidirectional…
Middle Level Managers' Quality of Leadership and Good Governance, and Organizational Performance of Wolaita Sodo University

ERIC Educational Resources Information Center

Shibru, Sintayehu; Bibiso, Mesfin; Ousman, Kedir

2017-01-01

The purpose of this study was to investigate the relationship between middle level managers' quality of leadership and good governance, and organization performance of Wolaita Sodo University. The study employed descriptive survey method and used quantitative approach. College/school Deans, Department heads and Coordinators were source of data.…
Implementing complex innovations: factors influencing middle manager support.

PubMed

Chuang, Emmeline; Jason, Kendra; Morgan, Jennifer Craft

2011-01-01

Middle manager resistance is often described as a major challenge for upper-level administrators seeking to implement complex innovations such as evidence-based protocols or new skills training. However, factors influencing middle manager support for innovation implementation are currently understudied in the U.S. health care literature. This article examined the factors that influence middle managers' support for and participation in the implementation of work-based learning, a complex innovation adopted by health care organizations to improve the jobs, educational pathways, skills, and/or credentials of their frontline workers. We conducted semistructured interviews and focus groups with 92 middle managers in 17 health care organizations. Questions focused on understanding middle managers' support for work-based learning as a complex innovation, facilitators and barriers to the implementation process, and the systems changes needed to support the implementation of this innovation. Factors that emerged as influential to middle manager support were similar to those found in broader models of innovation implementation within the health care literature. However, our findings extend previous research by developing an understanding about how middle managers perceived these constructs and by identifying specific strategies for how to influence middle manager support for the innovation implementation process. These findings were generally consistent across different types of health care organizations. Study findings suggest that middle manager support was highest when managers felt the innovation fit their workplace needs and priorities and when they had more discretion and control over how it was implemented. Leaders seeking to implement innovations should consider the interplay between middle managers' control and discretion, their narrow focus on the performance of their own departments or units, and the dedication of staff and other resources for empowering their managers to implement these complex innovations.
Instructional Leadership in Missouri: A Study of Middle-Level Building Principals and Student Achievement

ERIC Educational Resources Information Center

Carson, Craig L.

2013-01-01

The purpose of this descriptive study was to describe Missouri middle-level school principals' perceptions of their instructional leadership practices. The Principal Instructional Management Rating Scale (PIMRS) by Philip Hallinger was used to define the measured leadership tasks (www.philiphallinger.com). There were a total of 77 middle-level…
The middle manager role in energy company environmental efforts

NASA Astrophysics Data System (ADS)

Fischhoff, Maya E.

2005-12-01

This research examines the internal organizational processes determining corporate environmental action. Corporations have a tremendous environmental impact, yet relatively little is known about how employees within them view and work on these issues. The research focused on middle managers, a level of the company whose value is often questioned. Interviews were conducted with 70 middle managers at two energy companies (comprising utilities and unregulated businesses). Interviews examined the shape and significance of middle manager involvement in environmental issues, looking specifically at what issues middle managers deal with, what goals they pursue, and what approaches they use. The research finds middle managers' roles with respect to environmental issues to be far-reaching and complex. Much of their effort is focused on meeting regulatory requirements ("complying"). They are committed to compliance, in part for ethical reasons, but often find regulations frustrating and costly. Compliance is more challenging than commonly thought; it demands time, knowledge, and substantial creativity. In pursuing it, interviewees work with employees throughout the organization. This research shows middle managers interacting with those hierarchically above and below them in ways that greatly modify earlier portrayals of middle managers. Earlier portrayals often emphasized struggles for power within the organization. Here, middle managers work in ways best characterized as collaborative and supportive. Middle managers also have extensive involvement laterally within the company and with groups outside the company. These links have received modest attention in literature, yet are found to be terribly important. Middle managers' lateral efforts inside the company, often on teams, allow diverse expertise (e.g., from people in different functions) to be applied to environmental issues. Documenting middle managers' involvement externally, with governmental officials and sectors of the public, illuminates areas of very visible corporate impact. External interactions are also settings in which middle managers encounter alternative views about environmental issues. The study reveals the importance of middle managers in the challenge of environmental compliance. It provides knowledge that can be used by external entities seeking to connect with companies, and by companies seeking to address environmental issues better. It thus aids understanding of a critical societal challenge and opportunity.
Nurse middle managers contributions to patient-centred care: A 'managerial work' analysis.

PubMed

Lalleman, Pcb; Smid, Gac; Dikken, J; Lagerwey, M D; Schuurmans, M J

2017-10-01

Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between "organizing work" and "caring work" is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both "hands-on" and "heads-on" caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate "doings" of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work. © 2017 John Wiley & Sons Ltd.
The Career Development and Aspirations of Women in Middle-Level Management Positions in Business Firms.

ERIC Educational Resources Information Center

Wentling, Rose Mary

1992-01-01

According to interviews with 30 women in middle management, 4 factors pertinent to their success were educational credentials, hard work, mentors, and interpersonal skills. Barriers to career development were supervisors/directors, sex discrimination, lack of political savvy, and lack of career strategy. (SK)
Roles, skills, and competencies of middle managers in occupational therapy.

PubMed

Guo, Kristina L; Calderon, Ana

2007-01-01

This article describes the most essential roles, skills, and competencies needed by middle managers in occupational therapy organizations. Middle-level managers are responsible for a specific segment of the organization. They are uniquely positioned to foster changes in the department. Because of the challenges in the health care environment, it is important to discuss the roles that middle managers need to bring out the viability and growth of their departments and organization. These roles include planner, strategic planner, coordinator, leader, problem solver, and negotiator. To conduct these roles, skills and competencies that are closely linked to the effective performance of those roles are also described. Skills include human relations, marketing, and conceptual skills. Competencies include being able to manage attention, meaning, trust, and self, as well as being competent when conducting utilization reviews, program evaluations, documentation of services for quality and reimbursement purposes, and fiscal management. With these outlined roles, skills, and competencies, middle managers should be able to promote the mission of their organizations, support their employees, and navigate successfully in the competitive and ever-changing health care environment.
Management assessment : implications for development and training.

DOT National Transportation Integrated Search

1990-01-01

Training needs of first level, middle level, and upper level managers within the Federal Aviation Administration (FAA) were assessed through the analysis of two current agency surveys: the bienniel Job Satisfaction Survey and the new, annual Survey-F...
Human Resources in the Library System. Course 2, Study Guide. Final Report, Phase 2, Post-Master's Education for Middle and Upper-Level Personnel in Libraries and Information Centers.

ERIC Educational Resources Information Center

Goodman, Charles H.; Stone, Elizabeth W.

A study guide is presented for a course designed for the continuing education of professional librarians at the level of middle or upper management who find that they need understanding about human resources in the library system beyond that acquired on the job or in previous library education. The course has four units: (1) Management: A Systems…
Motivating middle managers. How to develop their mission potential.

PubMed

Parsons, R J; Rock, K; Hutcheson, O M; Nelson, D

1989-12-01

Today's unstable healthcare environment is prompting not-for-profit hospitals to explore ways to preserve a fading altruistic posture. Holy Cross Hospital, Salt Lake City, sees middle management as a key to preserving a mission-oriented commitment to the delivery of healthcare. It is tapping the potential of its middle managers through a specialized management development program linked to mission objectives that attempts to assess and enhance individual abilities. The hospital formed a management development committee to identify several managerial characteristics that could have the greatest positive impact on preserving the hospital's mission objectives. The committee identified six major categories for focus: mission and philosophy; leadership style and influence; staffing, coaching, and developing employees; implementation functions; decision-making functions; and quality assurance issues. The hospital developed a self-assessment questionnaire for middle managers. As a self-evaluation tool, the questionnaire may not accurately represent each manager's specific level of knowledge, but it shows each manager's perceived needs and provides a basis for the development of instructional resources. It has also been useful in raising managers' consciousness of their performance.

Human Resources in the Library System. Course 2, Leader's Handbook, Part 1: Designs for Learning. Final Report, Phase 2, Post-Master's Education for Middle and Upper-Level Personnel in Libraries and Information Centers.

ERIC Educational Resources Information Center

Goodman, Charles H.; Stone, Elizabeth W.

A leader's handbook is presented for a course designed for the continuing education of professional librarians at the level of middle or upper management who find that they need understanding about human resources in the library system beyond that acquired on the job or in previous library education. The course has four units: (1) Management: A…
Sense of community, organizational commitment and quality of services.

PubMed

Lampinen, Mai-Stiina; Suutala, ElinaAnnikki; Konu, Anne Irmeli

2017-10-02

Purpose The purpose of this paper is to examine how factors associated with a sense of community in the workplace are connected with organizational commitment and the quality of services among frontline managers and middle managers in social and health care services in Finland. Design/methodology/approach A questionnaire designed specifically for this research was sent to 241 lower-level and middle-level managers in social and health care services in central Finland. A total of 136 managers completed the questionnaire (response rate 56 per cent). The results were analyzed using descriptive statistics, exploratory factor analysis, Spearman's rank-order correlation coefficient and multiple linear regression analyses. Findings The study showed that feeling a sense of belonging, mutual trust and appreciation, and open interaction among colleagues were connected to organizational commitment for frontline managers and middle managers in social and health care services in Finland. Correspondingly, an open flow of information in the organization, job meaningfulness and appreciation received from managers' superiors were connected to the quality of services. Originality/value This study provides information on the factors that influence social and health care managers' organizational commitment and on items connected to their experience of the quality of services.
Democratic Leadership in Middle Schools of Chihuahua Mexico: Improving Middle Schools through Democracy

ERIC Educational Resources Information Center

Delgado, Manuel Lopez

2014-01-01

The purpose of this study was to analyse the effects of the implementation of a democratic approach to lead and manage middle schools in Chihuahua, Mexico. This research was based on a Likert questionnaire and semistructured interviews to explore the level of involvement of students, teachers, and parents in schools participating in a programme…
A Lesson for American Managers: Learning from Japanese Experiences in the U.S.

ERIC Educational Resources Information Center

Nosow, Sigmund

1984-01-01

Research finds that, in Japanese-owned plants in America, efforts are made to bring the system around slowly to a Japanese management style through acculturation, communication, and training. Problems engendered by these efforts emerge particularly at the middle management levels. Barriers to corporate unity are far fewer at the plant level. (CT)
The influence of leadership practices and empowerment on Canadian nurse manager outcomes.

PubMed

Spence Laschinger, Heather K; Wong, Carol A; Grau, Ashley L; Read, Emily A; Pineau Stam, Lisa M

2012-10-01

To examine the influence of senior nurse leadership practices on middle and first-line nurse managers' experiences of empowerment and organizational support and ultimately on their perceptions of patient care quality and turnover intentions. Empowering leadership has played an important role in staff nurse retention but there is limited research to explain the mechanisms by which leadership influences nurse managers' turnover intentions. This study was a secondary analysis of data collected using non-experimental, predictive mailed survey design. Data from 231 middle and 788 first-line Canadian acute care managers was used to test the hypothesized model using path analysis in each group. The results showed an adequate fit of the hypothesized model in both groups but with an added path between leadership practices and support in the middle line group. Transformational leadership practices of senior nurses empower middle- and first-line nurse managers, leading to increased perceptions of organizational support, quality care and decreased intent to leave. Empowered nurse managers at all levels who feel supported by their organizations are more likely to stay in their roles, remain committed to achieving quality patient care and act as influential role models for potential future leaders. © 2011 Blackwell Publishing Ltd.
Focus on training at CAFS.

PubMed

Azorbo, S; Muna, C

1993-01-01

The training and technical assistance programs of the Center for African Family Studies (CAFS), which is part of the International Planned Parenthood Federation for the African Region, were described. Programs included service delivery, management development, family life education, family planning communication, and research monitoring and evaluation. Several courses were offered: a week-long contraceptive technology update course for trainers and supervisors of family planning programs. Management training needs were filled through a 6-week middle level management course, a 2-week senior level management course, a 4-week community based family planning program course, a 6-week financial management of family planning and reproductive health programs course, and a 5-week course in leadership skills for management of women and health programs. Family life education courses were offered under the CAFS Women and Health Program for teachers, curriculum developers, youth leaders, and those working with young people for 3 weeks. Course issues of discussion included population and development, the family in contemporary African life, and policy legislation and laws to promote young people's health and social psychological and ethical aspects of adolescent sexuality. Family planning communication training programs were directed to strengthening IEC knowledge and skills over a 4-week period for senior and middle level personnel. The 3-week press course aimed to train journalists in print and electronic media for French-speaking countries who could gain cover population and family planning issues. The family planning research and evaluation course over 4 weeks aimed to increase the knowledge and skills of health personnel in project design, implementation, monitoring, and evaluation, in order to conduct assessment of program effectiveness. The course was directed to senior and middle level manager researchers, population project directors, and personnel of women-centered projects.
Business Ownership and Management.

ERIC Educational Resources Information Center

Kaser, Ken, Ed.

1991-01-01

Includes five articles: "Women in Management" (Zimmerer); "Business Boot Camp (interviews with young entrepreneurs)" (Kaser); "Plan Your Own Business Project" (Kohns); "Business Education and the Middle Level Student" (Patterson, Leblanc); and "Small Business Ownership Planning" (Fiber). (SK)
Human resources management and firm performance: The differential role of managerial affective and continuance commitment.

PubMed

Gong, Yaping; Law, Kenneth S; Chang, Song; Xin, Katherine R

2009-01-01

In this study, the authors developed a dual-concern (i.e., maintenance and performance) model of human resources (HR) management. The authors identified commonly examined HR practices that apply to the middle manager level and classified them into the maintenance- and performance-oriented HR subsystems. The authors found support for the 2-factor model on the basis of responses from 2,148 managers from 463 firms operating in China. Regression results indicate that the performance-oriented HR subsystems had a positive relationship with firm performance and that the relationship was mediated by middle managers' affective commitment to the firm. The maintenance-oriented HR subsystems had a positive relationship with middle managers' continuance commitment but not with their affective commitment and firm performance. This study contributes to the understanding of how HR practices relate to firm performance and offers an improved test of the argument that valuable and firm-specific HR provide a source of competitive advantage. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Problem Solving and the Development of Expertise in Management.

ERIC Educational Resources Information Center

Lash, Fredrick B.

This study investigated novice and expert problem solving behavior in management to examine the role of domain specific knowledge on problem solving processes. Forty-one middle level marketing managers in a large petrochemical organization provided think aloud protocols in response to two hypothetical management scenarios. Protocol analysis…
Development of a competency framework for nurse managers in Ireland.

PubMed

McCarthy, Geraldine; Fitzpatrick, Joyce J

2009-08-01

This article describes the results of an Irish national study on the Competency Model for Nursing Management commissioned by the Office of Health Management. More than 300 nurse managers and 80 service stakeholders (other professionals, managers, and service colleagues) participated in the development of generic competencies for nurse managers and specific competencies for three levels of managers-director level, middle manager level, and front-line managers. Examples of behavioral indicators (both positive and negative) for each competency level also have been delineated. Future efforts are being directed toward evaluating the usefulness of the competency model for assessing readiness to manage among job applicants, implementation of continuing education programs for nurse managers, and overall career development and planning. Copyright 2009, SLACK Incorporated.
Supporting Teachers' Management of Middle School Social Dynamics: The Scouting Report Process

ERIC Educational Resources Information Center

Farmer, Thomas W.; Chen, Chin-Chih; Hamm, Jill V.; Moates, Meredith M.; Mehtaji, Meera; Lee, David; Huneke, Michelle R.

2016-01-01

This describes the "scouting report" as an approach that social and behavior intervention specialists can use to help middle-level teachers create social contexts that support productive social roles and relationships of students with disabilities. Building from research on early adolescent social dynamics and context-based interventions…
Planning for the Business of Education.

ERIC Educational Resources Information Center

Nutt, Andy

There are two levels of planning: strategic and operational. Strategic planning takes place at the upper levels of management and relates to the longrange objectives of an organization. Operational planning takes place at the middle, or lower, management echelon and deals with the implementation of strategic plans. It is the task of the chief…
Role of Social Media in Diabetes Management in the Middle East Region: Systematic Review

PubMed Central

2018-01-01

Background Diabetes is a major health care burden in the Middle East region. Social networking tools can contribute to the management of diabetes with improved educational and care outcomes using these popular tools in the region. Objective The objective of this review was to evaluate the impact of social networking interventions on the improvement of diabetes management and health outcomes in patients with diabetes in the Middle East. Methods Peer-reviewed articles from PubMed (1990-2017) and Google Scholar (1990-2017) were identified using various combinations of predefined terms and search criteria. The main inclusion criterion consisted of the use of social networking apps on mobile phones as the primary intervention. Outcomes were grouped according to study design, type of diabetes, category of technological intervention, location, and sample size. Results This review included 5 articles evaluating the use of social media tools in the management of diabetes in the Middle East. In most studies, the acceptance rate for the use of social networking to optimize the management of diabetes was relatively high. Diabetes-specific management tools such as the Saudi Arabia Networking for Aiding Diabetes and Diabetes Intelligent Management System for Iraq systems helped collect patient information and lower hemoglobin A1c (HbA1c) levels, respectively. Conclusions The reviewed studies demonstrated the potential of social networking tools being adopted in regions in the Middle East to improve the management of diabetes. Future studies consisting of larger sample sizes spanning multiple regions would provide further insight into the use of social media for improving patient outcomes. PMID:29439941
Physical therapists' role in prevention and management of patellar tendinopathy injuries in youth, collegiate, and middle-aged indoor volleyball athletes

PubMed Central

Kulig, Kornelia; Noceti-DeWit, Lisa M.; Reischl, Stephen F.; Landel, Rob F.

2015-01-01

Patellar tendinopathy is highly prevalent in all ages and skill levels of volleyball athletes. To illustrate this, we discuss the clinical, biomechanical, and ultrasound imaging presentation and the intervention strategies of three volleyball athletes at different stages of their athletic career: youth, middle-aged, and collegiate. We present our examination strategies and interpret the data collected, including visual movement analysis and dynamics, relating these findings to the probable causes of their pain and dysfunction. Using the framework of the EdUReP concept, incorporating Education, Unloading, Reloading, and Prevention, we propose intervention strategies that target each athlete's specific issues in terms of education, rehabilitation, training, and return to sport. This framework can be generalized to manage patellar tendinopathy in other sports requiring jumping, from youth to middle age, and from recreational to elite competitive levels. PMID:26537811
"What We're Doing, We Do Musically": Leading and Managing Music in Secondary Schools

ERIC Educational Resources Information Center

Harvey, Janet A.; Beauchamp, Gary

2005-01-01

In English schools, many responsibilities have been delegated downwards to "middle level leaders". National standards for subject leadership assume that middle leadership skills are generic and the literature largely agrees with this view. This article presents data from the first pilot enquiry within ARTSLAMP (Arts Leadership and…
Leading and lagging indicators of occupational health and safety: The moderating role of safety leadership.

PubMed

Sheehan, Cathy; Donohue, Ross; Shea, Tracey; Cooper, Brian; Cieri, Helen De

2016-07-01

In response to the call for empirical evidence of a connection between leading and lagging indicators of occupational health and safety (OHS), the first aim of the current research is to consider the association between leading and lagging indicators of OHS. Our second aim is to investigate the moderating effect of safety leadership on the association between leading and lagging indicators. Data were collected from 3578 employees nested within 66 workplaces. Multi-level modelling was used to test the two hypotheses. The results confirm an association between leading and lagging indicators of OHS as well as the moderating impact of middle management safety leadership on the direct association. The association between leading and lagging indicators provides OHS practitioners with useful information to substantiate efforts within organisations to move away from a traditional focus on lagging indicators towards a preventative focus on leading indicators. The research also highlights the important role played by middle managers and the value of OHS leadership development and investment at the middle management level. Copyright © 2016 Elsevier Ltd. All rights reserved.
Executive Suite: Feminine Style.

ERIC Educational Resources Information Center

Lynch, Edith M.

The author provides the reader an "inside look" at women's role in management by selecting 95 women in management as a sample to gather research on women executives through questionnaires, personal talks, and formal interviews. Although the book is mainly about women in the middle/upper levels of management, coverage is given also to…
Capacity of middle management in health-care organizations for working with people—the case of Slovenian hospitals

PubMed Central

2013-01-01

Background Effective human resources management plays a vital role in the success of health-care sector reform. Leaders are selected for their clinical expertise and not their management skills, which is often the case at the middle-management level. The purpose of this study was to examine the situation in some fields that involve working with people in health-care organizations at middle-management level. Methods The study included eight state-owned hospitals in Slovenia. A cross-sectional study included 119 middle managers and 778 employees. Quota sampling was used for the subgroups. Structured survey questionnaires were administered to leaders and employees, each consisting of 24 statements in four content sets evaluated on a 5-point Likert-type scale. Respondents were also asked about the type and number of training or education programmes they had participated in over the last three years. Descriptive statistics, two-way analysis of variance, Pearson’s correlation coefficient and multiple linear regression were used. The study was conducted from March to December 2008. Results Statistically significant differences were established between leaders and employees in all content sets; no significant differences were found when comparing health-care providers and health-administration workers. Employment position was found to be a significant predictor for employee development (β = 0.273, P < 0.001), the leader–employee relationship (β = 0.291, P < 0.001) and organizational motivation (β = 0.258, P < 0.001). Area of work (β = 0.113, P = 0.010) and employment position (β = 0.389, P < 0.001) were significant predictors for personal involvement. Level of education correlated negatively with total scores for organizational motivation: respondents with a higher level of education were rated with a lower score (β = -0.117, P = 0.024). Health-care providers participate in management programmes less frequently than do health-administration workers. Conclusion Employee participation in change-implementation processes was low, as was awareness of the importance of employee development. Education of employees in Slovenian hospitals for leadership roles is still not perceived as a necessary investment for improving work processes. Hospitals are state owned and a national strategy should be developed on how to improve leadership and management in Slovenian hospitals. PMID:23663315
From strategy to action: how top managers' support increases middle managers' commitment to innovation implementation in health care organizations.

PubMed

Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J; Chin, Marshall H; Chiu, Michael; Schaefer, Cynthia T

2015-01-01

Evidence suggests that top managers' support influences middle managers' commitment to innovation implementation. What remains unclear is how top managers' support influences middle managers' commitment. Results may be used to improve dismal rates of innovation implementation. We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 U.S. health centers to assess whether top managers' support directly influences middle managers' commitment; by allocating implementation policies and practices; or by moderating the influence of implementation policies and practices on middle managers' commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. We found support for each hypothesized relationship: Results suggest that top managers increase middle managers' commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = .09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95% confidence interval [0.03, 0.17]); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Top managers can demonstrate their support directly by conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers' support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation.
Uncovering middle managers' role in healthcare innovation implementation

PubMed Central

2012-01-01

Background Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Discussion Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Summary Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation. PMID:22472001

Uncovering middle managers' role in healthcare innovation implementation.

PubMed

Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J

2012-04-03

Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.
Role of Social Media in Diabetes Management in the Middle East Region: Systematic Review.

PubMed

Alanzi, Turki

2018-02-13

Diabetes is a major health care burden in the Middle East region. Social networking tools can contribute to the management of diabetes with improved educational and care outcomes using these popular tools in the region. The objective of this review was to evaluate the impact of social networking interventions on the improvement of diabetes management and health outcomes in patients with diabetes in the Middle East. Peer-reviewed articles from PubMed (1990-2017) and Google Scholar (1990-2017) were identified using various combinations of predefined terms and search criteria. The main inclusion criterion consisted of the use of social networking apps on mobile phones as the primary intervention. Outcomes were grouped according to study design, type of diabetes, category of technological intervention, location, and sample size. This review included 5 articles evaluating the use of social media tools in the management of diabetes in the Middle East. In most studies, the acceptance rate for the use of social networking to optimize the management of diabetes was relatively high. Diabetes-specific management tools such as the Saudi Arabia Networking for Aiding Diabetes and Diabetes Intelligent Management System for Iraq systems helped collect patient information and lower hemoglobin A 1c (HbA 1c ) levels, respectively. The reviewed studies demonstrated the potential of social networking tools being adopted in regions in the Middle East to improve the management of diabetes. Future studies consisting of larger sample sizes spanning multiple regions would provide further insight into the use of social media for improving patient outcomes. ©Turki Alanzi. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.02.2018.
Slow progress in diarrhea case management in low and middle income countries: evidence from cross-sectional national surveys, 1985-2012.

PubMed

Sreeramareddy, Chandrashekhar T; Low, Yue-Peng; Forsberg, Birger Carl

2017-03-21

Diarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries. We analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver's care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys. Overall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or 'increased fluids' and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of 'increased fluids' decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%. Very limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver's care seeking behavior and health care provider's case management practices is needed to improve diarrhea case management in low- and-middle-income countries.
Promoting Mental Health in Italian Middle and High School: A Pilot Study.

PubMed

Veltro, Franco; Ialenti, Valentina; Morales García, Manuel Alejandro; Bonanni, Emiliana; Iannone, Claudia; D'Innocenzo, Marinella; Gigantesco, Antonella

2017-01-01

In Italy, a handbook has been developed based on the principles of cooperative learning, life skills, self-effectiveness, and problem-solving at high school level. Early studies have shown the handbook's effectiveness. It has been hypothesized that the revised handbook could be more effective in middle schools. The study design is a "pre- and posttest" that compares the results obtained from 91 students of the high schools with those of the 38 students from middle schools. The assessment was made through "self-reporting" questionnaires of (a) learning skills including problem-solving and (b) perceived self-efficacy in managing emotions, dysfunctional beliefs, and unhealthy behaviours (i.e., drinking/smoking). Significant improvements were observed in both groups with the exceptions of perceived self-efficacy in managing emotions. The improvement of dysfunctional beliefs and the learning of problem-solving skills were better in middle schools. The results confirm the authors' hypothesis that the use of this approach is much more promising in middle school.
Improving the effectiveness of health care innovation implementation: middle managers as change agents.

PubMed

Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J; Chin, Marshall H; Schaefer, Cynthia T

2013-02-01

The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers' commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers' commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers' influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected.
Impact of engaging middle management in practice interventions on staff support and learning culture: a quasi-experimental design.

PubMed

Henderson, Amanda; Burmeister, Liz; Schoonbeek, Sue; Ossenberg, Christine; Gneilding, Julieanne

2014-11-01

This study evaluated the impact of different levels of engaging middle management in ward based strategies implemented by a project educator. The challenge for learning in practice is to develop effective teams where experienced staff engage and foster learning with students and other novice staff. A quasi-experimental pre- and post- intervention four group design was conducted from November 2009 to May 2010 across four general surgical and four general medical inpatient matched units in two settings in South East Queensland, Australia. Staff survey data was used to compare control and intervention groups (one actively engaging nurse managers) before and after 'practice learning' interventions. The survey comprised demographic data and data from two validated scales (support instrument for nurses facilitating learning and clinical learning organisational culture). Number of surveys returned pre- and post-intervention was 336 from 713 (47%). There were significant differences across many subscales pertaining to staff perception of support in the intervention groups, with only one change in the control group. The number of significant different subscales in the learning culture was also greater when middle management supported the intervention. Middle management should work closely with facilitators to assist embedding practice interventions. © 2013 John Wiley & Sons Ltd.
Preparing Students for Front-Line Management: Non-Routine Day-to-Day Decisions

ERIC Educational Resources Information Center

Clydesdale, Greg; Tan, John

2009-01-01

Purpose: This paper attempts to reduce the gap between management education and practice. It emphasises day-to-day decisions that middle and lower level managers make. The purpose is to provide an education framework embodying a flexible approach to interpretation and solution creation, suitable for situations of ambiguity and uncertainty.…
High Level Competence: A Tool for Coping with Organizational Change

ERIC Educational Resources Information Center

Heilmann, Pia

2007-01-01

Purpose: The purpose of this paper is to find out and understand the different competence development needs of managers and their ways of learning. The examined managers work in middle management in Finnish information and communication technology sector (ICT) and paper business sector. Design/methodology/approach: The research was qualitative by…
Army Officers’ Attitudes of Conflict Management.

DTIC Science & Technology

1976-06-11

The purpose of this study was to measure the attitudes of the middle level career Army officers relative to the concepts of conflict management . The...the literature concerning conflict management and its related fields of study, an exploratory analysis employing Hierarchical Clustering Schemes, and... conflict management . (2) No difference exists in the attitudes of conflict management according to the sample’s three branch groups: combat arms
A snapshot of current gestational diabetes management practices from 26 low-income and lower-middle-income countries.

PubMed

Utz, Bettina; Kolsteren, Patrick; De Brouwere, Vincent

2016-08-01

To identify screening and management practices for gestational diabetes mellitus (GDM) in low-income and lower-middle-income countries. A cross-sectional survey was conducted between November 12, 2014 and May 11, 2015. Questionnaires were distributed to gynecologists, endocrinologists, and medical doctors who were representatives of national professional societies or were involved in providing care to patients with GDM in low-income or lower-middle-income countries in Africa, South Asia, and Latin America. The data were descriptively analyzed. Questionnaires were sent to 182 individuals and 77 healthcare providers from 26 countries completed the survey. The results demonstrated high diversity in screening and management practices. Only 52 (68%) participants reported that any guidelines were available in their setting. Management of GDM was found to take place mainly at the tertiary level and reported practices, including the frequency of post-diagnosis follow-up, modalities of glucose surveillance, and treatment and practices surrounding delivery, varied and did not always reflect the most recent evidence. Attempts to ensure greater adherence to latest consensus guidelines are required, and should be accompanied by systemic changes to improve the detection and management of GDM at primary- and secondary-level healthcare facilities to facilitate patient access to GDM screening and treatment. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Understanding middle managers' influence in implementing patient safety culture.

PubMed

Gutberg, Jennifer; Berta, Whitney

2017-08-22

The past fifteen years have been marked by large-scale change efforts undertaken by healthcare organizations to improve patient safety and patient-centered care. Despite substantial investment of effort and resources, many of these large-scale or "radical change" initiatives, like those in other industries, have enjoyed limited success - with practice and behavioural changes neither fully adopted nor ultimately sustained - which has in large part been ascribed to inadequate implementation efforts. Culture change to "patient safety culture" (PSC) is among these radical change initiatives, where results to date have been mixed at best. This paper responds to calls for research that focus on explicating factors that affect efforts to implement radical change in healthcare contexts, and focuses on PSC as the radical change implementation. Specifically, this paper offers a novel conceptual model based on Organizational Learning Theory to explain the ability of middle managers in healthcare organizations to influence patient safety culture change. We propose that middle managers can capitalize on their unique position between upper and lower levels in the organization and engage in 'ambidextrous' learning that is critical to implementing and sustaining radical change. This organizational learning perspective offers an innovative way of framing the mid-level managers' role, through both explorative and exploitative activities, which further considers the necessary organizational context in which they operate.
Perceptions of the Dilemma--Order versus Freedom at Managing Faculty: A Literature Review

ERIC Educational Resources Information Center

Karaferye, Figen; Agaoglu, Esmahan

2017-01-01

This study aims to examine the perceptions of the middle management (deans and heads of departments) and academicians on the dilemma order versus freedom at faculty management. It discusses how this dilemma is seen at an operational level and how it can be managed at university where both parties--with a managerial role or not--are…
Conceptualising Middle Management in Higher Education: A Multifaceted Discourse

ERIC Educational Resources Information Center

Clegg, Sue; McAuley, John

2005-01-01

Debates about middle management in higher education have been largely confined to the dominant discourse of managerialism. In this paper, we argue for an engagement with the broader management literature, with its multiple discourses of middle management. We present an analysis of middle management as a multifaceted phenomenon and review…
Elaborating on theory with middle managers' experience implementing healthcare innovations in practice.

PubMed

Birken, Sarah A; DiMartino, Lisa D; Kirk, Meredith A; Lee, Shoou-Yih D; McClelland, Mark; Albert, Nancy M

2016-01-04

The theory of middle managers' role in implementing healthcare innovations hypothesized that middle managers influence implementation effectiveness by fulfilling the following four roles: diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. The theory also suggested several activities in which middle managers might engage to fulfill the four roles. The extent to which the theory aligns with middle managers' experience in practice is unclear. We surveyed middle managers (n = 63) who attended a nursing innovation summit to (1) assess alignment between the theory and middle managers' experience in practice and (2) elaborate on the theory with examples from middle managers' experience overseeing innovation implementation in practice. Middle managers rated all of the theory's hypothesized four roles as "extremely important" but ranked diffusing and synthesizing information as the most important and selling innovation implementation as the least important. They reported engaging in several activities that were consistent with the theory's hypothesized roles and activities such as diffusing information via meetings and training. They also reported engaging in activities not described in the theory such as appraising employee performance. Middle managers' experience aligned well with the theory and expanded definitions of the roles and activities that it hypothesized. Future studies should assess the relationship between hypothesized roles and the effectiveness with which innovations are implemented in practice. If evidence supports the theory, the theory should be leveraged to promote the fulfillment of hypothesized roles among middle managers, doing so may promote innovation implementation.
Introduction to the Transference of High Technology Systems. An Intercultural Approach.

ERIC Educational Resources Information Center

Norton, Kent; And Others

A training program for upper-middle to upper-level managers of a company in Iran uses the lecture/seminar approach. The goals of the course are to develop insights into problem areas connected with the development of a pragmatic intercultural management model, and to introduce approaches and prerequisites for modern management. The 10 lectures…
Gender Differences in the Management of Four Different Personnel Disputes with Male and Female Employees.

ERIC Educational Resources Information Center

Rossi, Ana; Todd-Mancillas, Wm. R.

A study compared male and female managers' preferences for using communication-based as opposed to power-centered strategies for resolving employer-employee disputes. Subjects, 40 male and 40 female middle and upper level managers, were interviewed and asked to report their preferred manner of resolving four different personnel problems: (1) an…
Feasibility of Beginning a Program in Business Information Management. Volume XV, No. 9.

ERIC Educational Resources Information Center

Zilkowski, R.; Lucas, John A.

In December 1986, a study was conducted at Illinois' William Rainey Harper College (WRHC) to determine the feasibility of beginning a Business Information Management (BIM) program aimed at the middle-management level. A survey was mailed to 795 organizations with 250 or more employees in neighboring counties, requesting information on the interest…
Administrative Uses of Computers in the Schools.

ERIC Educational Resources Information Center

Bluhm, Harry P.

This book, intended for school administrators, provides a comprehensive account of how computer information systems can enable administrators at both middle and top management levels to manage the educational enterprise. It can be used as a textbook in an educational administration course emphasizing computer technology in education, an…
Middle Level Learning Number 48

ERIC Educational Resources Information Center

Freedman, Eric B.; Roberts, Scott L.

2013-01-01

Two articles are presented in this column. "Life in an Auto Factory: Simulating how Labor and Management Interact" by Eric B. Freedman describes a classroom simulation of management and labor relations in an auto factory. Classroom handouts are included. The next article, "Women of Action and County Names: Mary Musgrove County--Why…
Managing Diversity-Based Conflicts among Children. Fastback 414.

ERIC Educational Resources Information Center

Scott, Charles C.; And Others

This guide is designed to provide assistance in handling complex situational conflicts involving diversity through appropriate conflict management strategies for diverse classrooms at the elementary and middle school levels. Diversity-based conflict is not new in the United States. The classroom is, as it has been historically, one of the major…

Empowerment in nurse leader groups in middle management: a quantitative comparative investigation.

PubMed

Spencer, Caroline; McLaren, Susan

2017-01-01

The aim was to investigate structural empowerment in nurse leaders in middle management positions. Objectives were to determine levels of empowerment of nurse leaders and to compare levels of empowerment between nurse leader groups. Access to formal and informal power, opportunity, resources, information and support are determinants of structural empowerment. Empowerment of nurse leaders in middle management positions is vital given their roles in enabling nursing teams to deliver high-quality care, benefitting both patient and workforce outcomes. Quantitative component of a mixed methods study using survey principles. The Conditions of Work Effectiveness Questionnaire II was distributed to the total population (n = 517) of nurse leaders in an NHS Foundation Trust in England. Nurse leader groups comprised unit leaders (sisters, matrons) and senior staff nurses. Quantitative data entered on spss v 17/18, were analysed using descriptive and inferential statistics. Overall, the unit response rate was 44·1% (n = 228). Levels of total and global empowerment were moderate and moderate to high respectively. Groups did not differ significantly on these parameters or on five elements of total empowerment, but significantly higher scores were found for unit leaders' access to information. Significantly higher scores were found for senior staff nurses on selected aspects of informal power and access to resources, but scores were significantly lower than unit leaders for components of support. A moderately empowered population of nurse leaders differed in relation to access to information, aspects of support, resources and informal power, reflecting differences in roles, spheres of responsibility, hierarchical position and the constraints on empowerment imposed on unit leaders by financial and resource pressures. Empowerment of nurse leaders in middle management is vital in enabling nursing teams to deliver high-quality care. Roles, spheres of responsibility, hierarchical position and constraints imposed by financial and resource pressures influence nurse leader empowerment. Administrative support is needed to sustain practice engagement. © 2016 John Wiley & Sons Ltd.
Influence of socio-economic status on access to different components of SCI management across Indian population.

PubMed

Chhabra, H S; Bhalla, A M

2015-11-01

To assess the influence of financial constraints on access to different components of spinal cord injury (SCI) management in various socio-economic strata of the Indian population. Indian Spinal Injuries Centre (ISIC). One hundred fifty SCI individuals who came for follow-up at ISIC between March 2009 and March 2013 with at least 1 year of community exposure after discharge were included in the study. Socio-economic classification was carried out according to the Kuppuswamy scale, a standard scale for the Indian population. A self-designed questionnaire was administered. No sample was available from the lower group. There was a statistically significant difference (P<0.05) for the levels of difficulty perceived by different socio-economic groups in accessing different components of SCI management. Aided upper lower group was dependent on welfare schemes for in-hospital treatment but could not access other components of management once discharged. Unaided upper lower group either faced severe difficulty or could not access management. Majority of lower middle group faced severe difficulty. Upper middle group was equally divided into facing severe, moderate or no difficulty. Most patients in the upper group faced no difficulty, whereas some faced moderate and a small number of severe difficulty. Financial constraints affected all components of SCI management in all except the upper group. The results of the survey suggest that a very large percentage of the Indian population would find it difficult to access comprehensive SCI management and advocate extension of essential medical coverage to unaided upper lower, lower middle and upper middle groups.
Improving the Effectiveness of Health Care Innovation Implementation: Middle Managers as Change Agents

PubMed Central

Birken, Sarah A.; Lee, Shoou-Yih Daniel; Weiner, Bryan J.; Chin, Marshall H.; Schaefer, Cynthia T.

2013-01-01

The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers’ commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers’ commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers’ influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected. PMID:22930312
The dummies guide to promoting wildlife conservation in the Middle East: telling tales of unicorns and ossifrages to save the hawk and leopard.

PubMed

Bailey, Tom

2011-06-01

In the Middle East there are great pressures on the environment and wildlife. Indeed, many species are teetering on the edge of extinction. Wildlife health, management, and welfare are poorly understood concepts and are not important priorities for regional governments. What can be done to raise the level of awareness to wildlife health, management, and welfare in a region where most people live in large modern cities detached from nature? In this article, I relate the story of how a small group of colleagues and I harnessed our frustration at the pervasive indifference to conservation to positive effect. We took action to establish Wildlife Middle East News, an information resource to raise awareness of conservation issues and to enable better management and welfare of wildlife. This case study demonstrates how individuals, such as biologists, veterinarians, and environmental educators working with wildlife in narrow professional arenas can play a role in the solution of wider environmental problems.
[Violence prevention in secondary schools: the Faustlos-curriculum for middle school].

PubMed

Schick, Andreas; Cierpka, Manfred

2009-01-01

Schools and kindergartens are particularly suitable for the implementation of violence prevention programs. Many German schools and kindergartens have securely established the violence prevention curriculum Faustlos. The Faustlos programs for kindergartens and elementary schools are now complemented with the version for middle schools. As the kindergarten- and elementary school versions the middle school program too focuses on the theoretically profound, age group-tailored promotion of empathy, impulse control and anger management. These dimensions are subdivided into the five themes "understanding the problem" "training for empathy"; "anger management", "problem solving" and "applying skills" and taught stepwise, highly structured and based on several video sequences in 31 lessons. US-American evaluation studies proof the effectiveness and the violence prevention potential of the program. With the curriculum for middle schools a comprehensive Faustlos program package is now made available to sustainably promote core violence prevention competences of children and adolescents on a developmentally appropriate level and with a consistent didactic approach.
In praise of middle managers.

PubMed

Huy, Q N

2001-09-01

Middle managers have often been cast as dinosaurs. Has-beens. Mediocre managers and intermediaries who defend the status quo instead of supporting others' attempts to change organizations for the better. An INSEAD professor has examined this interesting breed of manager--in particular, middle managers' roles during periods of radical organizational change. His findings will surprise many. Middle managers, it turns out, make valuable contributions to the realization of radical change at companies--contributions that go largely unrecognized by most senior executives. Quy Nguyen Huy says these contributions occur in four major areas. First, middle managers often have good entrepreneurial ideas that they are able and willing to realize--if only they can get a hearing. Second, they're far better than most senior executives at leveraging the informal networks at companies that make substantive, lasting change. Because they've worked their way up the corporate ladder, middle managers' networks run deep. Third, they stay attuned to employees' emotional needs during organizational change, thereby maintaining the transformation's momentum. And finally, they manage the tension between continuity and change--they keep the organization from falling into extreme inertia or extreme chaos. The author examines each of these strengths, citing real-world examples culled from his research. Of course, not every middle manager in an organization is a paragon of entrepreneurial vigor and energy, Huy acknowledges. But cavalierly dismissing the roles that middle managers play--and carelessly reducing their ranks--will drastically diminish senior managers' chances of realizing radical change at their companies. Indeed, middle managers may be the most effective allies of corner office executives when it's time to make major changes in businesses.
From Strategy to Action: How Top Managers’ Support Increases Middle Managers’ Commitment to Innovation Implementation in Healthcare Organizations

PubMed Central

Lee, Shoou-Yih Daniel; Weiner, Bryan J.; Chin, Marshall H.; Chiu, Michael; Schaefer, Cynthia T.

2014-01-01

Background Evidence suggests that top managers’ support influences middle managers’ commitment to innovation implementation. What remains unclear is how top managers’ support influences middle managers’ commitment. Results may be used to improve dismal rates of innovation implementation. Methods We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 US health centers to assess whether top managers’ support influences middle managers’ commitment directly, by allocating implementation policies and practices, or by moderating the influence of implementation policies and practices on middle managers’ commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. Findings We found support for each hypothesized relationship: Results suggest that top managers increase middle managers’ commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = 0.09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95 percent CI: 0.03, 0.17); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Practice Implications Top managers can demonstrate their support by directly conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers’ support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation. PMID:24566252
A Correlational Study between IT Governance and the Effect on Strategic Management Functioning among Senior & Middle Management in Medium Scale Software Organizations

ERIC Educational Resources Information Center

Kurien, Sam

2013-01-01

The purpose of the study was to explore whether there are relationships between elements of information technology (IT) governance, strategic planning, and strategic functions among senior and mid-level management at medium-scaled software development firms. Several topics and models of IT governance literature were discussed and the gap in…
Importance and performance of managerial skills in the Australian aged care sector - a middle managers' perspective.

PubMed

Meissner, Ellen; Radford, Katrina

2015-09-01

This study examined the importance and performance of middle managers' skills to provide a starting point for a sector-wide leadership and management framework. There is an increasing consensus that the quality of management, leadership and performance of any organisation is directly linked to the capabilities of its middle managers and the preparation and on-going training they receive. A total of 199 middle managers from three aged care organisations in Australia participated in a questionnaire conducted during 2010-2011. This study found that middle managers perceived the need to develop their communication skills, self-awareness, change management, conflict resolution and leadership skills. Middle managers perceive a discrepancy between performance and importance of various managerial skills. This study demonstrated that provision of training needs to go beyond clinical skills development and further investigation into managers' needs is necessary, particularly considering the diversity of this critical group in organisations. Future training opportunities provided to middle managers need to address the 'softer' skills (e.g. communication) rather than 'technical' skills (e.g. clinical skills). The provision of training in these skills may improve their performance, which may also lead to increased job satisfaction, continuity in leadership and management and ultimately improvements in the quality of care provided. © 2014 John Wiley & Sons Ltd.
The relation characteristics of personality of managers working in Iran University of Medical Sciences with success and desirable job

PubMed Central

Atefi Manesh, Pezhman; Saleh Ardestani, Abbas; Kermani, Behnaz; Rezapoor, Aziz; Sarabi Asiabar, Ali

2015-01-01

Background: Several studies suggest the existence of an effective relationship between individuals’characteristics and important factors such as occupational and organizational performance, job satisfaction, organizational commitment, and etc. This study was designed based on the dimensions of personality (introversion /extroversion) of managers of Iran University of Medical Sciences at three levels (executive, middle and senior) with their career success rate. Methods: This was a cross-sectional descriptive study, whose population was all managers of Iran University of Medical Sciences. To collect data, two valid and reliable questionnaires were used. The first questionnaire assessed personality characteristics of each director, and the second measured occupational success. Related tests such as Pearson correlation test and independent comparison (independent t-test) at a significance level of 0.05 were used for data analysis. Results: Findings revealed no significant relationship between variables of introversion and extroversion and occupational success among the senior managers, (p> 0.05). However, there was a direct but incomplete relationship between introversion and extroversion, which correlated with job success among middle and executives managers. Conclusion: It seems that in all three levels of managers, if the managers communicated more with employees and if the subject of communication was more of executive nature, the correlation rate would increase between extroversion and introversion with job success variables. Therefore, it is suggested to give attention to organizational interaction and communication, and contingency variables such as organization condition, structure, formality and complexity. PMID:26793625
The relation characteristics of personality of managers working in Iran University of Medical Sciences with success and desirable job.

PubMed

Atefi Manesh, Pezhman; Saleh Ardestani, Abbas; Kermani, Behnaz; Rezapoor, Aziz; Sarabi Asiabar, Ali

2015-01-01

Several studies suggest the existence of an effective relationship between individuals'characteristics and important factors such as occupational and organizational performance, job satisfaction, organizational commitment, and etc. This study was designed based on the dimensions of personality (introversion /extroversion) of managers of Iran University of Medical Sciences at three levels (executive, middle and senior) with their career success rate. This was a cross-sectional descriptive study, whose population was all managers of Iran University of Medical Sciences. To collect data, two valid and reliable questionnaires were used. The first questionnaire assessed personality characteristics of each director, and the second measured occupational success. Related tests such as Pearson correlation test and independent comparison (independent t-test) at a significance level of 0.05 were used for data analysis. Findings revealed no significant relationship between variables of introversion and extroversion and occupational success among the senior managers, (p> 0.05). However, there was a direct but incomplete relationship between introversion and extroversion, which correlated with job success among middle and executives managers. It seems that in all three levels of managers, if the managers communicated more with employees and if the subject of communication was more of executive nature, the correlation rate would increase between extroversion and introversion with job success variables. Therefore, it is suggested to give attention to organizational interaction and communication, and contingency variables such as organization condition, structure, formality and complexity.
Identification of Tasks in Home Economics Related Occupations: Food Service.

ERIC Educational Resources Information Center

Iowa State Univ. of Science and Technology, Ames. Dept. of Home Economics Education.

The study was made to obtain curriculum development data for food service education programs below the baccalaureate level. Tasks related to the job functions of service, production, sanitation/safety, menu planning, procurement, supervision, and management were studied for five job categories of full-time personnel: middle-level service,…
Making Mendel's Model Manageable

ERIC Educational Resources Information Center

Mesmer, Karen

2006-01-01

Genetics is often a fascinating but difficult subject for middle level students. They can see the results of genes in every organism, but trying to visualize what happens at the level of genes is challenging for concrete thinkers. The author discusses an approach that helps students understand how genotypes can translate into phenotypes, then…
The Current State of Middle Management Preparation, Training, and Development in Academic Libraries

ERIC Educational Resources Information Center

Rooney, Michael P.

2010-01-01

This study examined the management experience, preparation, and training possessed by middle managers in academic libraries through the analysis of survey results. The analysis showed both advances in middle management preparation over recent decades and room for improvement in several aspects of management development and training within the…
Selling the OR: strategies to compete in the marketplace.

PubMed

Lee, M G

1989-07-01

1. OR directors are expected to be successful business managers in addition to their usual management responsibilities. 2. To complete with other health-care facilities, it is essential to incorporate marketing as part of the management strategy. 3. Marketing includes developing the skill level of all staff members, including middle managers, staff nurses, and ancillary personnel. 4. OR directors must create a work environment where the physician and staff are partners in providing quality patient care.
KM Critical Success Factors: A Comparison of Perceived Importance Versus Implementation in Malaysian ICT Companies

ERIC Educational Resources Information Center

Chong, Siong Choy

2006-01-01

Purpose: This research examines the level of perception and implementation of 11 identified knowledge management (KM) success factors and their differences among the information and communication technology (ICT) companies operating in Malaysia. Design/methodology/approach: The survey data was obtained from a study of 427 middle managers from 194…
Job Loss at Mid-Life: Managers and Executives Face the "New Risk Economy"

ERIC Educational Resources Information Center

Mendenhall, Ruby; Kalil, Ariel; Spindel, Laurel J.; Hart, Cassandra M. D.

2008-01-01

We use a life course framework to examine how the "new risk economy" has left middle-age professionals, managers and executives more vulnerable to job loss and unemployment despite high levels of human capital. Using in-depth qualitative data from 77 recently-unemployed white-collar workers, we examine perceptions of macro-economic…
Facilitating the Role of Middle Managers in Further Education.

ERIC Educational Resources Information Center

Briggs, Ann R. J.

2002-01-01

Interviews with staff, focus groups with middle managers, and a survey of management teams in British further education colleges identified aspects of middle managers' role. The role is largely intuitive and has transactional, transformational, supervisory, and representative aspects. Facilitators include clarity of college systems, support of…
The Use of Open-Ended Questions with Giving Feedback (OEQGF) for Effective Mathematic Learning

NASA Astrophysics Data System (ADS)

Sabilah, I.; Manoy, J. T.

2018-01-01

Feedback deals with giving information to students related to their task which is done through score of their achievement, reaction, and comments. Considering its hierarchy, task difficulty level consists of low, middle and high levels. The difficulty level of open-ended questions is middle to high. Open-ended question is a good way to train students’ knowledge. This research is a descriptive research which aims at describing teacher’s learning management, students’ activities, students’ learning achievement, and students’ responses in mathematic learning using OEQGF. The subject was a teacher of mathematics who teaches eighth graders, and students themselves. The research design used is one shot case study. The result shows that: management learning has been very well implemented by the teacher; every students’ activity has been carried out by students; the students’ learning achievement have reached the criteria of completeness, and the students’ responses can be considered as positive. Therefore, it can be concluded that mathematic learning using OEQGF is effective.
Operational considerations for the application of remotely sensed forest data from LANDSAT or other airborne platforms

NASA Technical Reports Server (NTRS)

Baker, G. R.; Fethe, T. P.

1975-01-01

Research in the application of remotely sensed data from LANDSAT or other airborne platforms to the efficient management of a large timber based forest industry was divided into three phases: (1) establishment of a photo/ground sample correlation, (2) investigation of techniques for multi-spectral digital analysis, and (3) development of a semi-automated multi-level sampling system. To properly verify results, three distinct test areas were selected: (1) Jacksonville Mill Region, Lower Coastal Plain, Flatwoods, (2) Pensacola Mill Region, Middle Coastal Plain, and (3) Mississippi Mill Region, Middle Coastal Plain. The following conclusions were reached: (1) the probability of establishing an information base suitable for management requirements through a photo/ground double sampling procedure, alleviating the ground sampling effort, is encouraging, (2) known classification techniques must be investigated to ascertain the level of precision possible in separating the many densities involved, and (3) the multi-level approach must be related to an information system that is executable and feasible.

What roles do middle managers play in implementation of innovative practices?

PubMed Central

Engle, Ryann L.; Lopez, Emily R.; Gormley, Katelyn E.; Chan, Jeffrey A.; Charns, Martin P.; Lukas, Carol VanDeusen

2017-01-01

Background: Middle managers play key roles in hospitals as the bridge between senior leaders and frontline staff. Yet relatively little research has focused on their role in implementing new practices. Purpose: The aim of this study was to expand the understanding of middle managers’ influence in organizations by looking at their activities through the lens of two complementary conceptual frameworks. Methodology/Approach: We analyzed qualitative data from 17 Veterans Affairs Medical Centers with high and low potential to change organizational practices. We analyzed 98 interviews with staff ranging from senior leaders to frontline staff to identify themes within an a priori framework reflecting middle manager activities. Findings: Analyses yielded 14 emergent themes that allowed us to classify specific expressions of middle manager commitment to implementation of innovative practices (e.g., facilitate improvement innovation, garner staff buy-in). In comparing middle manager behaviors in high and low change potential sites, we found that most emergent themes were present in both groups. However, the activities and interactions described differed between the groups. Practice Implications: Middle managers can use the promising strategies identified by our analyses to guide and improve their effectiveness in implementing new practices. These strategies can also inform senior leaders striving to guide middle managers in those efforts. PMID:26488239
Adapting a Psychosocial Intervention for Smartphone Delivery to Middle-Aged and Older Adults with Serious Mental Illness.

PubMed

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

2017-08-01

To describe the process of adapting an integrated medical and psychiatric self-management intervention to a smartphone application for middle-aged and older adults with serious mental illness using an adaptive systems engineering framework and user-centered design. First, we determined the technical abilities and needs of middle-aged and older adults with serious mental illnesses using smartphones. Then, we developed smartphone content through principles of user-centered design and modified an existing smartphone platform. Finally, we conducted a usability test using "think aloud" and verbal probing. We adapted a psychosocial self-management intervention to a smartphone application and tested its usability. Ten participants (mean age: 55.3 years, SD: 6.2 years) with serious mental illness and comorbid chronic health conditions reported a high level of usability and satisfaction with the smartphone application. Middle-aged and older adults with serious mental illness and limited technical abilities were able to participate in a process involving user-centered design and adaptation of a self-management intervention to be delivered by a smartphone. High usability ratings suggest that middle-aged and older adults with serious mental illness have the potential to use tailored smartphone interventions. Future research is indicated to establish effectiveness and to determine the type and intensity of clinical support needed to successfully implement smartphone applications as a component of community-based services for older adults with psychiatric and medical conditions. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
The National SShipbuilding Research Program. 1997 Ship Production Symposium. Proceedings

DTIC Science & Technology

1997-04-01

continues to advance the value and potential benefit of an ISO style process management system will increase. ISO provides the framework that is...understanding of systemic management beyond the buzzword level. In fairness , this probably is attributed to the fact that middle managers often perceive they...common or accepted practice. In the United States, the phrase of laisse - faire , or freedom of choice coupled with a lack of uniform standards continues to
Vision 2020, part I: profile of the future nurse leader.

PubMed

Scoble, Kathleen B; Russell, Gail

2003-06-01

The demand for knowledgeable and skilled nursing leaders at the first, middle, and executive levels of management in healthcare organizations drove a multi-phased project about the kinds of nurse managers who will be needed in the future and their educational needs. This first article in a two-part series describes seasoned nurse leaders' opinions about the educational preparation, experiences, and competencies desired in nurse managers for the year 2020.
Institute for Training in Library Management and Communication Skills. Final Report.

ERIC Educational Resources Information Center

Chang, Henry C.; And Others

An institute held December 10-16, 1978, in the United States Virgin Islands, trained 25 middle-level library administrators in the use of communications as a management tool. The institute was part of an on-going program of staff development in a multi-cultural, disadvantaged area. The program was based on these objectives: (1) to introduce basic…
On Being a Second Banana.

ERIC Educational Resources Information Center

Perry, William M.

1981-01-01

The article discusses the role of middle managers in an independent school setting and their relation to school heads. It suggests 14 principles of operation to meet the needs of school middle managers and to help clarify the role of the educational middle manager. (SB)
Decentralized State/Federal Level Emergency Evacuation Management Centers

DTIC Science & Technology

1982-08-01

or federal control , have been used for disaster mitigation, control , and relief, and to o provide personal and property security. The prestige and...level (or state/region-level) agencies. This change shortens the chain of command, which broadens the span of control . Typically, more reliable...amount of information passed up from operating to middle and top-levels will increase, as will the decisions and controls passed down. There will be
Industrial Training Practices.

ERIC Educational Resources Information Center

Beverstock, A.G.

Based primarily on British conditions, this volume concentrates on methods of industrial training for production workers, craftsmen and technicians, office personnel, technicians and technologists, supervisors, marketing and sales personnel, and the junior, middle, and senior or executive levels of management. General principles and fundamental…
Understanding the Work-Life Experiences and Goals of Women Middle Managers in Higher Education

ERIC Educational Resources Information Center

Hankinson, Marie

2013-01-01

Middle managers in higher education hold diverse titles and perform a variety of roles. Women represent a large portion of this midlevel management, but there is limited research exploring their experiences. As a result, little is known about women middle managers' career trajectories and what effect their experiences have on their future career…
Water-level changes in the High Plains aquifer, Republican River Basin in Colorado, Kansas, and Nebraska, 2002 to 2015

USGS Publications Warehouse

McGuire, V.L.

2016-12-29

The High Plains aquifer underlies 111.8 million acres (about 175,000 square miles) in parts of eight States—Colorado, Kansas, Nebraska, New Mexico, Oklahoma, South Dakota, Texas, and Wyoming. More than 95 percent of the water withdrawn from the High Plains aquifer is used for irrigation. Water-level declines began in parts of the High Plains aquifer soon after the beginning of substantial irrigation with groundwater in the aquifer area (about 1950). The Republican River Basin is 15.9 million acres (about 25,000 square miles) and is located in northeast Colorado, northern Kansas, and southwest Nebraska. The Republican River Basin overlies the High Plains aquifer for 87 percent of the basin area. Water-level declines had begun in parts of the High Plains aquifer within the Republican River Basin by 1964. In 2002, management practices were enacted in the Middle Republican Natural Resources District in Nebraska to comply with the Republican River Compact Final Settlement. The U.S. Geological Survey, in cooperation with the Middle Republican Natural Resources District, completed a study of water-level changes in the High Plains aquifer within the Republican River Basin from 2002 to 2015 to enable the Middle Republican Natural Resources District to assess the effect of the management practices, which were specified by the Republican River Compact Final Settlement. Water-level changes determined from this study are presented in this report.Water-level changes from 2002 to 2015 in the High Plains aquifer within the Republican River Basin, by well, ranged from a rise of 9.4 feet to a decline of 43.2 feet. The area-weighted, average water-level change from 2002 to 2015 in this part of the aquifer was a decline of 4.5 feet.
Worry experienced during the 2015 Middle East Respiratory Syndrome (MERS) pandemic in Korea

PubMed Central

Ro, Jun-Soo; Lee, Jin-Seok; Kang, Sung-Chan; Jung, Hye-Min

2017-01-01

Background Korea failed in its risk communication during the early stage of the Middle East Respiratory Syndrome (MERS) outbreak; consequently, it faced difficulties in managing MERS, while disease-related worry increased. Disease-related worry can help disease prevention and management, but can also have a detrimental effect. This study measured the overall level of disease-related worry during the MERS outbreak period in Korea and the influencing factors and levels of disease-related worry during key outbreak periods. Methods The cross-sectional survey included 1,000 adults who resided in Korea. An ordinal logistic regression was performed for the overall level of MERS-related worry, and influencing factors of worry were analyzed. A reliability test was performed on the levels of MERS-related worry during key outbreak periods. Results The overall level of MERS-related worry was 2.44. Multivariate analysis revealed that women and respondents w very poor subjective health status had higher levels of worry. Respondents with very high stress in daily life had higher levels of worry than those who reported having little stress. The reliability test results on MERS-related worry scores during key outbreak periods showed consistent scores during each period. Conclusion Level of worry increased in cases having higher perceived susceptibility and greater trust in informal information, while initial stage of outbreak was closely associated with that at later stages. These findings suggest the importance of managing the level of worry by providing timely and accurate disease-related information during the initial stage of disease outbreak. PMID:28273131
Validation of a clinical leadership qualities framework for managers in aged care: a Delphi study.

PubMed

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

2015-04-01

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

PubMed

OʼConnor, Mary

The trend of promoting clinical experts into management roles continues. New middle managers need a transitional plan that includes support, mentoring, and direction from senior leaders, including the chief nursing officer (CNO). This case study demonstrates how the CNO of one organization collaborated with a faculty member colleague to develop and implement a yearlong personalized on-boarding program for a group of new nurse middle managers.
Home Furnishings Merchandising. A Suggested Interdisciplinary Guide.

ERIC Educational Resources Information Center

Wray, Ralph D.; Hayden, Margaret B.

This curriculum guide contains three sections: introduction, curriculum material, and an annotated bibliography. Introductory information provides an overview of the home furnishings merchandising area, aptitudes needed, and career opportunities; discusses potential career ladders, which are divided into entry level, middle management, and…
Classroom Management and the Middle School Philosophy. Fastback 500.

ERIC Educational Resources Information Center

Dougherty, John W.

This document explores how teachers can connect the instructional and interpersonal approaches embedded in middle-school philosophy to effective classroom management. It describes the current mismatch between middle-school philosophy and practice and how the creation of middle-school grades introduced a volatile mismatch between a school's…
Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union.

PubMed

Kuhlmann, Ellen; Ovseiko, Pavel V; Kurmeyer, Christine; Gutiérrez-Lobos, Karin; Steinböck, Sandra; von Knorring, Mia; Buchan, Alastair M; Brommels, Mats

2017-01-06

Women's participation in medicine and the need for gender equality in healthcare are increasingly recognised, yet little attention is paid to leadership and management positions in large publicly funded academic health centres. This study illustrates such a need, taking the case of four large European centres: Charité - Universitätsmedizin Berlin (Germany), Karolinska Institutet (Sweden), Medizinische Universität Wien (Austria), and Oxford Academic Health Science Centre (United Kingdom). The percentage of female medical students and doctors in all four countries is now well within the 40-60% gender balance zone. Women are less well represented among specialists and remain significantly under-represented among senior doctors and full professors. All four centres have made progress in closing the gender leadership gap on boards and other top-level decision-making bodies, but a gender leadership gap remains relevant. The level of achieved gender balance varies significantly between the centres and largely mirrors country-specific welfare state models, with more equal gender relations in Sweden than in the other countries. Notably, there are also similar trends across countries and centres: gender inequality is stronger within academic enterprises than within hospital enterprises and stronger in middle management than at the top level. These novel findings reveal fissures in the 'glass ceiling' effects at top-level management, while the barriers for women shift to middle-level management and remain strong in academic positions. The uneven shifts in the leadership gap are highly relevant and have policy implications. Setting gender balance objectives exclusively for top-level decision-making bodies may not effectively promote a wider goal of gender equality. Academic health centres should pay greater attention to gender equality as an issue of organisational performance and good leadership at all levels of management, with particular attention to academic enterprises and newly created management structures. Developing comprehensive gender-sensitive health workforce monitoring systems and comparing progress across academic health centres in Europe could help to identify the gender leadership gap and utilise health human resources more effectively.
Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East.

PubMed

Al Sayed, Nasreen; Al Waili, Khalid; Alawadi, Fatheya; Al-Ghamdi, Saeed; Al Mahmeed, Wael; Al-Nouri, Fahad; Al Rukhaimi, Mona; Al-Rasadi, Khalid; Awan, Zuhier; Farghaly, Mohamed; Hassanein, Mohamed; Sabbour, Hani; Zubaid, Mohammad; Barter, Philip

2016-12-15

Plasma lipid disorders are key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) and are prevalent in the Middle East, with rates increasing in recent decades. Despite this, no region-specific guidelines for managing plasma lipids exist and there is a lack of use of guidelines developed in other regions. A multidisciplinary panel of regional experts was convened to develop consensus clinical recommendations for the management of plasma lipids in the Middle East. The panel considered existing international guidelines and regional clinical experience to develop recommendations. The panel's recommendations include plasma lipid screening, ASCVD risk calculation and treatment considerations. The panel recommend that plasma lipid levels should be measured in all at-risk patients and at regular intervals in all adults from the age of 20years. A scoring system should be used to calculate ASCVD risk that includes known lipid and non-lipid risk factors. Primary treatment targets include low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Lifestyle modifications should be first-line treatment for all patients; the first-line pharmacological treatment targeting plasma lipids in patients at moderate-to-high risk of ASCVD is statin therapy, with a number of adjunctive or second-line agents available. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. These consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
An empirical investigation of differences between mathematics specialists and non-specialists at the high school level in Cyprus: A Logistic regression Approach

NASA Astrophysics Data System (ADS)

Papanastasiou, Elena C.; Zembylas, Michalinos

2006-12-01

AN EMPIRICAL INVESTIGATION OF DIFFERENCES BETWEEN MATHEMATICS SPECIALISTS AND NON-SPECIALISTS AT THE HIGH-SCHOOL LEVEL in Cyprus - The data obtained from high-school seniors for the Third International Mathematics and Science Study (TIMSS) for the country of Cyprus appear to be contradictory. Although Cypriot students did not perform well in mathematics in elementary school, middle school, and in the non-advanced sectors of high school, students in advanced mathematics courses in high school managed to perform exceptionally well. In seeking to account for this apparent disparity, the present study examines the differences between mathematics specialists and non-specialists at the high-school level and discusses the implications that these have for teaching practice. It shows how students educated in an environment that might not be optimal for producing high-achieving students in mathematics and science in elementary and middle school (according to the TIMSS) might nonetheless manage to excel in these fields at the end of their schooling. In conclusion, the authors address the implications of their study for similar educational systems in other developing countries.
Power sharing. A transformational strategy for nurse retention, effectiveness, and extra effort.

PubMed

Trofino, Joan

2003-01-01

Power sharing with staff nurses is an essential strategy for organizational transformation. The current competitive health care environment requires a powerful team of participants, including staff at all levels, to provide health care in mutual partnership. The challenges of today's competitive and global environment call for collegial relationships among nurse executive leadership, middle nurse managers, and staff nurses. Research has demonstrated that middle nurse managers maintain primary responsibility for staff nurse retention. A higher retention rate was reported among nurses who were very satisfied with their nurse managers. Nurses considered favorably nurse managers who value staff contributions, promote information sharing, and exert influence for a stable work environment. Furthermore, as staff nurse satisfaction increased, effectiveness and extra effort also increased when staff nurses perceived transformational leadership strategies. Strategies for power sharing include serving as role models and mentors, energizing staff, resisting attitudes of staff ownership, reducing staff nurse stress of leader presence, and information sharing and commendations at meetings.
Physical therapy management of knee osteoarthritis in the middle-aged athlete.

PubMed

Adams, Thomas; Band-Entrup, Debra; Kuhn, Scott; Legere, Lucas; Mace, Kimberly; Paggi, Adam; Penney, Matthew

2013-03-01

Osteoarthritis (OA) is prevalent in today's population, including the athletic and recreationally active "middle-aged" population. OA is a degenerative condition of the articular/hyaline cartilage of synovial joints and commonly affects the knee joint. In general, athletic participation does not specifically influence a higher incidence of knee OA in this population; however, traumatic injury to the knee joint poses a definitive risk in developing early-onset OA. The purpose of this article is to review evidence-based nonpharmacological interventions for the conservative management of knee OA. Manual therapy, therapeutic exercise, patient education, and weight management are strongly supported in the literature for conservative treatment of knee OA. Modalities [thermal, electrical stimulation (ES), and low-level laser therapy (LLLT)] and orthotic intervention are moderately supported in the literature as indicated management strategies for knee OA. While many strongly supported conservative interventions have been published, additional research is needed to determine the most effective approach in treating knee OA.

Analysis of diverse regulatory networks in a hierarchical context shows consistent tendencies for collaboration in the middle levels

PubMed Central

Bhardwaj, Nitin; Yan, Koon-Kiu; Gerstein, Mark B.

2010-01-01

Gene regulatory networks have been shown to share some common aspects with commonplace social governance structures. Thus, we can get some intuition into their organization by arranging them into well-known hierarchical layouts. These hierarchies, in turn, can be placed between the extremes of autocracies, with well-defined levels and clear chains of command, and democracies, without such defined levels and with more co-regulatory partnerships between regulators. In general, the presence of partnerships decreases the variation in information flow amongst nodes within a level, more evenly distributing stress. Here we study various regulatory networks (transcriptional, modification, and phosphorylation) for five diverse species, Escherichia coli to human. We specify three levels of regulators—top, middle, and bottom—which collectively govern the non-regulator targets lying in the lowest fourth level. We define quantities for nodes, levels, and entire networks that measure their degree of collaboration and autocratic vs. democratic character. We show individual regulators have a range of partnership tendencies: Some regulate their targets in combination with other regulators in local instantiations of democratic structure, whereas others regulate mostly in isolation, in more autocratic fashion. Overall, we show that in all networks studied the middle level has the highest collaborative propensity and coregulatory partnerships occur most frequently amongst midlevel regulators, an observation that has parallels in corporate settings where middle managers must interact most to ensure organizational effectiveness. There is, however, one notable difference between networks in different species: The amount of collaborative regulation and democratic character increases markedly with overall genomic complexity. PMID:20351254
A comparison of top and middle level women administrators in social work, nursing, and education: career supports and barriers.

PubMed

Collins, S K

1984-01-01

Presented in this article are findings from a descriptive study of a national stratified random sample of 259 women administrators in social work, nursing, and education. Subjects responded to a 54 item, mailed questionnaire about their career experiences. The author explores career support from parents and persons within their work organizations. Barriers of sex discrimination and difficulties balancing career and family responsibilities are included. Finally, the extent to which the women administrators provided career assistance to other women is discussed. Comparisons between the three fields and between top and middle management levels are emphasized. Recommendations are made for increasing women's opportunities for career achievement within the fields studied.
Exploring the Influence of Information Overload on Middle Management Decision-Making in Organizations

ERIC Educational Resources Information Center

Carlevale, Edward A.

2010-01-01

This phenomenological study was an exploration of information overload and how it influenced middle management decision-making in a single organization. In-depth interviews were used to gather lived experiences of 22 middle managers at XYZ Defense Company in California. Data were analyzed using both HyperRESEARCH TM 2.8 software and a manual…
"Turning Points": The Personal and Professional Circumstances That Lead Academics to Become Middle Managers

ERIC Educational Resources Information Center

Floyd, Alan

2012-01-01

In the current higher education climate, there is a growing perception that the pressures associated with being an academic middle manager outweigh the perceived rewards of the position. This article investigates the personal and professional circumstances that lead academics to become middle managers by drawing on data from life history…
Evidence-Informed Leadership in the Japanese Context: Middle Managers at a University Self-Access Center

ERIC Educational Resources Information Center

Adamson, John; Brown, Howard

2012-01-01

This study reports on the steering of a self-access learning center in a Japanese university by its "middle management" committee over the first years of its operation. Middle management practice was informed by an ethnographic archive of various facets of center use, particularly concerning language policy and curriculum integration, issues about…
Ethical challenges for medical professionals in middle manager positions: a debate article.

PubMed

Schnoor, Joerg; Heyde, Christoph-Eckhard; Ghanem, Mohamed

2015-01-01

Demographic changes increase the financing needs of all social services. This change also generates new and complex demands on the medical staff. Accordingly, medical professionals in middle management positions hold a characteristic sandwich position between top management and the operational core. This sandwich position often constitutes new challenges. In the industrial field, the growing importance of the middle management for the company's success has already been recognized. Accordingly, the growing demand on economy urges an analysis for the medical field. While there are nearly no differences in the nature of the tasks of medical middle manager in the areas of strategy, role function, performance pressure and qualifications compared to those tasks of the industrial sector, there are basic differences as well. Especially the character of "independence" of the medical profession and its ethical values justifies these differences. Consequently, qualification of medical professionals may not be solely based on medical academic career. It is also based on the personal ability or potential to lead and to manage. Above all, the character of "independence" of the medical profession and its ethical values justifies medical action that is based on the patient's well-being and not exclusively on economic outcomes. In the future, medical middle managers are supposed to achieve an optimized balance between a patient-centered medicine and economic measures. It will be a basic requirement that middle managers accept their position and the resultant tasks putting themselves in a more active position. Because of that, middle managers can become "value-added bridge-builders".
The Lived-Through Experience of the Senior Teacher: A Closer Look at a Middle Management and Leadership Position in Bahraini Public Schools

ERIC Educational Resources Information Center

Razzak, Nina Lutfi Abdul

2015-01-01

Senior teachers in Bahraini public schools are a part of the Kingdom's national educational reform initiatives underway. The main role they play is that of leading and managing a group or cluster of teachers who teach the same subject matter at the same grade level. They are therefore more or less like "department heads". With advances…
Professional Identities of Middle Managers: A Case Study in the Faculty of Health and Social Care

ERIC Educational Resources Information Center

Thomas-Gregory, Annette

2014-01-01

This article presents and discusses the findings of a recent study on the professional identities of middle managers in a school of healthcare in a selected Chartered (pre-1992) UK university. Attention focuses on the career backgrounds of the middle managers, perception of identity and the interactional balance between the professional, academic…
Technical Training Requirements of Middle Management in the Greek Textile and Clothing Industries.

ERIC Educational Resources Information Center

Fotinopoulou, K.; Manolopoulos, N.

A case study of 16 companies in the Greek textile and clothing industry elicited the training needs of the industry's middle managers. The study concentrated on large and medium-sized work units, using a lengthy questionnaire. The study found that middle managers increasingly need to solve problems and ensure the reliability of new equipment and…
Design of Flight Vehicle Management Systems

NASA Technical Reports Server (NTRS)

Meyer, George; Aiken, Edwin W. (Technical Monitor)

1994-01-01

As the operation of large systems becomes ever more dependent on extensive automation, the need for an effective solution to the problem of design and validation of the underlying software becomes more critical. Large systems possess much detailed structure, typically hierarchical, and they are hybrid. Information processing at the top of the hierarchy is by means of formal logic and sentences; on the bottom it is by means of simple scalar differential equations and functions of time; and in the middle it is by an interacting mix of nonlinear multi-axis differential equations and automata, and functions of time and discrete events. The lecture will address the overall problem as it relates to flight vehicle management, describe the middle level, and offer a design approach that is based on Differential Geometry and Discrete Event Dynamic Systems Theory.
Leadership Succession Management in a University Health Faculty

ERIC Educational Resources Information Center

McMurray, Anne M.; Henly, Debra; Chaboyer, Wendy; Clapton, Jayne; Lizzio, Alf; Teml, Martin

2012-01-01

We report on a succession planning pilot project in an Australian university health faculty. The programme aimed to enhance organisational stability and develop leadership capacity in middle level academics. Six monthly sessions addressed university and general leadership topics, communication, decision-making, working with change, self-management…
Is College Affordable? Are Loans Manageable? What Do Colleges' Net Price Calculators Show? Policy Bulletin

ERIC Educational Resources Information Center

Advisory Committee on Student Financial Assistance, 2012

2012-01-01

A review of net price calculators--a financial aid tool mandated by the "Higher Education Opportunity Act" of 2008--reveals that students from low-, moderate-, and middle-income families face record-level net prices at 4-year public colleges today. These net prices will translate into levels of average total loan burden far in excess of…
Is intramedullary nailing more effective than non-operative treatment in adults with displaced middle-third clavicle fractures?

PubMed

Hill, Christopher Edward

2014-09-01

Clavicle fractures are common, accounting for 5-12 % of all fractures. Traditionally, displaced middle-third clavicle fractures have been managed non-operatively but the associated displacement often leads to mal-union with shortening, cosmetic deformity and occasionally non-union, with clinicians looking towards alternative operative methods such as intramedullary nailing (IMN). However, such methods have their own complications. In order to ascertain the effectiveness of IMN in the management of middle-third clavicle fractures compared with non-operative treatment, analysis of recent evidence is required and this review aims to achieve that, focusing on relevant, contemporary randomised-control trials. Essential search-terms identified from the research question were used to formulate a search strategy. A systematic search of multiple databases was then performed from 1966 until present and appropriate papers for appraisal identified. Thirteen papers were identified, with 10 excluded using appropriate eligibility criteria. The remaining papers were then critically appraised. With regards shoulder function, all papers demonstrated an association between IMN and a significantly (P < 0.05) superior shoulder function score, but no consensus with regards to complication rates. However, all have identified limitations; therefore, their overall findings must be considered conservatively. Further, high-quality research, ideally in the form of well-designed, multi-centre RCTs is required to allow acceptable implementation of IMN of middle-third clavicle fractures into widespread practice. However, early results demonstrate that in young patients with displaced middle-third clavicle fractures, who are motivated to return to work, IMN provides superior functional results and should be considered. However, the importance of considering each patient individually as to their suitability for each management option, before coming to an informed decision with the patient rather than having a blanket approach to MTCF is essential. Level 1.
Directing and Facilitating Distributed Pedagogical Leadership: Best Practices in Early Childhood Education

ERIC Educational Resources Information Center

Bøe, Marit; Hognestad, Karin

2017-01-01

This paper uses a hybrid leadership framework to examine how formal teacher leaders at the middle management level direct and facilitate staff resources for distributed pedagogical leadership. By conducting qualitative shadowing, involving video observation, field notes and stimulated recall interviews, and abductive analysis, this study…
Classroom Management Strategies for Difficult Students: Promoting Change through Relationships

ERIC Educational Resources Information Center

Beaty-O'Ferrall, Mary Ellen; Green, Alan; Hanna, Fred

2010-01-01

Teachers in middle level schools face overwhelming demands and challenges in their classrooms. They are expected to know content and pedagogy, develop engaging lessons that meet the needs of diverse learners, and use a variety of instructional strategies that will boost student achievement while they simultaneously develop positive relationships…
Discriminatory Air Pollution

ERIC Educational Resources Information Center

McCaull, Julian

1976-01-01

Described are the patterns of air pollution in certain large urban areas. Persons in poverty, in occupations below the management or professional level, in low-rent districts, and in black population are most heavily exposed to air pollution. Pollution paradoxically is largely produced by high energy consuming middle-and upper-class households.…
Directors, Deans, Doctors, Divergers: The Four Career Paths of SSAOs

ERIC Educational Resources Information Center

Biddix, J. Patrick

2013-01-01

Career paths in student affairs generally follow a conventional course: graduate degree to entry-level position, progressive responsibility until middle management, and then a decision to remain, work to advance, or change fields. Studies on factors influencing career advancement have enlightened qualitative considerations individuals face when…
Policy options to improve leadership of middle managers in the Australian residential aged care setting: a narrative synthesis

PubMed Central

2010-01-01

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

ERIC Educational Resources Information Center

Manczuk, Suzanne

1999-01-01

Describes the following resources for managing a middle school media center: literature bibliographies with on-target middle school recommendations and useful annotations; resources for teaching primary sources; resources on censorship and banned books; basic Internet guides; copyright-law resources; information-literacy standards; and…
Comprehensive Guide for Middle School Programs. Instructor's Guide.

ERIC Educational Resources Information Center

Hansen, Joan

This instructor's guide contains materials for use in teaching a middle school exploratory home economics course. Addressed in the individual units of the guide are the following topics: nutrition education and food management, parenting education, resource management, clothing management, and personal management. Each section contains a unit…

The Influence of Pain Severity and Interference on Satisfaction with Pain Management among Middle-Aged and Older Adults

PubMed Central

Krok-Schoen, Jessica L.; O'Connor, Melissa L.; Brooks, Amber K.

2016-01-01

Background. Health outcomes are often contingent on how effective the individual is able to manage existent illness-related symptoms. This is all the more relevant among chronic pain patients. Objective. This study aimed to identify indicators of pain treatment satisfaction among middle-aged and older adults (N = 150) receiving outpatient treatment from a comprehensive cancer center. Methods. Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. Results. Descriptive data showed that middle-aged adults reported more pain locations, greater pain severity, and less satisfaction with pain treatment. A multivariate model was specified, showing older adults being more satisfied with their pain treatment. For the middle-aged adults, treatment satisfaction was generally lower with greater pain severity. This counters that for the older adults, where treatment satisfaction remained consistent despite increased levels of pain severity. Conclusion. These findings address an important issue regarding how pain is experienced across the life course. This suggests that general assumptions cannot be made about the health outcomes of older adults. Beyond the descriptive definitions of pain, there remains the need to develop models that account for determinants that may account for the pain experience among a diverse adult population. PMID:28100956
Middle management of research

NASA Technical Reports Server (NTRS)

Graham, Robert W.

1990-01-01

The role of the middle manager in a research organization is discussed. The middle manager serves as a liaison between upper management and researchers to assure that individual research projects manifest the goals of the organization. The author draws on his long experience in this role to describe management practices that have proven successful. A general discussion is presented of the makeup of a research environment, derived from a study of a division involved in aerospace research and development (R and D). The study emphasized the importance of planning and management style in producing an attractive environment. Management practices are described, which include goal setting, planning, staffing, reviewing and evaluating, and rewarding. The importance of selecting and defining an appropriate research area is discussed. It is emphasized that in relating to the staff the middle manager must cultivate the human side of supervision, develop the art of delegating responsibility, judiciously select facilities, and provide recognition and meaningful rewards to develop a productive research staff. The development of the staff is probably the most important and challenging role of the manager.
Effect of Disease Improvement with Self-Measurement Compliance (Measurement Frequency Level) in SmartCare Hypertension Management Service.

PubMed

Lee, Chang-Hee; Chang, Byeong-Yun

2016-03-01

This study's purpose was to analyze the effect of the SmartCare pilot project, which was conducted in 2011 in South Korea. Recent studies of telehealth mostly compare the intervention group and the control group. Therefore, it is necessary to analyze the disease improvement effect depending on the self-measurement compliance (measurement frequency level) of patients who are receiving the hypertension management services. In the SmartCare center, health managers (nurses, nutritionists, and exercise prescribers) monitored the measurement data transmitted by participants through the SmartCare system. The health managers provided the prevention, consultation, and education services remotely to patients. Of the 231 participants who were enrolled in the study, the final analysis involved 213 individuals who completed their blood pressure measurements and SmartCare services until the end of a 6-month service period. The evaluated measurement group was classified into three groups (Low, Middle, and High) by evenly dividing the monthly average frequency of measurement for 6 months. The evaluation indices were systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, and body mass index (BMI); this information was transmitted through the SmartCare system. For changes in the evaluation indices after 6 months compared with the initial baseline, in the Low Group, SBP and DBP slightly decreased, and weight and BMI slightly increased (difference not statistically significant). In the Middle Group, SBP and DBP decreased slightly (difference not statistically significant); however, both weight and BMI decreased (difference statistically significant). In the High Group, SBP, DBP, weight, and BMI decreased (difference statistically significant). Patients who received the SmartCare services with higher measurement frequency levels at home showed greater effectiveness regarding the provided services compared with those patients with lower levels of BP, weight, and BMI control.
Specialized Middle Level Teacher Preparation: Moving from Advocacy to Actualization

ERIC Educational Resources Information Center

Cook, Chris M.; Howell, Penny B.; Faulkner, Shawn A.

2016-01-01

Is specialized middle level teacher preparation necessary? This essay offers the authors' thoughts regarding middle level teaching and the necessity of specialized middle level teacher preparation. The reader is encouraged to further the discussion of middle level teacher preparation from advocacy to actualization.
Managing Further Education: Learning Enterprise. Educational Management: Research and Practice.

ERIC Educational Resources Information Center

Lumby, Jacky

Based on a national survey of college managers, this book discusses how incorporation of colleges in England has changed working lives of middle and senior managers. Chapter 1 describes the context in which colleges have worked since 1993 and the research rationale and methodology. Chapter 2 analyzes how far senior and middle managers' leadership…
Perceived organizational problems in health care: a pilot test of the structured problem and success inventory.

PubMed

Nyström, Monica E; Terris, Darcey D; Sparring, Vibeke; Tolf, Sara; Brown, Claire R

2012-01-01

Our objective was to test whether the Structured Problem and Success Inventory (SPI) instrument could capture mental representations of organizational and work-related problems as described by individuals working in health care organizations and to test whether these representations varied according to organizational position. A convenience sample (n = 56) of middle managers (n = 20), lower-level managers (n = 20), and staff (n = 16) from health care organizations in Stockholm (Sweden) attending organizational development courses during 2003-2004 was recruited. Participants used the SPI to describe the 3 most pressing organizational and work-related problems. Data were systematically reviewed to identify problem categories and themes. One hundred sixty-four problems were described, clustered into 13 problem categories. Generally, middle managers focused on organizational factors and managerial responsibilities, whereas lower-level managers and staff focused on operational issues and what others did or ought to do. Furthermore, we observed similarities and variation in perceptions and their association with respondents' position within an organization. Our results support the need for further evaluation of the SPI as a promising tool for health care organizations. Collecting structured inventories of organizational and work-related problems from multiple perspectives may assist in the development of shared understandings of organizational challenges and lead to more effective and efficient processes of solution planning and implementation.
The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study.

PubMed

Barasa, Edwine W; Cleary, Susan; English, Mike; Molyneux, Sassy

2016-09-30

Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findings RESULTS: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes.
Extreme groundwater levels caused by extreme weather conditions - the highest ever measured groundwater levels in Middle Germany and their management

NASA Astrophysics Data System (ADS)

Reinstorf, F.; Kramer, S.; Koch, T.; Pfützner, B.

2017-12-01

Extreme weather conditions during the years 2009 - 2011 in combination with changes in the regional water management led to maximum groundwater levels in large areas of Germany in 2011. This resulted in extensive water logging, with problems especially in urban areas near rivers, where water logging produced huge problems for buildings and infrastructure. The acute situation still exists in many areas and requires the development of solution concepts. Taken the example of the Elbe-Saale-Region in the Federal State of Saxony-Anhalt, were a pilot research project was carried out, the analytical situation, the development of a management tool and the implementation of a groundwater management concept are shown. The central tool is a coupled water budget - groundwater flow model. In combination with sophisticated multi-scale parameter estimation, a high-resolution groundwater level simulation was carried out. A decision support process with an intensive stakeholder interaction combined with high-resolution simulations enables the development of a management concept for extreme groundwater situations in consideration of sustainable and environmentally sound solutions mainly on the base of passive measures.
Can parental monitoring and peer management reduce the selection or influence of delinquent peers? Testing the question using a dynamic social network approach.

PubMed

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

2013-11-01

We tested whether parents can reduce affiliation with delinquent peers through 3 forms of peer management: soliciting information, monitoring rules, and communicating disapproval of peers. We examined whether peer management interrupted 2 peer processes: selection and influence of delinquent peers. Adolescents' feelings of being overcontrolled by parents were examined as an additional moderator of delinquent selection and influence. Using network data from a community sample (N = 1,730), we tested whether selection and influence processes varied across early, middle, and late adolescent cohorts. Selection and influence of delinquent peers were evident in all 3 cohorts and did not differ in strength. Parental monitoring rules reduced the selection of delinquent peers in the oldest cohort. A similar effect was found in the early adolescent cohort, but only for adolescents who did not feel overcontrolled by parents. Monitoring rules increased the likelihood of selecting a delinquent friend among those who felt overcontrolled. The effectiveness of communicating disapproval was also mixed: in the middle adolescent network, communicating disapproval increased the likelihood of an adolescent selecting a delinquent friend. Among late adolescents, high levels of communicating disapproval were effective, reducing the influence of delinquent peers for adolescents reporting higher rates of delinquency. For those who reported lower levels of delinquency, high levels of communicating disapproval increased the influence of delinquent peers. The results of this study suggest that the effectiveness of monitoring and peer management depend on the type of behavior, the timing of its use, and whether adolescents feel overcontrolled by parents.
Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

PubMed

Cardoso, Fatima; Bese, Nuran; Distelhorst, Sandra R; Bevilacqua, Jose Luiz B; Ginsburg, Ophira; Grunberg, Steven M; Gralla, Richard J; Steyn, Ann; Pagani, Olivia; Partridge, Ann H; Knaul, Felicia Marie; Aapro, Matti S; Andersen, Barbara L; Thompson, Beti; Gralow, Julie R; Anderson, Benjamin O

2013-10-01

Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment. Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.
Educating for International Interdependence: The Role of the Academic Library--Ohio University and Malaysia.

ERIC Educational Resources Information Center

Mulliner, K.; Lee, Hwa-Wei

There is a role, and even a responsibility, for academic libraries in the United States in cooperating with students, scholars, colleagues, institutions, and governments in Third World nations. For example, the international library internship program, in which professional librarians at the middle-management level spend three to six months…
The Real Glass Ceiling. Your Career.

ERIC Educational Resources Information Center

Savage, Adrian

2002-01-01

There is a powerful and common glass ceiling (barrier that prevents capable employees from being promoted) that affects men as much as women. Between middle management and the executive level, corporate culture shifts to one based on power and a worker must play by new rules even if these have never been explained. (JOW)
Two Views on Collective Bargaining.

ERIC Educational Resources Information Center

Southern Regional Education Board, Atlanta, GA.

Presented are two arguments on academic collective bargaining, by John R. Silber and Robert Nielsen. Dr. Silber argues that faculty organization causes the university to become more like a factory than a university, that a faculty member has more in common with a middle level manager today than with a professor of 25 years ago, and that…
Women: Managers Stuck in the Middle?

ERIC Educational Resources Information Center

O'Leary, Virginia E.

Promoting women into higher level organizational positions is vital as a social issue and a subject for organizational theory and research. Recently, Henning and Jardin have identified an internal factor that poses a problem to women and their job-related aspirations. The absence of long-term career commitment has been found to inhibit the…
Redesigning the Role of Deputy Heads in Norwegian Schools--Tensions between Control and Autonomy?

ERIC Educational Resources Information Center

Abrahamsen, Hedvig

2018-01-01

A substantial body of research emphasises school leadership as a major influence on quality improvement in schools. Although numerous studies have identified the importance of the principal, fewer studies have examined the middle management level within schools, the deputy heads and assistant principals. Influenced by international trends, local…
The Relationships between Organizational Culture and Environmental Scanning: A Case Study.

ERIC Educational Resources Information Center

Miller, Jerry P.

1994-01-01

Based on interview and survey data from 220 upper- and middle-level managers within a Fortune 500 manufacturing firm, this case study describes how differences in organizational values influence the frequency with which decision makers use oral, written, and electronic sources of information for environmental scanning. (91 references) (LRW)
Othered Voices: Asylum-Seeking Mothers and Early Years Education

ERIC Educational Resources Information Center

Whitmarsh, Judy

2011-01-01

Strengthening the home-school partnership is a strategy to raise achievement levels and to engage "hard-to-reach" parents with education in the UK, however this political ideal has been critiqued as exclusive and based on a white, middle class model. This article explores how six asylum-seeking mothers manage their children's early years…
Assessment of Factor Affecting Institutional Performance: The Case of Wolaita Sodo University

ERIC Educational Resources Information Center

Shibru, Sintayehu; Bibiso, Mesfin; Ousman, Kedir

2017-01-01

The purpose of this study is to explore factors that affect institutional performance of Wolaita Sodo University. The study has identified middle level manager's perceptions toward institutional performance to indicate the key factors that seem to affect the performance of the university. Data were collected using structured questionnaires and…
Blended Learning: Communication, Locations and Work-Life Practices

ERIC Educational Resources Information Center

Moe, Carl Erik; Rye, Stale Angen

2011-01-01

The article discusses blended learning and how various delivery formats affect the way learning is situated in work-life practices. The authors approached this issue through an empirical study of an in-service training programme for middle-level managers in a number of case organisations. The programme used a combination of e-learning, textbooks…
Research of the Rio Grande Ecosystem Management Program

Treesearch

Deborah M. Finch

2000-01-01

This paper describes the mission, objectives, and preliminary results of the Middle Rio Grande Ecosystem Management Research Program managed at the Rocky Mountain Research Station's Albuquerque laboratory. This program was initiated in 1994 to address growing pressures to effectively manage the limited resources of the middle Rio Grande Basin. The program is...

Management challenges faced by managers of New Zealand long-term care facilities.

PubMed

Madas, E; North, N

2000-01-01

This article reports on a postal survey of 78 long-term care managers in one region of New Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) were middle-aged females holding nursing but not management qualifications. Most long-term care facilities (69%) tended to be stand-alone facilities providing a single type of care (rest home or continuing care hospital). The most prominent issues facing managers were considered to be inadequate funding to match the growing costs of providing long-term care and occupancy levels. Managers believed that political/regulatory, economic and social factors influenced these issues. Despite a turbulent health care environment and the challenges facing managers, long-term care managers reported they were coping well and valued networking.
Leveraging Independent Management and Chief Engineer Hierarchy: Vertically and Horizontally-Derived Technical Authority Value

NASA Technical Reports Server (NTRS)

Barley, Bryan; Newhouse, Marilyn

2012-01-01

In the development of complex spacecraft missions, project management authority is usually extended hierarchically from NASA's highest agency levels down to the implementing institution's project team level, through both the center and the program. In parallel with management authority, NASA utilizes a complementary, but independent, hierarchy of technical authority (TA) that extends from the agency level to the project, again, through both the center and the program. The chief engineers (CEs) who serve in this technical authority capacity oversee and report on the technical status and ensure sound engineering practices, controls, and management of the projects and programs. At the lowest level, implementing institutions assign project CEs to technically engage projects, lead development teams, and ensure sound technical principles, processes, and issue resolution. At the middle level, programs and centers independently use CEs to ensure the technical success of their projects and programs. At the agency level, NASA's mission directorate CEs maintain technical cognizance over every program and project in their directorate and advise directorate management on the technical, cost, schedule, and programmatic health of each. As part of this vertically-extended CE team, a program level CE manages a continually varying balance between penetration depth and breadth across his or her assigned missions. Teamwork issues and information integration become critical for management at all levels to ensure value-added use of both the synergy available between CEs at the various agency levels, and the independence of the technical authority at each organization.
Experience of social role strain in Korean women with type 2 diabetes.

PubMed

Park, Hyunjeong; Wenzel, Jennifer A

2013-06-01

To expand our understanding of the experience of social role strain in the context of diabetes care among middle-aged married Korean women with type 2 diabetes. Diabetes remains an international concern. There are special challenges experienced by middle-aged married women who may not prioritize self-care and disease management. These challenges may be heightened in certain cultures due to traditional female and family roles along with other social norms and values. Descriptive qualitative study. This qualitative descriptive study involves in-depth interviews conducted between January-February 2007 with ten middle-aged married Korean women purposively selected to represent both higher and lower levels of role strain as measured by the measure of role gratification and strain instrument from the companion study, which was conducted simultaneously. Korean women in this study reported 'resentment regarding previous role strain'. This psychosocial burden was heightened by a noted pattern of 'sacrificing self in favour of others', which complicated both their personal lives and their ability to take care of themselves physically. Added to this were feelings of guilt related to their diabetes and the requirements of day-to-day management expressed as, 'my diabetes makes me a liability'. The women's role-strain experience related to their diabetes was intertwined with their past and current daily life. Further explication and interventions to address and manage role strain could potentially improve women's disease management and overall quality of life. © 2012 Blackwell Publishing Ltd.
Socio-demographic patterns of disability among older adult populations of low-income and middle-income countries: results from World Health Survey.

PubMed

Hosseinpoor, Ahmad Reza; Bergen, Nicole; Kostanjsek, Nenad; Kowal, Paul; Officer, Alana; Chatterji, Somnath

2016-04-01

Our objective was to quantify disability prevalence among older adults of low- and middle-income countries, and measure socio-demographic distribution of disability. World Health Survey data included 53,447 adults aged 50 or older from 43 low- and middle-income countries. Disability was a binary classification, based on a composite score derived from self-reported functional difficulties. Socio-demographic variables included sex, age, marital status, area of residence, education level, and household economic status. A multivariate Poisson regression model with robust variance was used to assess associations between disability and socio-demographic variables. Overall, 33.3 % (95 % CI 32.2-34.4 %) of older adults reported disability. Disability was 1.5 times more common in females, and was positively associated with increasing age. Divorced/separated/widowed respondents reported higher disability rates in all but one study country, and education and wealth levels were inversely associated with disability rates. Urban residence tended to be advantageous over rural. Country-level datasets showed disparate patterns. Effective approaches aimed at disability prevention and improved disability management are warranted, including the inclusion of equity considerations in monitoring and evaluation activities.
Workaholism and mental health problems among municipal middle managers in Norway.

PubMed

Midje, Hilde H; Nafstad, Ingunn T; Syse, Jonn; Torp, Steffen

2014-10-01

To provide empirical knowledge about the antecedents and outcomes of workaholism among municipal middle managers within the framework of the job demands-resources model. We used a self-administered questionnaire to collect cross-sectional data (n = 118) on job demands, job resources, work engagement, workaholism, and mental health problems. Workaholism correlated positively with both work engagement and mental health problems. Job demands affected workaholism and mental health problems more strongly than did job resources. The results indicate that workaholism does not mediate the effects of certain work characteristics on mental health problems, but rather that workaholics create excessive job demands that harm their health. Preventing workaholism should be a central concern of municipal stakeholders because workaholic behavior among middle managers may harm organizational performance and employee health and middle managers' own health.
A Survey of Factors Affecting Workplace Performance and Career Advancement of Black Women Administrators in Middle and Upper Level Management Positions in Community Colleges. Summary of Findings.

ERIC Educational Resources Information Center

Johnson, Marguerite; And Others

In 1991, a survey was conducted of 150 black female administrators at the department chair level and above at 65 community colleges in 19 states. The questionnaire solicited information on respondent characteristics, such as age, degrees, and salary, and their perceptions of the degree to which each of 20 variables positively or negatively…
Middle and Elementary School Students’ Changes in Self-Determined Motivation in a Basketball Unit Taught using the Tactical Games Model

PubMed Central

Harvey, Stephen; Gil-Arias, Alexander; Smith, Megan Lorraine; Smith, Lindsey Rachel

2017-01-01

Abstract Studies examining student motivation levels suggest that this is a significant factor in students’ engagement in physical education and may be positively affected when teachers employ alternative pedagogical models such as game-centered approaches (GCAs). The aim of this study was to investigate changes in self-determined motivation of students as they participated in a GCA-basketball unit taught using the Tactical Games Model (TGM). Participants were 173 students (84 girls), 79 middle school (45 girls) and 94 (39 girls) elementary school students from four seventh and five fourth/fifth grade co-educational classes. Two teachers taught 32 (middle) and 33 (elementary) level one TGM basketball lessons. Need satisfaction and self-determined motivation data were collected using a previously validated instrument, while lesson context and teacher behavior data were recorded using systematic observation instruments. Repeated measures MANOVAs were employed to examine pre-posttest differences. Results revealed a significant main effect for time in need satisfaction for both middle (relatedness increased) and elementary school students (autonomy decreased) and a significant main effect in self-determined motivation for middle school students only (introjected regulation, external regulation, and amotivation all increased). Approximately 48%/42% (middle/elementary) of lesson time was game play, 22%/22% skill practice, 17%/17% management, and 13%/19% knowledge. The primary teacher behaviors used were instruction, management, specific observation, corrective feedback and modelling. Results indicate that it is important for future research to pay greater attention to the contextual factors associated with the application of the TGM, such as the students’ previous exposure to TGM lessons, and the teachers’ training and experience in utilizing the TGM. Indeed, results of the present study demonstrate that a longer-term commitment to the TGM is necessary to reduce controlling teacher behaviors, which will lead to positive changes in students’ need satisfaction and self-determined motivation. Future research is therefore needed to embrace this challenge to provide an increased evidence-base for GCAs such as the TGM. PMID:29134047
Middle and Elementary School Students' Changes in Self-Determined Motivation in a Basketball Unit Taught using the Tactical Games Model.

PubMed

Harvey, Stephen; Gil-Arias, Alexander; Smith, Megan Lorraine; Smith, Lindsey Rachel

2017-10-01

Studies examining student motivation levels suggest that this is a significant factor in students' engagement in physical education and may be positively affected when teachers employ alternative pedagogical models such as game-centered approaches (GCAs). The aim of this study was to investigate changes in self-determined motivation of students as they participated in a GCA-basketball unit taught using the Tactical Games Model (TGM). Participants were 173 students (84 girls), 79 middle school (45 girls) and 94 (39 girls) elementary school students from four seventh and five fourth/fifth grade co-educational classes. Two teachers taught 32 (middle) and 33 (elementary) level one TGM basketball lessons. Need satisfaction and self-determined motivation data were collected using a previously validated instrument, while lesson context and teacher behavior data were recorded using systematic observation instruments. Repeated measures MANOVAs were employed to examine pre-posttest differences. Results revealed a significant main effect for time in need satisfaction for both middle (relatedness increased) and elementary school students (autonomy decreased) and a significant main effect in self-determined motivation for middle school students only (introjected regulation, external regulation, and amotivation all increased). Approximately 48%/42% (middle/elementary) of lesson time was game play, 22%/22% skill practice, 17%/17% management, and 13%/19% knowledge. The primary teacher behaviors used were instruction, management, specific observation, corrective feedback and modelling. Results indicate that it is important for future research to pay greater attention to the contextual factors associated with the application of the TGM, such as the students' previous exposure to TGM lessons, and the teachers' training and experience in utilizing the TGM. Indeed, results of the present study demonstrate that a longer-term commitment to the TGM is necessary to reduce controlling teacher behaviors, which will lead to positive changes in students' need satisfaction and self-determined motivation. Future research is therefore needed to embrace this challenge to provide an increased evidence-base for GCAs such as the TGM.
Classroom Management Strategies of Highly Effective Teachers in Diverse Middle Schools: Be Strict and Calm, Not Mean

ERIC Educational Resources Information Center

McGregor, Katheryne L.

2012-01-01

This qualitative research study investigated and identified the classroom management strategies of 12 highly effective middle school teachers who served diverse student populations at two different school sites. In addition, this research explored the beliefs and experiences of 305 diverse middle school students regarding their experiences with…
A Nascent Look at Theoretical Frameworks in Middle Level Education Research

ERIC Educational Resources Information Center

Reyes, Cynthia; Netcoh, Steven

2015-01-01

This paper describes a qualitative content analysis of research articles published on middle level education in the last decade. This analysis was conducted on manuscripts appearing in two premier middle level education journals: "Middle Grades Research Journal" (MGRJ) and "Research in Middle Level Education Online" (RMLE) to…
Training Middle Managers of South African Public Schools in Leadership and Management Skills

ERIC Educational Resources Information Center

Mampane, Sharon Thabo

2017-01-01

The purpose of this conceptual explanatory research is to highlight the importance of training of Middle Managers or Heads of Department (HoDs) in leadership and management in South African public schools. Leadership responsibilities in schools are becoming more complex to the extent that principals can no longer be sole leaders in schools. The…
Can hospital dashboards provide visibility of information from bedside to board? A case study approach.

PubMed

Pace, Adriana; Buttigieg, Sandra C

2017-04-10

Purpose The purpose of this paper is to analyse hospital dashboards' visibility of information at different management levels to improve quality and performance in an acute general hospital. Design/methodology/approach Data were generated via 21 semi-structured interviews across different management levels. Findings All management levels had greater visibility of information, could make informed decisions, and registered performance improvement. Specifically, waiting time improved, however since introduction of hospital dashboards was work-in-progress at time of study, managers could not record improvement in terms of cost reductions, clinical effectiveness, patient safety and patient satisfaction. Different managerial levels had different visibility with top management having the greatest. Research limitations/implications In single case studies, where only one context is used, the findings cannot be reproduced in different contexts; even though most of the results could be matched with the current literature. Practical implications The need to have balanced key performance indicators that take into account other facets of improvements, apart from time, has been emphasised. Furthermore, if middle and departmental managers have greater visibility, this would allow them to work towards a strategic fit between the departments that they manage with the rest of the hospital. Originality/value There is scant literature regarding performance dashboards' enhancement of visibility of information at different management levels. Furthermore, according to the authors' knowledge, no other paper has tried to identify and discuss the different levels of information, which should be visible from bedside to board namely to management, clinicians and public.
Monitoring Seasonal Land Subsidence and Uplift in the Green Valley Area of the Tucson Active Management Area Groundwater Basin, Southern Arizona using Interferometric Synthetic Aperture Radar (InSAR) Data and Global Navigation Satellite System (GNSS) Data

NASA Astrophysics Data System (ADS)

Conway, B. D.

2013-12-01

The Green Valley land subsidence feature is located in southern Arizona, approximately 20 miles south of the Tucson metropolitan area within the town of Sahuarita. Groundwater levels fluctuate as much as 110 feet annually, caused by seasonal pumping demands of a nearby pecan orchard. Recent Arizona Department of Water Resources (ADWR) InSAR data and GNSS survey data reveal that seasonal land subsidence and subsequent uplift are occurring as a direct result of seasonal groundwater level fluctuations. Data from a nearby ADWR transducer shows that the groundwater level begins to decline around middle to late February, dropping as much as 110 feet by the end of June. Groundwater levels generally remain somewhat stable until the middle of October, when the groundwater level begins to rise. Groundwater levels will rise as much as 110 feet by the middle of February; a complete 12-month recovery. ADWR InSAR and GNSS survey data show that land subsidence occurs from February until May followed by a stable period, then uplift occurs from October to February. The Green Valley land subsidence feature is a dynamic hydrogeological system that requires continued deformation monitoring using both InSAR and GNSS data. Radarsat-2 Interferograms that illustrate both seasonal subsidence and uplift. Surveyed elevation and groundwater level change data that document how seasonal groundwater fluctuations result in seasonal land subsidence and uplift.
The 21st Century Challenges and the Food-Energy-Water-Security (FEWS) Nexus in the Middle East Region

NASA Astrophysics Data System (ADS)

Moradkhani, H.; Hameed, M.

2017-12-01

Developing countries have experienced crucial conditions in meeting the needs for food, energy, and water security. This paper presents a country-level quantitative assessment of the current issues associated with the Food-Energy-Water-Security (FEWS) Nexus in the Middle East region. In this study, sixteen countries in the Middle East region are chosen, namely, Arabian Peninsula, Iran, Syria, Lebanon, Israel, Palestine, Egypt, and Turkey. The most recent datasets are used to study and analyze the factors that have emerged the demand to understand and manage the linkage of FEW systems in the region. Water scarcity, extreme events, population growth, urbanization, economic growth, poverty, and political stability are found to be the key drivers of the current challenges in the Middle East region. Additionally, the results suggest that these factors have created a subsequent stress on FEW resources specifically on water sector in the region. Therefore, more attention is required to sustain the FEW resources and cope with the socio-economic development.
Toward a Middle-Range Theory of Weight Management.

PubMed

Pickett, Stephanie; Peters, Rosalind M; Jarosz, Patricia A

2014-07-01

The authors of this paper present the middle-range theory of weight management that focuses on cultural, environmental, and psychosocial factors that influence behaviors needed for weight control. The theory of weight management was developed deductively from Orem's theory of self-care, a constituent theory within the broader self-care deficit nursing theory and from research literature. Linkages between the conceptual and middle-range theory concepts are illustrated using a substruction model. The development of the theory of weight management serves to build nursing science by integrating extant nursing theory and empirical knowledge. This theory may help predict weight management in populations at risk for obesity-related disorders. © The Author(s) 2014.
Therapist-child interaction in the middle minutes of sensory integration treatment.

PubMed

Dunkerley, E; Tickle-Degnen, L; Coster, W J

1997-01-01

The purpose of this study was to describe the management of challenge during therapist-child interaction in sensory integration treatment. This descriptive and relational study of the middle minutes of treatment sessions partially replicated an earlier study of the beginning minutes. One-minute videotape clips taken from the middle minutes of 38 treatment sessions were shown to therapist judges who rated qualities of therapist and child behavior. Two patterns emerged from the correlations of ratings: work and playfulness. Work for the child involved trying hard, cooperating and seeking assistance, whereas work for the therapist involved assisting and guiding the child. Play for the child included enjoying the activity, being successful and confident, and trying hard. For the therapist, play involved being creative and behaving playfully. Patterns of work and play were different across different levels of challenge to the child.
Five Approaches to Avoid When Managing the Middle School Classroom

ERIC Educational Resources Information Center

Englehart, Joshua M.

2013-01-01

Too often, teachers encountering difficulties with classroom management focus only on the students rather than critically examining the influence of their own approaches on student behavior. Given the particular challenges that middle school students present, certain practices and expectations exacerbate management issues, and a lack of awareness…
Examining the Perception of the Order versus Freedom Dilemma in University Management

ERIC Educational Resources Information Center

Karaferye, Figen; Agaoglu, Esmahan

2017-01-01

This study aims to analyze how the middle management at university handle with the order versus freedom dilemma--bureaucratic discipline, professional expertise; coordination, communication; managerial planning and individual initiative by giving a university case. A survey was applied on two different sample groups. 607 middle managers and…
Family Help and Homework Management Reported by Middle School Students.

ERIC Educational Resources Information Center

Xu, Jianzhong; Corno, Lyn

2003-01-01

This study drew on survey data from 121 urban middle school students to define features of homework management. Findings indicated that arranging the environment and controlling emotions related systematically to family help with homework. Homework management indices were unrelated to standardized achievement test scores. Findings generated…
Effect of Middle-Level Leader and Teacher Emotional Intelligence on School Teachers' Job Satisfaction: The Case of Hong Kong

ERIC Educational Resources Information Center

Wong, Chi-Sum; Wong, Ping-Man; Peng, Kelly Z.

2010-01-01

Emotional intelligence (EI) has been an emerging topic for educational, psychological and management researchers and consultants in recent years. Despite the emerging consensus of its definition and evidence reported in business organizations, relatively little empirical evidence have been reported in the education literature. We conducted two…

Stress Education Curriculum: Grades 6-12, Middle and High School Levels. Revised Fourth Edition.

ERIC Educational Resources Information Center

Trotter, Jennie C.

Everyone experiences stress; there is no escaping it. This manual is concerned with teaching young people various positive coping skills to help them handle stress in their lives. It is designed to help professionals such as teachers, nurses, school counselors, and youth recreational leaders teach students lessons on stress management. It is…
School-Wide Positive Behavior Support: Effects on Pennsylvania High School Achievement, Discipline, and Climate

ERIC Educational Resources Information Center

Fox, Jon David

2013-01-01

Teachers and administrators are faced with managing the behaviors of students while preparing for the high stakes testing associated with the No Child Left Behind Act. One program that has demonstrated positive results at the elementary and middle school level is the school-wide positive behavior support model (SWPBS). Limited research is…
Identifying the Training Needs of Heads of Department in a Newly Established University in Vietnam

ERIC Educational Resources Information Center

Nguyen, Thi Lan Huong

2012-01-01

Although middle-level academic managers really need training in order to perform their roles adequately in the very changing context of higher education, little formal training is provided, particularly in less developed countries. This paper identifies the training needs of Heads of Department in a newly established university in Vietnam as a…
The Labour Market Impacts of High Technology: Implications for the Universities.

ERIC Educational Resources Information Center

Selleck, Laura J.

Implications for universities of high technology industries and the labor market are unclear. There is a need to ease the transition for those categories of workers who will be affected: women, low- and medium-skill workers in manufacturing, and certain categories of middle-level managers. The provision of highly qualified personnel is the…
Decision Styles and Rationality: An Analysis of the Predictive Validity of the General Decision-Making Style Inventory

ERIC Educational Resources Information Center

Curseu, Petru Lucian; Schruijer, Sandra G. L.

2012-01-01

This study investigates the relationship between the five decision-making styles evaluated by the General Decision-Making Style Inventory, indecisiveness, and rationality in decision making. Using a sample of 102 middle-level managers, the results show that the rational style positively predicts rationality in decision making and negatively…
Confronting the Neo-Liberal Brute: Reflections of a Higher Education Middle-Level Manager

ERIC Educational Resources Information Center

Maistry, S. M.

2012-01-01

The higher education scenario in South Africa is fraught with tensions and contradictions. Publicly funded Higher Education Institutions (HEIs) face a particular dilemma. They are expected to fulfill a social mandate which requires a considered response to the needs of the communities in which they are located while simultaneously aspiring for…
School Ethnicity and Governance Influences on Work Absence of Teachers and School Administrators

ERIC Educational Resources Information Center

Rosenblatt, Zehava; Shirom, Arie

2006-01-01

Purpose: The purpose of the study was to examine the extent to which school ethnic affiliation (Jewish vs. Arab) and site-based management affected the absence of teachers and school administrators. Research Design: Background individual and organization-level data on the population of elementary and middle-school teachers (52, 056 teachers at 2,…
Medical Abortion Provision by Pharmacies and Drug Sellers in Low- and Middle-Income Countries: A Systematic Review.

PubMed

Footman, Katharine; Keenan, Katherine; Reiss, Kate; Reichwein, Barbara; Biswas, Pritha; Church, Kathryn

2018-03-01

We undertook a systematic review to assess 1) the level and quality of pharmacy and drug shop provision of medical abortion (MA) in low- and middle-income countries (LMICs) and 2) interventions to improve quality of provision. We used standardized terms to search six databases for peer-reviewed and grey literature. We double-extracted data using a standardized template, and double-graded studies for methodological quality. We identified 22 studies from 16 countries reporting on level and quality of MA provision through pharmacies and drug sellers, and three intervention studies. Despite widespread awareness and provision of MA drugs, even in legally restricted contexts, most studies found that pharmacy workers and drug sellers had poor knowledge of effective regimens. Evidence on interventions to improve pharmacy and drug shop provision of MA was limited and generally low quality, but indicated that training could be effective in improving knowledge. Programmatic attention should focus on the development and rigorous evaluation of innovative interventions to improve women's access to information about MA self-management in low-and middle-income countries. © 2018 The Population Council, Inc.
Curbing the urge to care: A Bourdieusian analysis of the effect of the caring disposition on nurse middle managers' clinical leadership in patient safety practices.

PubMed

Lalleman, P C B; Smid, G A C; Lagerwey, M D; Shortridge-Baggett, L M; Schuurmans, M J

2016-11-01

Nurse managers play an important role in implementing patient safety practices in hospitals. However, the influence of their professional background on their clinical leadership behaviour remains unclear. Research has demonstrated that concepts of Bourdieu (dispositions of habitus, capital and field) help to describe this influence. It revealed various configurations of dispositions of the habitus in which a caring disposition plays a crucial role. We explore how the caring disposition of nurse middle managers' habitus influences their clinical leadership behaviour in patient safety practices. Our paper reports the findings of a Bourdieusian, multi-site, ethnographic case study. Two Dutch and two American acute care, mid-sized, non-profit hospitals. A total of 16 nurse middle managers of adult care units. Observations were made over 560h of shadowing nurse middle managers, semi-structured interviews and member check meetings with the participants. We observed three distinct configurations of dispositions of the habitus which influenced the clinical leadership of nurse middle managers in patient safety practices; they all include a caring disposition: (1) a configuration with a dominant caring disposition that was helpful (via solving urgent matters) and hindering (via ad hoc and reactive actions, leading to quick fixes and 'compensatory modes'); (2) a configuration with an interaction of caring and collegial dispositions that led to an absence of clinical involvement and discouraged patient safety practices; and (3) a configuration with a dominant scientific disposition showing an investigative, non-judging, analytic stance, a focus on evidence-based practice that curbs the ad hoc repertoire of the caring disposition. The dispositions of the nurse middle managers' habitus influenced their clinical leadership in patient safety practices. A dominance of the caring disposition, which meant 'always' answering calls for help and reactive and ad hoc reactions, did not support the clinical leadership role of nurse middle managers. By perceiving the team of staff nurses as pseudo-patients, patient safety practice was jeopardized because of erosion of the clinical disposition. The nurse middle managers' clinical leadership was enhanced by leadership behaviour based on the clinical and scientific dispositions that was manifested through an investigative, non-judging, analytic stance, a focus on evidence-based practice and a curbed caring disposition. Copyright © 2016 Elsevier Ltd. All rights reserved.
Potentiometric surface of the upper Floridan aquifer, west-central Florida, May 2011

USGS Publications Warehouse

Ortiz, Anita G.

2011-01-01

The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing freshwater are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public supply, domestic use, irrigation, and brackish water desalination in coastal communities (Southwest Florida Water Management District, 2000). This map report shows the potentiometric surface of the Upper Floridan aquifer measured in May 2011. The potentiometric surface is an imaginary surface connecting points of equal altitude to which water will rise in tightly-cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the dry season, when groundwater levels usually are at an annual low and withdrawals for agricultural use typically are high. The cumulative average rainfall of 45.74 inches for west-central Florida (from June 2010 through May 2011) was 6.85 inches below the historical cumulative average of 52.59 inches (Southwest Florida Water Management District, 2011). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District. This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September from 1975 through 2010. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during the period May 23-27, 2011. Supplemental water-level data were collected by other agencies and companies. Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a "snapshot" of conditions at a specific time, nor do they necessarily coincide with the seasonal low water-level condition.
Potentiometric Surface of the Upper Floridan Aquifer, West-central Florida, May 2010

USGS Publications Warehouse

Ortiz, A.G.

2010-01-01

The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing fresh water are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public supply, domestic use, irrigation, and brackish water desalination in coastal communities (Southwest Florida Water Management District, 2000). This map report shows the potentiometric surface of the Upper Floridan aquifer measured in May 2010. The potentiometric surface is an imaginary surface connecting points of equal altitude to which water will rise in tightly-cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the dry season, when groundwater levels usually are at an annual low and withdrawals for agricultural use typically are high. The cumulative average rainfall of 55.21 inches for west-central Florida (from June 2009 through May 2010) was 2.55 inches above the historical cumulative average of 52.66 inches (Southwest Florida Water Management District, 2010). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District. This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September since 1975. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during the period May 17-21, 2010. Supplemental water-level data were collected by other agencies and companies. Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a 'snapshot' of conditions at a specific time, nor do they necessarily coincide with the seasonal low water-level condition.
Leadership for safety: industrial experience.

PubMed

Flin, R; Yule, S

2004-12-01

The importance of leadership for effective safety management has been the focus of research attention in industry for a number of years, especially in energy and manufacturing sectors. In contrast, very little research into leadership and safety has been carried out in medical settings. A selective review of the industrial safety literature for leadership research with possible application in health care was undertaken. Emerging findings show the importance of participative, transformational styles for safety performance at all levels of management. Transactional styles with attention to monitoring and reinforcement of workers' safety behaviours have been shown to be effective at the supervisory level. Middle managers need to be involved in safety and foster open communication, while ensuring compliance with safety systems. They should allow supervisors a degree of autonomy for safety initiatives. Senior managers have a prime influence on the organisation's safety culture. They need to continuously demonstrate a visible commitment to safety, best indicated by the time they devote to safety matters.
Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PubMed Central

Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-01-01

Abstract Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. PMID:28369396
Extreme groundwater levels caused by extreme weather conditions - the highest ever measured groundwater levels in Middle Germany and their management

NASA Astrophysics Data System (ADS)

Reinstorf, F.

2016-12-01

Extreme weather conditions during the years 2009 - 2011 in combination with changes in the regional water management and possible impacts of climate change led to maximum groundwater levels in large areas of Germany in 2011. This resulted in extensive water logging, with problems especially in urban areas near rivers, where water logging produced huge problems for buildings and infrastructure. The acute situation still exists in many areas and requires the development of solution concepts. Taken the example of the Elbe-Saale-Region in the Federal State of Saxony-Anhalt, were a pilot research project was carried out, the analytical situation, the development of a management tool and the implementation of a groundwater management concept are shown. The central tool is a coupled water budget - groundwater flow model. In combination with sophisticated multi-scale parameter estimation, a high resolution groundwater level simulation was carried out. A decision support process with a very intensive stakeholder interaction combined with high resolution simulations enables the development of a management concept for extreme groundwater situations in consideration of sustainable and environmentally sound solutions mainly on the base of passive measures.
Extreme groundwater levels caused by extreme weather conditions - the highest ever measured groundwater levels in Middle Germany and their management

NASA Astrophysics Data System (ADS)

Reinstorf, Frido; Kramer, Stefanie; Koch, Thomas; Seifert, Sven; Monninkhoff, Bertram; Pfützner, Bernd

2017-04-01

Extreme weather conditions during the years 2009 - 2011 in combination with changes in the regional water management and possible impacts of climate change led to maximum groundwater levels in large areas of Germany in 2011. This resulted in extensive water logging, with problems especially in urban areas near rivers, where water logging produced huge problems for buildings and infrastructure. The acute situation still exists in many areas and requires the development of solution concepts. Taken the example of the Elbe-Saale-Region in the Federal State of Saxony-Anhalt, were a pilot research project was carried out, the analytical situation, the development of a management tool and the implementation of a groundwater management concept are shown. The central tool is a coupled water budget - groundwater flow model. In combination with sophisticated multi-scale parameter estimation, a high resolution groundwater level simulation was carried out. A decision support process with a very intensive stakeholder interaction combined with high resolution simulations enables the development of a management concept for extreme groundwater situations in consideration of sustainable and environmentally sound solutions mainly on the base of passive measures.
The Quality Improvement Management Approach as Implemented in a Middle School.

ERIC Educational Resources Information Center

Bayless, David L.; And Others

1992-01-01

The Total Quality Management Theory of W. E. Deming can be adapted within an educational organization to build structures that support educators' beliefs. A case study of the implementation of Deming principles at the LeRoy Martin Middle School in Raleigh (North Carolina) illustrates the effectiveness of this management approach. (SLD)
Teachers' Perceptions of Effective Classroom Management within an Inner-City Middle School.

ERIC Educational Resources Information Center

Turner, Catana L.

This study was undertaken to obtain descriptive information about teachers' perceptions of effective classroom management within an inner-city middle school. Thirteen teachers in one such school in Tennessee were interviewed about their classroom management behaviors. Teachers appeared to have an elaborate system of beliefs related to the themes…
Middle Managers in UK Higher Education Conceptualising Experiences in Support of Reflective Practice

ERIC Educational Resources Information Center

Birds, Rachel

2014-01-01

This paper examines the role of reflexivity in supporting middle managers in understanding and facilitating large-scale change management projects in their organisations. Utilising an example from a UK university, it is argued that the development of a conceptual model to fit local circumstances enables deeper understanding and better informed…
Schooling the Middle Manager. Professional Study No. 5406.

ERIC Educational Resources Information Center

Robinson, George D.

The aim of this study is to evaluate industrial approaches to management development programs to ascertain the applicability of using similar schooling techniques in Air Force managerial development. The primary emphasis is on where the Air Force might benefit from industry's experience in the middle manager area. An additional objective is the…
Middle School Teachers' Perceptions of Barriers of Managing Student Behavior

ERIC Educational Resources Information Center

Whitlock, Winifred Nicole

2012-01-01

Despite training and support, many middle school teachers struggle to create, implement, and enforce research-based strategies to manage students' behaviors. The purpose of this case study was to examine teachers' perceptions about the barriers of managing student behavior. The research questions investigated 9 teachers' perceived…

Follow-up of an elementary school intervention for asthma management: do gains last into middle school?

PubMed

Greenberg, Cindy; Luna, Pamela; Simmons, Gretchen; Huhman, Marian; Merkle, Sarah; Robin, Leah; Keener, Dana

2010-06-01

Albuquerque Public Schools (APS), in collaboration with the Centers for Disease Control and Prevention, conducted an evaluation to examine whether students who were exposed to the APS asthma program in elementary school retained benefits into middle school. APS middle school students who participated in the APS asthma program in elementary school, including the Open Airways for Schools (OAS) education curriculum, responded to a follow-up questionnaire (N = 121) and participated in student focus groups (N = 40). Asthma management self-efficacy scores from the follow-up questionnaire were compared to scores obtained before and after the OAS education component. Additional items assessed students' asthma symptoms, management skills, avoidance of asthma triggers, and school impact. Although asthma management self-efficacy scores declined in middle school among students exposed to the asthma program in elementary school, they remained significantly higher than scores obtained during elementary school prior to the OAS intervention. The results indicate that although students benefited from the asthma program delivered in elementary school, they need booster sessions and continued school support in middle school.
Recent floods in the Middle Ebro River, Spain: hydrometeorological aspects and floodplain management

NASA Astrophysics Data System (ADS)

Domenech, S.; Espejo, F.; Ollero, A.; Sánchez-Fabre, M.

2009-09-01

The Ebro River has the largest Mediterranean basin in the Iberian Peninsula and the third one by surface among those of the Mediterranean Sea. The middle stretch of this river is especially interesting because it constitutes a very economically important axis of population in a semi-arid environment context. Flooding processes are common in the Middle Ebro River, but the combination among decrease of discharges, dam construction and expansion and reinforcement of defences created an unusually quiet period as regards flooding events during the last quarter of the previous century. Nevertheless, with the turn of the century it seems that the Middle Ebro River has entered into new dynamics, with bigger and more frequent floods, the appearance of which has changed its seasonal nature. The most relevant examples are those of February 2003 and March-April 2007. The present paper examines these recent trends and discusses their possible causes from the points of view of hydro-meteorology, flood management through the use of reservoirs, and floodplain management. The consequences of recent floods in the Middle Ebro River have reopened the debate about possible risk management measures.
Potentiometric Surface of the Upper Floridan Aquifer, West-Central Florida, September 2006

USGS Publications Warehouse

Ortiz, A.G.

2007-01-01

The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing freshwater are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public supply, domestic use, irrigation, and brackish water desalination in coastal communities (Southwest Florida Water Management District, 2000). This map report shows the potentiometric surface of the Upper Floridan aquifer measured in September 2006. The potentiometric surface is an imaginary surface connecting points of equal altitude to which water will rise in tightly cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the wet season, when ground-water levels usually are at an annual high and withdrawals for agricultural use typically are low. The cumulative average rainfall of 46.06 inches for west-central Florida (from October 2005 through September 2006) was 6.91 inches below the historical cumulative average of 52.97 inches (Southwest Florida Water Management District, 2006). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District. This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September since 1975. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during September 18-22, 2006. Supplemental water-level data were collected by other agencies and companies. A corresponding potentiometric-surface map was prepared for areas east and north of the Southwest Florida Water Management District boundary by the U.S. Geological Survey office in Orlando, Florida (Kinnaman, 2007). Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a 'snapshot' of conditions at a specific time, nor do they necessarily coincide with the seasonal high water-level condition.
Potentiometric surface of the Upper Floridan aquifer, west-central Florida, September 2005

USGS Publications Warehouse

Ortiz, A.G.

2006-01-01

The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing freshwater are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public-supply, domestic use, irrigation, and brackish-water desalination in coastal communities (Southwest Florida Water Management District, 2000).This map report shows the potentiometric surface of the Upper Floridan aquifer measured in September 2005. The potentiometric surface is an imaginary surface, connecting points of equal altitude to which water will rise in tightly cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the wet season, when ground-water levels usually are at an annual high and withdrawals for agricultural use typically are low. The cumulative average rainfall of 55.19 inches for west-central Florida (from October 2004 through September 2005) was 2.00 inches above the historical cumulative average of 53.19 inches (Southwest Florida Water Management District, 2005). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District.This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September since 1975. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during the period September 19-23, 2005. Supplemental water-level data were collected by other agencies and companies. A corresponding potentiometric-surface map was prepared for areas east and north of the Southwest Florida Water Management District boundary by the U.S. Geological Survey office in Altamonte Springs, Florida (Kinnaman, 2006). Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a "snapshot" of conditions at a specific time, nor do they necessarily coincide with the seasonal high water-level condition.
Potentiometric Surface of the Upper Floridan Aquifer, West-Central Florida, September 2007

USGS Publications Warehouse

Ortiz, A.G.

2008-01-01

The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing fresh water are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public supply, domestic use, irrigation, and brackish water desalination in coastal communities (Southwest Florida Water Management District, 2000). This map report shows the potentiometric surface of the Upper Floridan aquifer measured in September 2007. The potentiometric surface is an imaginary surface connecting points of equal altitude to which water will rise in tightly-cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the wet season, when ground-water levels usually are at an annual high and withdrawals for agricultural use typically are low. The cumulative average rainfall of 39.50 inches for west-central Florida (from October 2006 through September 2007) was 13.42 inches below the historical cumulative average of 52.92 inches (Southwest Florida Water Management District, 2007). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District. This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September since 1975. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during the period September 17-21, 2007. Supplemental water-level data were collected by other agencies and companies. A corresponding potentiometric-surface map was prepared for areas east and north of the Southwest Florida Water Management District boundary by the U.S. Geological Survey office in Orlando, Florida (Kinnaman and Dixon, 2008). Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a 'snapshot' of conditions at a specific time, nor do they necessarily coincide with the seasonal high water-level condition.
Potentiometric Surface of the Upper Floridan Aquifer, West-Central Florida, September 2008

USGS Publications Warehouse

Ortiz, Anita G.

2009-01-01

The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing fresh water are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public supply, domestic use, irrigation, and brackish water desalination in coastal communities (Southwest Florida Water Management District, 2000). This map report shows the potentiometric surface of the Upper Floridan aquifer measured in September 2008. The potentiometric surface is an imaginary surface connecting points of equal altitude to which water will rise in tightly-cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the wet season, when ground-water levels usually are at an annual high and withdrawals for agricultural use typically are low. The cumulative average rainfall of 50.63 inches for west-central Florida (from October 2007 through September 2008) was 2.26 inches below the historical cumulative average of 52.89 inches (Southwest Florida Water Management District, 2008). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District. This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September since 1975. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during the period September 15-19, 2008. Supplemental water-level data were collected by other agencies and companies. A corresponding potentiometric-surface map was prepared for areas east and north of the Southwest Florida Water Management District boundary by the U.S. Geological Survey office in Orlando, Florida (Kinnaman and Dixon, 2009). Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a 'snapshot' of conditions at a specific time, nor do they necessarily coincide with the seasonal high water-level condition.
Potentiometric Surface of the Upper Floridan Aquifer, West-Central Florida, May 2008

USGS Publications Warehouse

Ortiz, A.G.

2008-01-01

The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing fresh water are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public supply, domestic use, irrigation, and brackish water desalination in coastal communities (Southwest Florida Water Management District, 2000). This map report shows the potentiometric surface of the Upper Floridan aquifer measured in May 2008. The potentiometric surface is an imaginary surface connecting points of equal altitude to which water will rise in tightly-cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the dry season, when ground-water levels usually are at an annual low and withdrawals for agricultural use typically are high. The cumulative average rainfall of 46.95 inches for west-central Florida (from June 2007 through May 2008) was 5.83 inches below the historical cumulative average of 52.78 inches (Southwest Florida Water Management District, 2008). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District. This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September since 1975. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during the period May 19-23, 2008. Supplemental water-level data were collected by other agencies and companies. A corresponding potentiometric-surface map was prepared for areas east and north of the Southwest Florida Water Management District boundary by the U.S. Geological Survey office in Orlando, Florida (Kinnaman and Dixon, 2008). Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a 'snapshot' of conditions at a specific time, nor do they necessarily coincide with the seasonal low water-level condition.
Potentiometric Surface of the Upper Floridan Aquifer, West-Central Florida, May 2007

USGS Publications Warehouse

Ortiz, A.G.

2008-01-01

The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing fresh water are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public supply, domestic use, irrigation, and brackish water desalination in coastal communities (Southwest Florida Water Management District, 2000). This map report shows the potentiometric surface of the Upper Floridan aquifer measured in May 2007. The potentiometric surface is an imaginary surface connecting points of equal altitude to which water will rise in tightly-cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the dry season, when ground-water levels usually are at an annual low and withdrawals for agricultural use typically are high. The cumulative average rainfall of 41.21 inches for west-central Florida (from June 2006 through May 2007) was 11.63 inches below the historical cumulative average of 52.84 inches (Southwest Florida Water Management District, 2007). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District. This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September since 1975. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during the period May 21-25, 2007. Supplemental water-level data were collected by other agencies and companies. A corresponding potentiometric-surface map was prepared for areas east and north of the Southwest Florida Water Management District boundary by the U.S. Geological Survey office in Orlando, Florida (Kinnaman and Dixon, 2007). Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a 'snapshot' of conditions at a specific time, nor do they necessarily coincide with the seasonal low water-level condition.
Maintained Individual Data Distributed Likelihood Estimation (MIDDLE)

PubMed Central

Boker, Steven M.; Brick, Timothy R.; Pritikin, Joshua N.; Wang, Yang; von Oertzen, Timo; Brown, Donald; Lach, John; Estabrook, Ryne; Hunter, Michael D.; Maes, Hermine H.; Neale, Michael C.

2015-01-01

Maintained Individual Data Distributed Likelihood Estimation (MIDDLE) is a novel paradigm for research in the behavioral, social, and health sciences. The MIDDLE approach is based on the seemingly-impossible idea that data can be privately maintained by participants and never revealed to researchers, while still enabling statistical models to be fit and scientific hypotheses tested. MIDDLE rests on the assumption that participant data should belong to, be controlled by, and remain in the possession of the participants themselves. Distributed likelihood estimation refers to fitting statistical models by sending an objective function and vector of parameters to each participants’ personal device (e.g., smartphone, tablet, computer), where the likelihood of that individual’s data is calculated locally. Only the likelihood value is returned to the central optimizer. The optimizer aggregates likelihood values from responding participants and chooses new vectors of parameters until the model converges. A MIDDLE study provides significantly greater privacy for participants, automatic management of opt-in and opt-out consent, lower cost for the researcher and funding institute, and faster determination of results. Furthermore, if a participant opts into several studies simultaneously and opts into data sharing, these studies automatically have access to individual-level longitudinal data linked across all studies. PMID:26717128
Middle manager involvement in strategy development in not-for profit organizations: the director of nursing perspective--how organizational structure impacts on the role.

PubMed

Carney, M

2004-01-01

An attempt was made to link organizational structure and strategic management and, in the process, to identify how organizational structure impacts on the strategic management role of Directors of Nursing working in acute care hospitals in the Republic of Ireland. Directors of Nursing are recognized as holding a pivotal role in health care delivery. The need for their involvement in strategic management is acknowledged, yet it is not clear if this role is influenced by organizational structure. It is recognized that strategic involvement increases the likelihood that middle managers' initiatives will be in line with top management's concept of corporate strategy. The principal thesis is that organizational members will exercise a higher level of strategic consensus if they have been initially involved in the development of strategy. The study was undertaken in not-for-profit health service organizations, through a series of 25 semi-structured interviews with Directors of Nursing. The review of the literature was undertaken simultaneously with grounded theory analysis of the interviews. This research suggests that structure does impact on the role, conferring both positive benefits and negative consequences. Structure is identified in this study, in terms of organizational hierarchy, and the locus of control pertaining in each organization. Two predominating structure models are discussed and analysed.
GMAT versus Alternatives: Predictive Validity Evidence from Central Europe and the Middle East

ERIC Educational Resources Information Center

Koys, Daniel

2010-01-01

The author found that the GPA at the end of the MBA program is most accurately predicted by the Graduate Management Admission Test (GMAT) and the Test of English as a Foreign Language (TOEFL). MBA GPA is also predicted, though less accurately, by the Scholastic Level Exam, a mathematics test, undergraduate GPA, and previous career progression. If…
Vocational Profiles and Training Requirements of Foremen and Overseers in the Textile/Clothing Sector in Portugal.

ERIC Educational Resources Information Center

Pereira, Licinio Chainho; And Others

A study examined the current needs of middle management in the textile and clothing industry in Portugal. Focus was on Level 3--foremen, overseers, and team leaders. Eight of 400 enterprises responded to the first questionnaire; 370 of 1,000 responded to the revised questionnaire. The following data were collected: number of employees according to…
The Evolution of the MasAgro Hubs: Responsiveness and Serendipity as Drivers of Agricultural Innovation in a Dynamic and Heterogeneous Context

ERIC Educational Resources Information Center

Camacho-Villa, Tania Carolina; Almekinders, Conny; Hellin, Jon; Martinez-Cruz, Tania Eulalia; Rendon-Medel, Roberto; Guevara-Hernández, Francisco; Beuchelt, Tina D.; Govaerts, Bram

2016-01-01

Purpose: Little is known about effective ways to operationalize agricultural innovation processes. We use the MasAgro program in Mexico (which aims to increase maize and wheat productivity, profitability and sustainability), and the experiences of middle level "hub managers", to understand how innovation processes occur in heterogeneous…
How Are Alabama's Teachers Integrating the International Society for Technology in Education (ISTE) Standards in the Classroom: Measuring Technology Integration's IMPACT--Roberts Middle School.

ERIC Educational Resources Information Center

Ash, Stephanie B.; Sun, Feng; Sundin, Robert

Alabama's Preparing Tomorrow's Teachers To Use Technology program developed an assessment instrument to measure the level of technology integration into Alabama's classrooms. The instrument asked questions related to five factors: (1) general instruction integration; (2) teaching students to use technology; (3) managing technology resources; (4)…
Homework Management Scale: Confirming the Factor Structure with Middle School Students in China

ERIC Educational Resources Information Center

Xu, Jianzhong; Fan, Xitao; Du, Jianxia

2015-01-01

This study presents a psychometric evaluation of the Homework Management Scale (HMS) for mathematics, consisting of five subscales for measuring homework management strategies. Confirmatory factor analyses were conducted with a sample of middle school students (N = 796). Results indicated that the factor structure of the Chinese version of the HMS…
Teachers in Need of Space: The Content and Changing Context of Work

ERIC Educational Resources Information Center

Mulholland, Rosie; McKinlay, Andy; Sproule, John

2017-01-01

To further understand differential perceptions of work and wellbeing this paper considers the influence of gender and years in current role (YCR). We surveyed 399 secondary school teachers (class teachers n = 185; middle managers n = 175 and senior managers n = 38) from the central belt of Scotland. Sixty-six per cent of middle managers reported…
Supporting Academic Middle Managers in Higher Education: Do We Care?

ERIC Educational Resources Information Center

Floyd, Alan

2016-01-01

In the current higher education environment, the need to develop and support good leaders and managers could hardly be more pressing. Yet, research on how academic middle managers are supported in their roles is surprisingly sparse. The purpose of this paper is to address this perceived gap in the literature by reporting on the findings from two…
Workplace Participatory Occupational Health/Health Promotion Program

PubMed Central

Zhang, Yuan; Flum, Marian; Kotejoshyer, Rajashree; Fleishman, Jane; Henning, Robert; Punnett, Laura

2018-01-01

Nursing home employees experience high physical and psychosocial workloads, resulting in poor health outcomes. An occupational health/health promotion program, designed to facilitate employee participation, was initiated in three nursing homes. The aim of the current study was to evaluate facilitators and barriers of the program after 3-year implementation. Focus groups with employees and in-depth interviews with top and middle managers were conducted. The Social Ecological Model was used to organize the evaluation. Facilitators and barriers were reported from both managers’ and employees’ perspectives, and were categorized as intrapersonal, interpersonal, institutional, and corporate level. Management support, financial resources, and release time for participation were identified as the three most important factors. Supports from multiple levels including both human and environment, and managers and employees, are important for a successful participatory occupational health/health promotion program. PMID:26977705
Delivery of Type 2 diabetes care in low- and middle-income countries: lessons from Lima, Peru.

PubMed

Cardenas, M K; Miranda, J J; Beran, D

2016-06-01

The health system's response is crucial to addressing the increasing burden of diabetes, particularly that affecting low- and middle-income countries. This study aims to assess the facilitators and barriers that help or hinder access to care for people with diabetes in Peru. We used a survey tool to design and collect qualitative and quantitative data from primary and secondary sources of information at different levels of the health system. We performed 111 interviews in Lima, the capital city of Peru, with patients with diabetes, healthcare providers and healthcare officials. We applied the six building blocks framework proposed by the World Health Organization in our analysis. We found low political commitment, as well as several barriers that directly affect access to medicines, regular laboratory check-ups and follow-up appointments for diabetes, especially at the primary healthcare level. Three major system-level barriers were identified: (1) the availability of information at different healthcare system levels that affects several processes in the healthcare provision; (2) insufficient financial resources; and (3) insufficient human resources trained in diabetes management. Despite an initial political commitment by the Peruvian government to improve the delivery of diabetes care, there exist several key limitations that affect access to adequate diabetes care, especially at the primary healthcare level. In a context in which various low- and middle-income countries are aiming to achieve universal health coverage, this study provides lessons for the implementation of strategies related to diabetes care delivery. © 2016 Diabetes UK.
The role of leadership perception as a mediator between managers' self-monitoring and subordinate attitudes.

PubMed

Özalp Türetgen, Ilknur; Unsal, Pinar; Dural, Uzay

2017-01-01

Although the role of social cognition in leadership perception has been emphasized frequently in recent years, research using this approach in an organizational context is rare. This study investigated subordinates' perceptions of their managers as leaders (that is, to what extent they perceive their manager as a leader) as a potential mediating factor explaining the relationship between managers' self-monitoring and their subordinates' attitudes toward their organizations. The study was carried out with middle-level managers (N = 64) and their subordinates (N = 210) from various business organizations in Turkey. Results indicate that subordinates' leadership perceptions of their managers mediate the relationship between managers' self-monitoring and their subordinates' affective and normative organizational commitment. These results provide insight into some of the antecedents and outcomes of leadership perception.

Desks, Dollars, and Deficits: Managing a Middle School during a Recession.

ERIC Educational Resources Information Center

Merrill, Adeline B.

1992-01-01

A brief history of East Ridge Middle School in Connecticut illustrates the strong economic and demographic pressures that can work against a middle school. The principal plays a crucial role in preserving both the structure and the programs of an effective middle school. Points out strategies to protect and develop middle schools in tough economic…
Teacher Research at the Middle Level: Strengthening the Essential Attributes of Education for Young Adolescents

ERIC Educational Resources Information Center

DiLucchio, Connie; Leaman, Heather; Elicker, Kathleen; Mathisen, Denise

2014-01-01

Teacher research (practitioner inquiry) is an effective form of professional development for middle level teachers. Through teacher research, classroom teachers develop the skills needed to demonstrate mastery of the performance standards for middle level master teacher candidates. Using well-established research methods, middle level educators…
Middle Level Education in Rural Communities: Implications for School Leaders

ERIC Educational Resources Information Center

Thomas, Douglas D.

2005-01-01

Middle level teachers and administrators working in small or rural schools often face unique obstacles in implementing recommended middle level practices. From sharing staff and schedules with other school sites, to inappropriate instructional techniques, to a general lack of understanding of the middle level philosophy, these obstacles can be a…
Occupational Outlets for Middle Level Training. What Is the Future of Middle Level Training?

ERIC Educational Resources Information Center

Mills, Paul; Cesnich, Janine

This project intended to determine whether a middle-level employment base existed in manufacturing and service industries in South Australia and to examine current trends and future directions of middle-level (paraprofessional) vocational training. The study used the following methods: literature review; labor market analysis; surveys of…
Specialized Preparation for Middle Level Teachers: A National Review of Teacher Preparation Programs

ERIC Educational Resources Information Center

Howell, Penny B.; Faulkner, Shawn A.; Cook, Chris M.; Miller, Nicole C.; Thompson, Nicole L.

2016-01-01

Since William Alexander's (1963, 1995) call for attention to the need for specialized middle level teacher preparation in 1963, 45 states have created requirements for middle level certification, licensure, or endorsement (Association for Middle Level Education [AMLE], 2014) which have led to institutions of teacher preparation creating routes…
Comprehensive and Critical Review of Middle Grades Research and Practice 2000-2013

ERIC Educational Resources Information Center

Yoon, Bogum; Malu, Kathleen F.; Schaefer, Mary Beth; Reyes, Cynthia; Brinegar, Kathleen

2015-01-01

This article synthesizes reports of middle grades research and practice from 2000-2013 that appeared in "Middle Grades Research Journal," "Middle School Journal," and "Research in Middle Level Education Online," 3 publications that specifically and exclusively report on middle level research and practice. This…
Information flow and work productivity through integrated information technology

NASA Technical Reports Server (NTRS)

Wigand, R. T.

1985-01-01

The work environment surrounding integrated office systems is reviewed. The known effects of automated office technologies is synthesized and their known impact on work efficiency is reviewed. These effects are explored with regard to their impact on networks, work flow/processes, as well as organizational structure and power. Particular emphasis is given to structural changes due to the introduction of newer information technologies in organizations. The new information technologies have restructed the average organization's middle banks and, as a consequence, they have shrunk drastically. Organizational pyramids have flattened with fewer levels since executives have realized that they can get ahold of the needed information via the new technologies quicker and directly and do not have to rely on middle-level managers. Power shifts are typically accompanied with the introduction of these technologies resulting in the generation of a new form of organizational power.
Developing Female Middle-Managers in Australian Universities

ERIC Educational Resources Information Center

Wallace, Michelle; Marchant, Teresa

2009-01-01

Universities should be developing female middle-managers for reasons of gender balance (Aitkin in "The Last Boilerhouse Address," Canberra University 2001), the skills shortage, pending mass retirements (Chesterman in "Not doable jobs? Exploring senior women's attitudes to leadership roles in universities." Women's Higher…
Assessing teachers' positive psychological functioning at work: Development and validation of the Teacher Subjective Wellbeing Questionnaire.

PubMed

Renshaw, Tyler L; Long, Anna C J; Cook, Clayton R

2015-06-01

This study reports on the initial development and validation of the Teacher Subjective Wellbeing Questionnaire (TSWQ) with 2 samples of educators-a general sample of 185 elementary and middle school teachers, and a target sample of 21 elementary school teachers experiencing classroom management challenges. The TSWQ is an 8-item self-report instrument for assessing teachers' subjective wellbeing, which is operationalized via subscales measuring school connectedness and teaching efficacy. The conceptualization and development processes underlying the TSWQ are described, and results from a series of preliminary psychometric and exploratory analyses are reported to establish initial construct validity. Findings indicated that the TSWQ was characterized by 2 conceptually sound latent factors, that both subscales and the composite scale demonstrated strong internal consistency, and that all scales demonstrated convergent validity with self-reported school supports and divergent validity with self-reported stress and emotional burnout. Furthermore, results indicated that TSWQ scores did not differ according to teachers' school level (i.e., elementary vs. middle), but that they did differ according to unique school environment (e.g., 1 middle school vs. another middle school) and teacher stressors (i.e., general teachers vs. teachers experiencing classroom management challenges). Results also indicated that, for teachers experiencing classroom challenges, the TSWQ had strong short-term predictive validity for psychological distress, accounting for approximately half of the variance in teacher stress and emotional burnout. Implications for theory, research, and the practice of school psychology are discussed. (c) 2015 APA, all rights reserved).
Managing Nonsuicidal Self-Injury in Schools: Use of a Structured Protocol to Manage the Behavior and Prevent Social Contagion

ERIC Educational Resources Information Center

Walsh, Barent; Muehlenkamp, Jennifer J.

2013-01-01

Nonsuicidal self-injury (NSSI) such as cutting, burning, self-hitting, and abrading is currently occurring at high rates in middle schools, high schools, and universities. This article focuses on understanding and managing NSSI strategically within middle and high school settings. The need for, and specific components of, a thorough staff training…
The Impact of Managerialism on the Strategy Work of University Middle Managers

ERIC Educational Resources Information Center

Davis, Annemarie; Jansen van Rensburg, Mari; Venter, Peet

2016-01-01

In an attempt to understand the effects of managerialism on university managers in a developing country, we set out to gather rich data on the strategy work of middle managers through a single case study at a South African university. Managerialism has the potential to solve inefficiencies in university systems and processes, as it could help to…
Middle Level Teacher Certification in South Carolina: A Case Study in Educational Policy Development

ERIC Educational Resources Information Center

Virtue, David C.

2007-01-01

South Carolina made a significant step forward in middle level education reform by enacting middle level teacher certification in 2001. This qualitative case study documents the process through which the state legislation developed, with a particular focus on how middle level teacher certification arrived and remained on the public policy agenda…
Leadership in Middle Level Education. Volume I: A National Survey of Middle Level Leaders and Schools.

ERIC Educational Resources Information Center

Valentine, Jerry W.; And Others

The National Association of Secondary School Principals periodically studies practices and characteristics of secondary schools to help inform educators and shape policy. Such studies of middle-level education were conducted in 1966 and 1981. As middle-level education moved into the 1990s, many new questions about education and leadership needed…
Spatial distribution and health risk assessment of toxic metals associated with receptor population density in street dust: a case study of Xiandao District, Changsha, Middle China.

PubMed

Li, Fei; Huang, Jinhui; Zeng, Guangming; Huang, Xiaolong; Liu, Wenchu; Wu, Haipeng; Yuan, Yujie; He, Xiaoxiao; Lai, Mingyong

2015-05-01

Spatial characteristics of the properties (dust organic material and pH), concentrations, and enrichment levels of toxic metals (Ni, Hg, Mn and As) in street dust from Xiandao District (Middle China) were investigated. Method of incorporating receptor population density into noncarcinogenic health risk assessment based on local land use map and geostatistics was developed to identify their priority pollutants/regions of concern. Mean enrichment factors of studied metals decreased in the order of Hg ≈ As > Mn > Ni. For noncarcinogenic effects, the exposure pathway which resulted in the highest levels of exposure risk for children and adults was ingestion except Hg (inhalation of vapors), followed by dermal contact and inhalation. Hazard indexes (HIs) for As, Hg, Mn, and Ni to children and adults revealed the following order: As > Hg > Mn > Ni. Mean HI for As exceeded safe level (1) for children, and the maximum HI (0.99) for Hg was most approached the safe level. Priority regions of concern were indentified in A region at each residential population density and the areas of B at high and moderate residential population density for As and the high residential density area within A region for Hg, respectively. The developed method was proved useful due to its improvement on previous study for making the priority areas of environmental management spatially hierarchical and thus reducing the probability of excessive environmental management.
Patients’ management of type 2 diabetes in Middle Eastern countries: review of studies

PubMed Central

Alsairafi, Zahra Khalil; Taylor, Kevin Michael Geoffrey; Smith, Felicity J; Alattar, Abdulnabi T

2016-01-01

The increased prevalence of diabetes in Middle Eastern countries is a health policy priority. Important risk factors for diabetes have been identified. Lifestyle interventions and adherence to medications are central to disease prevention and management. This review focuses on the management of type 2 diabetes mellitus in Middle Eastern countries. The aim is to identify the ways in which knowledge, health beliefs, and social and cultural factors influence adherence to medication and lifestyle measures. Thirty-four studies were identified following a systematic search of the literature. The studies describe the influence of knowledge, health beliefs, culture, and lifestyle on the management of type 2 diabetes mellitus in the Middle East. Findings indicate a lack of health knowledge about diabetes among populations, which has implications for health behaviors, medication adherence, and treatment outcomes. Many identified health beliefs and cultural lifestyle factors, such as religious beliefs, beliefs about fasting during Ramadan, and sedentary lifestyles played a role in patients’ decisions. For better management of this disease, a collaborative approach between patients, their families, health care professionals, and governments should be adopted. Implementing behavioral strategies and psychological interventions that incorporate all health care professionals in the management process have been shown to be effective methods. Such services help patients change their behavior. However, the utilization of such services and interventions is still limited in Arabian countries. Physicians in the Middle East are the health care professionals most involved in the care process. PMID:27354775
Patients' management of type 2 diabetes in Middle Eastern countries: review of studies.

PubMed

Alsairafi, Zahra Khalil; Taylor, Kevin Michael Geoffrey; Smith, Felicity J; Alattar, Abdulnabi T

2016-01-01

The increased prevalence of diabetes in Middle Eastern countries is a health policy priority. Important risk factors for diabetes have been identified. Lifestyle interventions and adherence to medications are central to disease prevention and management. This review focuses on the management of type 2 diabetes mellitus in Middle Eastern countries. The aim is to identify the ways in which knowledge, health beliefs, and social and cultural factors influence adherence to medication and lifestyle measures. Thirty-four studies were identified following a systematic search of the literature. The studies describe the influence of knowledge, health beliefs, culture, and lifestyle on the management of type 2 diabetes mellitus in the Middle East. Findings indicate a lack of health knowledge about diabetes among populations, which has implications for health behaviors, medication adherence, and treatment outcomes. Many identified health beliefs and cultural lifestyle factors, such as religious beliefs, beliefs about fasting during Ramadan, and sedentary lifestyles played a role in patients' decisions. For better management of this disease, a collaborative approach between patients, their families, health care professionals, and governments should be adopted. Implementing behavioral strategies and psychological interventions that incorporate all health care professionals in the management process have been shown to be effective methods. Such services help patients change their behavior. However, the utilization of such services and interventions is still limited in Arabian countries. Physicians in the Middle East are the health care professionals most involved in the care process.
Physiological and Psychological Effects of a Forest Therapy Program on Middle-Aged Females.

PubMed

Ochiai, Hiroko; Ikei, Harumi; Song, Chorong; Kobayashi, Maiko; Miura, Takashi; Kagawa, Takahide; Li, Qing; Kumeda, Shigeyoshi; Imai, Michiko; Miyazaki, Yoshifumi

2015-12-01

The natural environment is increasingly recognized as an effective counter to urban stress, and "Forest Therapy" has recently attracted attention as a relaxation and stress management activity with demonstrated clinical efficacy. The present study assessed the physiological and psychological effects of a forest therapy program on middle-aged females. Seventeen Japanese females (62.2 ± 9.4 years; mean ± standard deviation) participated in this experiment. Pulse rate, salivary cortisol level, and psychological indices were measured on the day before forest therapy and on the forest therapy day. Pulse rate and salivary cortisol were significantly lower than baseline following forest therapy, indicating that subjects were in a physiologically relaxed state. Subjects reported feeling significantly more "comfortable," "relaxed," and "natural" according to the semantic differential (SD) method. The Profile of Mood State (POMS) negative mood subscale score for "tension-anxiety" was significantly lower, while that for "vigor" was significantly higher following forest therapy. Our study revealed that forest therapy elicited a significant (1) decrease in pulse rate, (2) decrease in salivary cortisol levels, (3) increase in positive feelings, and (4) decrease in negative feelings. In conclusion, there are substantial physiological and psychological benefits of forest therapy on middle-aged females.
The Effects of Mother Education Programs on the Functionality, Anger Management and Conflict Solution Levels of Families

ERIC Educational Resources Information Center

Kabasakal, Zekavet

2013-01-01

Problem Statement: Studies carried out in recent years both in Turkey and abroad indicate that child and teenage violence has increased and become widespread. Annually, 91.1% of deaths due to violence in the world occur in low and middle-income countries. Family life is an important element in understanding violent behavior as it relates to family…
Organizational Cultural Factors Hindering Women Ascending to Top Management Positions in Public Universities in Kenya: A Case of Moi University

ERIC Educational Resources Information Center

Makori, Rebecca S.; Onyango, Maria; Attyang, Judith Miguda; Bantu, Edward; Onderi, Peter Omae

2016-01-01

It is observed that the major setback to economic development in Kenya is stagnation in industrial development. To overcome these, Kenya plans to be a middle level income nation by the year 2030. These plans are to be realized through "Vision 2030." To achieve these goals, Kenya requires gender mainstreamed team of highly skilled workers…
Leaders for a Movement: Professional Preparation and Development of Middle Level Teachers and Administrators. The Handbook of Research in Middle Level Education.

ERIC Educational Resources Information Center

Andrews, P. Gayle, Ed.; Anfara, Vincent A., Jr., Ed.

Papers included in this volume include: "Leaders for Movement: An Introduction to the Professional Preparation and Development of Middle Level Teachers and Administrators" (P. Gayle Andrews and Vincent A. Anfara, Jr.); (1) "Middle Level Teacher Preparation: Status, Progress, and Challenges" (C. Kenneth McEwin, Tracy W. Smith,…

Effects of the weight management program based self-efficacy for body composition, blood lipid profile, weight self-efficacy lifestyles, depression in middle-aged obese women.

PubMed

Park, Nam Hee; An, Hye Gyung

2006-12-01

This study was done to determine the effects of weight management program using self-efficacy in middle-aged obese women. The study also attempted to measure the effects of the program on the weight efficacy lifestyle, body composition, and depression. The research design of this study was a nonequivalent control group pretest-posttest design. The experimental group consisted of 21 middle-aged obese women and another 21 middle-aged obese women in the control group. The women in the experimental group participated in the weight management program for 12 weeks using self-efficacy. The weight management program using self-efficacy included education on effects of exercise for weight control, aerobic exercise program, muscle training and counseling through the telephone. After 12 weeks of participation in the program, BMI (p<.0001), body fat % (p<.0001), abdominal fat (p<.0001), in the experimental group were significantly decreased compared to the control group. Weight self-efficacy lifestyle (p<.0001) and depression (p=.006) in the experimental group were significantly improved after the program compared to the control group. According to these findings, weight management program self-efficacy for middle-aged obese women could increase weight efficacy lifestyle, and decrease depression, BMI, body fat, and abdominal fat. The result also suggested that the increasing weight efficacy and lifestyle help the obese women to perform and continue exercise. This program could be used in the community such as public health center for weight care and mental health promotion of middle-aged obese women.
Trust into Mistrust: The Uncertain Marriage between Public and Private Sector Practice for Middle Managers in Education

ERIC Educational Resources Information Center

Thompson, Carol; Wolstencroft, Peter

2018-01-01

The role of the middle manager has proved to be a difficult one to define due to the fluid nature of the tasks performed and the heterogeneity of understanding that exists for the term. This is further complicated by the differences associated with the context in which individual manager's work. This research, which explores the drive towards…
The Rating of High-Performing Principals' Performance on Their Leadership Dimensions by Senior Administrators, Middle Managers and Classroom Teachers

ERIC Educational Resources Information Center

Hutton, Disraeli Montgomery

2016-01-01

The purpose of the study was to determine if there was a difference in the ratings among senior administrators/managers, middle managers and classroom teachers of the four dimensions of leadership performance related to high-performing principals in the Jamaican public school system. The study showed that there were differences in how senior…
The Middle Eastern Regional Irrigation Management Information Systems project-update

USDA-ARS?s Scientific Manuscript database

The Middle Eastern Regional Irrigation Management Information Systems Project (MERIMIS) was formulated at a meeting of experts from the region in Jordan in 2003. Funded by the U.S. Department of State, it is a cooperative regional project bringing together participants from Israel, Jordan, Palestini...
Middle East Regional Irrigation Management Information Systems project-Some science products

USDA-ARS?s Scientific Manuscript database

Similarities in the aridity of environments and water scarcity for irrigation allow common approaches to irrigation management problems and research methods in the Southern Great Plains of the United States and the Middle East. Measurement methods involving weighing lysimeters and eddy covariance sy...
A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences.

PubMed

Mousavi, Seyed Mohammad Hadi; Dargahi, Hossein; Mohammadi, Sara

2016-10-01

Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it seems there are a lot of challenges in this way. Therefore, it is suggested that a detailed audit is conducted among hospitals' current status regarding different characteristics of HROs, and workshops are held for medical and non-medical employees and managers of hospitals as an influencing factor; and a re-assessment process afterward, can help moving the hospitals from their current position towards an HROs culture.
A study of the effects of active listening on listening attitudes of middle managers.

PubMed

Kubota, Shinya; Mishima, Norio; Nagata, Shoji

2004-01-01

The present study was conducted to clarify the direct effects of active listening (AL) training given to middle managers in a local government. Altogether, 345 middle managers participated in 13 AL training sessions over two years. We developed the Inventive Experiential Learning (IEL) method, and used it as the central training method in this study. To investigate how well the participants learned AL, we asked the middle managers to answer a shorter version of the Active Listening Attitude Scale (ALAS) consisting of two subscales-i.e. "Listening Attitude" and "Listening Skill"-before training, one month after and three months after training. Altogether, 284 middle managers answered the questionnaire three times. The scores of each subscale were analyzed by repeated measurement analysis of variance. The participants were divided into three groups using the percentile values of the original sample of ALAS, i.e. low-score group (-24%), medium-score group (25-75%) and high-score group (76%-), and the proportionate changes were examined. The results showed both the "Listening Attitude" and "Listening Skill" subscales increased significantly after training. Analysis of the percentiles showed that the proportion of the low-score group decreased and that of the high-score group increased in both subscales, from one to three months after training. These changes are considered to indicate that the participants have learned AL although they attended AL training for only one day.
Leader Derailment in Academe: Does the Training Match the Problems?

ERIC Educational Resources Information Center

Williams, Feruzan Irani; Campbell, Constance; McCartney, William; Gooding, Carl

2012-01-01

Leader derailment of middle managers in higher education is most often attributable to self-defeating behaviors (SDBs) and problems with interpersonal relationships (PIRs). This study attempted to determine whether training provided for middle managers in Academe sufficiently addresses these issues. Our findings suggest that while little more than…
Japanese Adolescents' Disclosure and Information Management with Parents

ERIC Educational Resources Information Center

Nucci, Larry; Smetana, Judith; Araki, Noriyuki; Nakaue, Masataka; Comer, Jessamy

2014-01-01

Adolescents' obligation to disclose and their actual disclosure about their activities to parents, justifications for nondisclosure, and strategies for information management were examined in different domains in 460 middle adolescents (M[subscript age] = 16.6 years) from working and middle-class families in Japan. Adolescents felt most obligated…
Classroom Management and Students' Self-Esteem: Creating Positive Classrooms

ERIC Educational Resources Information Center

Demirdag, Seyithan

2015-01-01

Middle school students experience substantial changes in their emotion and cognition while they grow. They have mixed feelings, which may negatively affect their motivation, self-esteem, and academic success due to different classroom management strategies of their teachers. There is available research about motivation of middle school students…
Strategic Innovation in HE: The Roles of Academic Middle Managers

ERIC Educational Resources Information Center

Kallenberg, Ton

2007-01-01

This article explains the development of, and presents a theoretical framework for, harnessing the roles of the academic middle manager in strategic innovation in Dutch higher education, thereby increasing higher education's ability to learn, innovate and develop a competitive advantage. The framework is developed from theoretical models of role…
Eight Truths for Middle Managers in Lean Times.

ERIC Educational Resources Information Center

Lewis, David W.

1991-01-01

Suggests strategies to help middle managers in libraries cope with difficult financial times. Highlights include resource allocations; the importance of change to prevent a decline in quality and to demonstrate some degree of control; the need to control both financial and staff resources; and providing vision for the future. (LRW)
America's Middle Schools: Practices and Progress. A 25 Year Perspective.

ERIC Educational Resources Information Center

McEwin, C. Kenneth; And Others

The 1990s will likely be a watershed period for middle level education, as the real challenges surrounding making "second level" changes replace the euphoria that accompanied early growth of the middle school movement. Yet, zealousness still characterizes reform efforts at the middle level. This study, the most comprehensive ever…
Leadership for safety: industrial experience

PubMed Central

Flin, R; Yule, S

2004-01-01

The importance of leadership for effective safety management has been the focus of research attention in industry for a number of years, especially in energy and manufacturing sectors. In contrast, very little research into leadership and safety has been carried out in medical settings. A selective review of the industrial safety literature for leadership research with possible application in health care was undertaken. Emerging findings show the importance of participative, transformational styles for safety performance at all levels of management. Transactional styles with attention to monitoring and reinforcement of workers' safety behaviours have been shown to be effective at the supervisory level. Middle managers need to be involved in safety and foster open communication, while ensuring compliance with safety systems. They should allow supervisors a degree of autonomy for safety initiatives. Senior managers have a prime influence on the organisation's safety culture. They need to continuously demonstrate a visible commitment to safety, best indicated by the time they devote to safety matters. PMID:15576692
Middle-Level Reform in High- And Low-Performing Middle Schools: A Question of Implementation?

ERIC Educational Resources Information Center

Roney, Kathleen; Brown, Kathleen M.; Anfara, Vincent A., Jr.

2004-01-01

Although reports calling for middle level schooling reform first appeared in the mid-1970s, change has been slow to come. In Turning Points: Preparing American Youth for the 21st Century (1989), the Carnegie Council on Adolescent Development outlined eight essential elements of middle level education. Drawing from the Carnegie Council's…
Teacher Preferences for Middle Grades: Insights into Attracting Teacher Candidates

ERIC Educational Resources Information Center

Radcliffe, Rich A.; Mandeville, Thomas F.

2007-01-01

Shortages of middle-level teacher candidates may cause teacher educators to recruit candidates by focusing on what attracts and discourages candidates about teaching at the middle level. The authors used a survey approach (n = 110) to investigate why preservice middle school and high school teachers and in-service middle school teachers chose the…
Chronic disease self-management education courses: utilization by low-income, middle-aged participants.

PubMed

Horrell, Lindsey N; Kneipp, Shawn M; Ahn, SangNam; Towne, Samuel D; Mingo, Chivon A; Ory, Marcia G; Smith, Matthew Lee

2017-06-27

Individuals living in lower-income areas face an increased prevalence of chronic disease and, oftentimes, greater barriers to optimal self-management. Disparities in disease management are seen across the lifespan, but are particularly notable among middle-aged adults. Although evidence-based Chronic Disease Self-management Education courses are available to enhance self-management among members of this at-risk population, little information is available to determine the extent to which these courses are reaching those at greatest risk. The purpose of this study is to compare the extent to which middle-aged adults from lower- and higher-income areas have engaged in CDSME courses, and to identify the sociodemographic characteristics of lower-income, middle aged participants. The results of this study were produced through analysis of secondary data collected during the Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. During this initiative, data was collected from 100,000 CDSME participants across 45 states within the United States, the District of Columbia, and Puerto Rico. Of the entire sample included in this analysis (19,365 participants), 55 people lived in the most impoverished counties. While these 55 participants represented just 0.3% of the total study sample, researchers found this group completed courses more frequently than participants from less impoverished counties once enrolled. These results signal a need to enhance participation of middle-aged adults from lower-income areas in CDSME courses. The results also provide evidence that can be used to inform future program delivery choices, including decisions regarding recruitment materials, program leaders, and program delivery sites, to better engage this population.
Validation of the Competencies Needed by Vocational Education Teachers, Middle Managers, and Administrators. Phase II of a Professional Development Study for Massachusetts, Volume I.

ERIC Educational Resources Information Center

Boston Univ., MA. School of Education.

This is the first of four volumes reporting phase 2 of a two-phase project to examine the competency-based vocational teacher education movement and analyze the current state of the art (phase 1), and to assess the implications for preservice, inservice, and leadership level professional development programs in career and occupational education in…
Everything I know about business I learned from monopoly.

PubMed

Orbanes, Phil

2003-01-01

Is there an analogy for business to the beginning, middle, and end rhythm in games? Phil Orbanes thinks so. A good manager might engineer these types of shifts over the course of a critical project--and be prepared for different moods and levels of motivation from people. In this article, one of the world's foremost board game designers reflects on what makes people want to compete--and win.
Supportive and palliative care for metastatic breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

PubMed

Cleary, James; Ddungu, Henry; Distelhorst, Sandra R; Ripamonti, Carla; Rodin, Gary M; Bushnaq, Mohammad A; Clegg-Lamptey, Joe N; Connor, Stephen R; Diwani, Msemo B; Eniu, Alexandru; Harford, Joe B; Kumar, Suresh; Rajagopal, M R; Thompson, Beti; Gralow, Julie R; Anderson, Benjamin O

2013-10-01

Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced-stage disease. While cure is not a realistic outcome, site-specific interventions, supportive care, and palliative care can achieve meaningful outcomes and improve quality of life. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three resource-stratified tables: health system resource allocations, resource allocations for organ-based metastatic breast cancer, and resource allocations for palliative care. These tables illustrate how health systems can provide supportive and palliative care services for patients at a basic level of available resources, and incrementally add services as more resources become available. The health systems table includes health professional education, patient and family education, palliative care models, and diagnostic testing. The metastatic disease management table provides recommendations for supportive care for bone, brain, liver, lung, and skin metastases as well as bowel obstruction. The third table includes the palliative care recommendations: pain management, and psychosocial and spiritual aspects of care. The panel considered pain management a priority at a basic level of resource allocation and emphasized the need for morphine to be easily available in LMICs. Regular pain assessments and the proper use of pharmacologic and non-pharmacologic interventions are recommended. Basic-level resources for psychosocial and spiritual aspects of care include health professional and patient and family education, as well as patient support, including community-based peer support. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies.

PubMed

Petersen, Inge; Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-06-01

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
Managerial Competencies for Middle Managers: Some Empirical Findings from China

ERIC Educational Resources Information Center

Qiao, June Xuejun; Wang, Wei

2009-01-01

Purpose: This study aims to identify managerial competencies required for successful middle managers in China. Design/methodology/approach: First a questionnaire survey was distributed among MBA and EMBA students at a major university in China, and then two case studies were conducted to collect more in-depth data. Findings: The findings of this…
Body Power! School-Based Weight Management for Middle School Adolescents. Leader's Manual.

ERIC Educational Resources Information Center

Dennee, Phyllis M.; And Others

This leader's manual contains the materials required to present a school-based weight management curriculum that may be offered both in school and outside the school setting for middle-school adolescents. The first section contains instructor information regarding the following topics: need for the program; program objectives; timeline and…
A Quantitative Needs Assessment Technique for Cross-Cultural Work Adjustment Training.

ERIC Educational Resources Information Center

Selmer, Lyn

2000-01-01

A study of 67 Swedish expatriate bosses and 104 local Hong Kong middle managers tested a quantitative needs assessment technique measuring work values. Two-thirds of middle managers' work values were not correctly estimated by their bosses, especially instrumental values (pay, benefits, security, working hours and conditions), indicating a need…
Gender Differences in Career Paths in Banking.

ERIC Educational Resources Information Center

Morgan, Sandra; And Others

1993-01-01

Analyzed career paths of middle managers in bank. Study of matched pairs found that men (n=25) advanced faster and reached middle management through fewer promotions and positions than did women (n=25). Men had significantly more work experience outside of banking. In banking careers, men held more jobs in lending, whereas women occupied more…
Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

PubMed Central

Prabhakaran, Dorairaj; Anand, Shuchi; Watkins, David; Gaziano, Thomas; Wu, Yangfeng; Mbanya, Jean Claude; Nugent, Rachel

2018-01-01

Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action. PMID:29108723
Evaluation of the user requirements processes for NASA terrestrial applications programs

NASA Technical Reports Server (NTRS)

1982-01-01

To support the evolution of increasingly sound user requirements definition processes that would meet the broad range of NASA's terrestrial applications planning and management needs during the 1980's, the user requirements processes as they function in the real world at the senior and middle management levels were evaluated. Special attention was given to geologic mapping and domestic crop reporting to provide insight into problems associated with the development and management of user established conventional practices and data sources. An attempt was made to identify alternative NASA user interfaces that sustain strengths, alleviate weaknesses, maximize application to multiple problems, and simplify management cognizance. Some of the alternatives are outlined and evaluated. It is recommended that NASA have an identified organizational point of focus for consolidation and oversight of the user processes.
[Effective delegation].

PubMed

Fang, Li; Hung, Chich-Hsiu

2008-12-01

Ninety-seven percent of middle level managers feel they face work overload. The source of this problem may lie in a failure to delegate tasks effectively. If a manager does not effectively delegate, he/she is more likely to report fatigue, stress and depression. Conversely, effectively delegating tasks will improve overall job quality, professional growth in subordinates and cooperation within the team. While it is necessary for managers to delegate tasks effectively, few can be considered to be good natural 'delegators'. Learning and training is necessary for managers to develop the necessary confidence and maturity. This article describes the definitions, purpose and benefits of delegation; factors related to effective delegation; strategies related to successful delegation and skills related to performing cross-cultural delegations. Such issues have seldom been addressed in previous articles. Moreover, nursing implications and suggested applications in nursing practice, education, management and research are mentioned. This article is intended to provide directions to nursing managers and subordinates to promote delegation knowledge and skills.
Research on a simulation-based ship production support system for middle-sized shipbuilding companies

NASA Astrophysics Data System (ADS)

Song, Young Joo; Woo, Jong Hun; Shin, Jong Gye

2009-12-01

Today, many middle-sized shipbuilding companies in Korea are experiencing strong competition from shipbuilding companies in other nations. This competition is particularly affecting small- and middle-sized shipyards, rather than the major shipyards that have their own support systems and development capabilities. The acquisition of techniques that would enable maximization of production efficiency and minimization of the gap between planning and execution would increase the competitiveness of small- and middle-sized Korean shipyards. In this paper, research on a simulation-based support system for ship production management, which can be applied to the shipbuilding processes of middle-sized shipbuilding companies, is presented. The simulation research includes layout optimization, load balancing, work stage operation planning, block logistics, and integrated material management. Each item is integrated into a network system with a value chain that includes all shipbuilding processes.
The effects of total dissolved gas on chum salmon fry survival, growth, gas bubble disease, and seawater tolerance

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

Geist, David R.; Linley, Timothy J.; Cullinan, Valerie I.

2013-02-01

Chum salmon Oncorhynchus keta alevin developing in gravel habitats downstream of Bonneville Dam on the Columbia River are exposed to elevated levels of total dissolved gas (TDG) when water is spilled at the dam to move migrating salmon smolts downstream to the Pacific Ocean. Current water quality criteria for the management of dissolved gas in dam tailwaters were developed primarily to protect salmonid smolts and are assumed to be protective of alevin if adequate depth compensation is provided. We studied whether chum salmon alevin exposed to six levels of dissolved gas ranging from 100% to 130% TDG at three developmentmore » periods between hatch and emergence (hereafter early, middle, and late stage) suffered differential mortality, growth, gas bubble disease, or seawater tolerance. Each life stage was exposed for 50 d (early stage), 29 d (middle stage), or 16 d (late stage) beginning at 13, 34, and 37 d post-hatch, respectively, through 50% emergence. The mortality for all stages from exposure to emergence was estimated to be 8% (95% confidence interval (CI) of 4% to 12%) when dissolved gas levels were between 100% and 117% TDG. Mortality significantly increased as dissolved gas levels rose above 117% TDG,; with the lethal concentration that produced 50% mortality (LC50 ) was estimated to be 128.7% TDG (95% CI of 127.2% to 130.2% TDG) in the early and middle stages. By contrast, there was no evidence that dissolved gas level significantly affected growth in any life stage except that the mean wet weight at emergence of early stage fish exposed to 130% TDG was significantly less than the modeled growth of unexposed fish. The proportion of fish afflicted with gas bubble disease increased with increasing gas concentrations and occurred most commonly in the nares and gastrointestinal tract. Early stage fish exhibited higher ratios of filament to lamellar gill chloride cells than late stage fish, and these ratios increased and decreased for early and late stage fish, respectively, as gas levels increased; however, there were no significant differences in mortality between life stages after 96 h in seawater. The study results suggest that current water quality guidelines for the management of dissolved gas appear to offer a conservative level of protection to chum salmon alevin incubating in gravel habitat downstream of Bonneville Dam.« less
Women in healthcare: barriers and enablers from a developing country perspective.

PubMed

Tlaiss, Hayfaa A

2013-06-01

As the under-representation of women in management positions continues to persist globally, little is known about the experiences of women in the healthcare sector in the context of the developing Middle Eastern nations. In an attempt to address this knowledge gap, the current study explores some of the barriers that hinder and the enablers that foster women's career advancement in the healthcare sector. To meet its objectives, the current study uses a relational approach that integrates the macro socio-cultural, meso-organisational, and micro-individual levels of analysis. Guided by institutional theory as a theoretical framework and social constructionism as a philosophical stance, the current study adopts a qualitative research methodology. It capitalizes on in-depth, semi-structured, face-to-face interviews with women managers in different occupational fields, across the managerial hierarchy in the healthcare sector in Lebanon. Snowballing and purposeful sampling procedures were used, and the interviews were analysed using thematic analysis, focusing on identifying new, emerging themes. The results of the study confirm the salience of discriminatory cultural values, gendered social roles and expectations in Middle Eastern societies, and illustrate their role as barriers hindering women's career advancement. The results also portray the spillover effect of societal expectations and cultural gender stereotypes into the organisational realm, resulting in widely experienced attitudinal and structural organisational barriers. This study also illustrates how the enablers that facilitate and promote women's career progression unfold amidst the interplay between the macro and meso factors, lending credence to the role of women's agency at the individual micro level. Amongst the toll of barriers, Middle Eastern women navigate the patriarchy of their cultures and the discrimination inherent in their organisations by using their agency and persistence as they construct and negotiate their careers in management. This study provides new knowledge on the status of Middle Eastern women in the healthcare sector, a sub-category of female employees that to date, is under-researched. It primarily highlights the role of agency in building women's careers. It also stresses the notion that the complexity of women's careers in the healthcare sector can be best understood using a relational approach that highlights the intersectionality between gender, agency, socio-cultural realities and organisational boundaries.
Women in Healthcare: Barriers and Enablers from a Developing Country Perspective

PubMed Central

Tlaiss, Hayfaa A.

2013-01-01

Background: As the under-representation of women in management positions continues to persist globally, little is known about the experiences of women in the healthcare sector in the context of the developing Middle Eastern nations. In an attempt to address this knowledge gap, the current study explores some of the barriers that hinder and the enablers that foster women’s career advancement in the healthcare sector. To meet its objectives, the current study uses a relational approach that integrates the macro socio-cultural, meso-organisational, and micro-individual levels of analysis. Methods: Guided by institutional theory as a theoretical framework and social constructionism as a philosophical stance, the current study adopts a qualitative research methodology. It capitalizes on in-depth, semi-structured, face-to-face interviews with women managers in different occupational fields, across the managerial hierarchy in the healthcare sector in Lebanon. Snowballing and purposeful sampling procedures were used, and the interviews were analysed using thematic analysis, focusing on identifying new, emerging themes. Results: The results of the study confirm the salience of discriminatory cultural values, gendered social roles and expectations in Middle Eastern societies, and illustrate their role as barriers hindering women’s career advancement. The results also portray the spillover effect of societal expectations and cultural gender stereotypes into the organisational realm, resulting in widely experienced attitudinal and structural organisational barriers. This study also illustrates how the enablers that facilitate and promote women’s career progression unfold amidst the interplay between the macro and meso factors, lending credence to the role of women’s agency at the individual micro level. Amongst the toll of barriers, Middle Eastern women navigate the patriarchy of their cultures and the discrimination inherent in their organisations by using their agency and persistence as they construct and negotiate their careers in management. Conclusion: This study provides new knowledge on the status of Middle Eastern women in the healthcare sector, a sub-category of female employees that to date, is under-researched. It primarily highlights the role of agency in building women’s careers. It also stresses the notion that the complexity of women’s careers in the healthcare sector can be best understood using a relational approach that highlights the intersectionality between gender, agency, socio-cultural realities and organisational boundaries. PMID:24596833
How Do Selected Novice Middle School Teachers from Various Certification Pathways Perceive the Effectiveness of Their Teacher Preparation?

ERIC Educational Resources Information Center

Hesson, Nicole

2016-01-01

This study compared the three most common pathways of traditional preparation for novice middle level teachers (elementary, middle level, and secondary) and attempted to answer the central question of which group felt best prepared for middle level teaching. Selected novice teachers from each of the three pathways were interviewed and asked to…
How Do Selected Novice Middle School Teachers from Various Certification Pathways Perceive the Effectiveness of Their Teacher Preparation?

ERIC Educational Resources Information Center

Hesson, Nicole

2016-01-01

This dissertation study compared the three most common pathways of traditional preparation for novice middle level teachers (elementary, middle level, and secondary) and attempted to answer the central question of which group felt best prepared for middle level teaching. Selected novice teachers from each of the three pathways were interviewed and…
Resveratrol reduces the levels of circulating androgen precursors but has no effect on, testosterone, dihydrotestosterone, PSA levels or prostate volume. A 4-month randomised trial in middle-aged men.

PubMed

Kjaer, Thomas Nordstrøm; Ornstrup, Marie Juul; Poulsen, Morten Møller; Jørgensen, Jens Otto Lunde; Hougaard, David Michael; Cohen, Arieh Sierra; Neghabat, Shadman; Richelsen, Bjørn; Pedersen, Steen Bønløkke

2015-09-01

Resveratrol is a naturally occurring polyphenol with purported inhibitory effects on prostate growth and cancer development. A number of studies have demonstrated that resveratrol reduces prostate growth in animal models and reduces prostate cell growth in vitro. Based on these pre-clinical findings, interest in resveratrol is increasing in relation to the management of benign prostate hyperplasia (BPH) and prostate cancer. So far, no human trials have evaluated the effects of resveratrol on circulating androgens, prostate size, or biochemical markers of prostate size. In a randomized placebo controlled clinical study using two doses of resveratrol (150 mg or 1,000 mg resveratrol daily) for 4 months, we evaluated the effects on prostate size, prostate specific antigen (PSA) and sex steroid hormones in 66 middle-aged men suffering from the metabolic syndrome(MetS). At baseline, prostate size and PSA were positively correlated (R = 0.34, P < 0.007) as was prostate size and age (R = 0.37, P < 0.003). Prostate size did not correlate with testosterone, free testosterone, dihydrotestosterone (DHT), or any other androgen precursor at baseline. The highest dose of resveratrol lowered the serum level of androstenedione 24% (P = 0.052), dehydroepiandrosterone (DHEA) 41% (P < 0.01), and dehydroepiandrosterone-sulphate (DHEAS) 50% (p<0.001), compared to the control group. However, prostate size and levels of PSA, testosterone, free testosterone and DHT remained unchanged. In this population of middle-aged men suffering from MetS, high dose resveratrol (1,000 mg daily) administration for 4 months significantly lowered serum levels of the androgen precursors androstenedione, DHEA and DHEAS, whereas prostate size and circulating levels of PSA, testosterone, free testosterone, and dihydrotestosterone were unaffected. The present study suggests that resveratrol does not affect prostate volume in healthy middle-aged men as measured by PSA levels and CT acquired prostate volumes. Consequently, we find no support for the use of resveratrol in the treatment of benign prostate hyperplasia. © 2015 Wiley Periodicals, Inc.
Making Medicare Advantage a Middle-Class Program

PubMed Central

Glazer, Jacob; McGuire, Thomas

2013-01-01

This paper studies the role of Medicare's premium policy in sorting beneficiaries between traditional Medicare (TM) and managed care plans in the Medicare Advantage (MA) program. Beneficiaries vary in their demand for care. TM fully accommodates demand but creates a moral hazard inefficiency. MA rations care but disregards some elements of the demand. We describe an efficient assignment of beneficiaries to these two options, and argue that efficiency requires an MA program oriented to serve the large middle part of the distribution of demand: the “middle class.” Current Medicare policy of a “single premium” for MA plans cannot achieve efficient sorting. We characterize the demand-based premium policy that can implement the efficient assignment of enrollees to plans. If only a single premium is feasible, the second-best policy involves too many of the low-demand individuals in MA and a too low level of services relative to the first best. We identify approaches to using premium policy to revitalize MA and improve the efficiency of Medicare. PMID:23454916
Making Medicare advantage a middle-class program.

PubMed

Glazer, Jacob; McGuire, Thomas G

2013-03-01

This paper studies the role of Medicare's premium policy in sorting beneficiaries between traditional Medicare (TM) and managed care plans in the Medicare advantage (MA) program. Beneficiaries vary in their demand for care. TM fully accommodates demand but creates a moral hazard inefficiency. MA rations care but disregards some elements of the demand. We describe an efficient assignment of beneficiaries to these two options, and argue that efficiency requires an MA program oriented to serve the large middle part of the distribution of demand: the "middle class." Current Medicare policy of a "single premium" for MA plans cannot achieve efficient sorting. We characterize the demand-based premium policy that can implement the efficient assignment of enrollees to plans. If only a single premium is feasible, the second-best policy involves too many of the low-demand individuals in MA and a too low level of services relative to the first best. We identify approaches to using premium policy to revitalize MA and improve the efficiency of Medicare. Copyright © 2012 Elsevier B.V. All rights reserved.
Growing Epidemic of Coronary Heart Disease in Low- and Middle-Income Countries

PubMed Central

Gaziano, Thomas A.; Bitton, Asaf; Anand, Shuchi; Abrahams-Gessel, Shafika; Murphy, Adrianna

2010-01-01

Coronary heart disease (CHD) is the single largest cause of death in the developed countries and is one of the leading causes of disease burden in developing countries. In 2001, there were 7.3 million deaths due to CHD worldwide. Three-fourths of global deaths due to CHD occurred in the low and middle-income countries. The rapid rise in CHD burden in most of the low and middle and income countries is due to socio-economic changes, increase in life span and acquisition of lifestyle related risk factors. The CHD death rate, however, varies dramatically across the developing countries. The varying incidence, prevalence, and mortality rates reflect the different levels of risk factors, other competing causes of death, availability of resources to combat CVD, and the stage of epidemiologic transition that each country or region finds itself. The economic burden of CHD is equally large but solutions exist to manage this growing burden. PMID:20109979
Ambulatory Blood Pressure Monitoring: A Complementary Strategy for Hypertension Diagnosis and Management in Low-Income and Middle-Income Countries.

PubMed

Abdalla, Marwah

2017-02-01

Ambulatory blood pressure monitoring (ABPM) can assess out-of-clinic blood pressure. ABPM is an underutilized resource in low-income and middle-income countries but should be considered a complementary strategy to clinic blood pressure measurement for the diagnosis and management of hypertension. Potential uses for ABPM in low-income and middle-income countries include screening of high-risk individuals who have concurrent communicable diseases, such as HIV, and in task-shifting health care strategies. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Barriers and facilitators for implementing programmes and services to address hyperglycaemia in pregnancy in low and middle income countries: A systematic review.

PubMed

Kragelund Nielsen, Karoline; Damm, Peter; Bygbjerg, Ib C; Kapur, Anil

2018-04-21

An estimated 87.6% of hyperglycaemia in pregnancy cases are in low and middle income countries (LMICs). The aim of this study is to review the evidence on barriers and facilitators to programmes and services addressing hyperglycaemia in pregnancy in LMICs. A systematic review and narrative synthesis was conducted based on searches in PubMed. A total of 23 qualitative and quantitative studies were included. Barriers and facilitators exist at the health system level, individual level and social and societal levels and are often interacting. At the health system level they relate to capacity in terms of human and material resources; availability of feasible and appropriate guidelines; organisational management and referral pathways. Individual level barriers and facilitators include knowledge; risk perception; illness beliefs; financial condition; work obligations; concerns for the baby and hardship associated with services. At the social and societal level important factors are: perceptions and norms related to women's roles, mobility and health; the knowledge and support of women's social network; and structural aspects. Numerous factors influence programmes and services addressing hyperglycaemia in pregnancy in LMICs. Thus, several components are needed to ensure detection, treatment and follow-up of women with hyperglycaemia in pregnancy. Copyright © 2018 Elsevier B.V. All rights reserved.

Will there be a pharmacy leadership crises? An ASHP Foundation Scholar-in-residence report.

PubMed

White, Sara J

2005-04-15

Health-system pharmacy directors, managers, practitioners, students, and employers were surveyed to assess the situation of current and future leaders in pharmacy and generate recommendations for preventing shortages. Online surveys were sent to pharmacy directors, pharmacy middle managers, current pharmacy practitioners pharmacy students, and employers recruiting for management positions using ASHP's membership and CareerPharm databases. Directors, managers, and practitioners were asked about their job satisfaction and future plans. The trends in demographics and attitudes toward the balance between family and work were assessed among directors, managers, practitioners, and students. Employers were asked about their perceived ease of filling managerial positions. While most pharmacy directors and middle managers were satisfied with their current positions, 80% of directors and 77% of middle managers anticipated leaving their jobs in the next decade. Men comprised 72% of directors, 50% of middle managers, 62% of practitioners, and 21% of pharmacy students. The majority of pharmacy students and practitioners reported being married to a working spouse and having children and expressed a desire to balance their personal life with their career. The top reasons cited by students and practitioners for not seeking leadership positions were having to give up clinical practice and competing responsibilities. More than half of employers felt it was more difficult to recruit managers now than it was three years ago. A significant gap in pharmacy leadership in the next 5-10 years is expected, as well as a shift in work force composition and attitude. Mentoring and residencies are important methods of fostering new leaders in the profession.
Isolated Systolic Hypertension in Young and Middle-Aged Adults.

PubMed

Yano, Yuichiro; Lloyd-Jones, Donald M

2016-11-01

Young and middle-aged adults (ages ≤50 years) are increasingly prone to stroke, kidney disease, and worsening cardiovascular disease (CVD) mortality. An alarming increase in the prevalence of high blood pressure (BP) may underlie the adverse trend. However, there is often uncertainty in BP management for young and middle-aged adults. Isolated systolic hypertension (ISH) is one such example. Whether ISH in young and middle-aged adults represents "pseudo" or "spurious" hypertension is still being debated. ISH in young and middle-aged adults is a heterogeneous entity; some individuals appear to have increased stroke volume, whereas others have stiffened aortae, or both. One size does not seem to fit all in the clinical management of ISH in young and middle-aged adults. Rather than treating ISH as a monolithic condition, detailed phenotyping of ISH based on (patho)physiology and in the context of individual global cardiovascular risks would seem to be most useful to assess an individual expected net benefit from therapy. This review provides an overview of the current understanding of ISH in young and middle-aged adults, including the prevalence, pathophysiology, and treatment.
Public-private implementation of integrated emergency response services: Case study of GVK Emergency Management and Research Institute in Karnataka, India.

PubMed

Sriram, Veena M; Gururaj, Gopalkrishna; Hyder, Adnan A

2017-12-01

Emergency medical services are important to the functioning of health systems, but these services tend to be neglected in low- and middle-income countries, such as India. In recent years, several models of pre-hospital emergency medical services have emerged in India. Research on these models holds important lessons for existing and future emergency medical service programs in low- and middle-income countries. Our objective was to provide a comprehensive description of the organizational structure and service delivery model of a public-private partnership in the southern Indian state of Karnataka, GVK Emergency Management and Research Institute, with a particular focus on its operations in Bengaluru. A case study methodology was used to explore systematically the organizational model of GVK Emergency Management and Research Institute in Karnataka. Qualitative data were collected through an in-person site visit to GVK Emergency Management and Research Institute headquarters in Bengaluru in July 2013. Three sources were used: in-depth, semistructured interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization. The organization follows a standardized model across the states and union territories where they have contractual arrangements, including Karnataka. Processes for fleet maintenance, information systems/information technology and training, and deployment were well structured at the organizational level. The public-private partnership appears pro-poor in orientation; however, further demand-side research is required on the perspective of patients. Our study reveals a functional structure at the organizational level, which provides a key service at no cost to users. Detailed analyses of this nature can help inform global efforts for the development and strengthening of emergency medical services systems. Copyright © 2017 Elsevier Inc. All rights reserved.
The Middle Level Principalship. Volume I: A Survey of Middle Level Principals and Programs. Report of National Study of Schools in the Middle.

ERIC Educational Resources Information Center

Valentine, Jerry; And Others

A national questionnaire survey of 1,413 principals of middle-level schools (those offering any combination of grades 5 through 9) gathered data on principals' personal and professional traits, tasks, problems, and opinions on selected educational issues; on school programs; and on student, school, staff, and community characteristics. The data…
Potentiometric Surface of the Upper Floridan Aquifer, West-Central Florida, May 2009

USGS Publications Warehouse

Ortiz, Anita G.

2009-01-01

The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing fresh water are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public supply, domestic use, irrigation, and brackish water desalination in coastal communities (Southwest Florida Water Management District, 2000). This map report shows the potentiometric surface of the Upper Floridan aquifer measured in May 2009. The potentiometric surface is an imaginary surface connecting points of equal altitude to which water will rise in tightly-cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the dry season, when ground-water levels usually are at an annual low and withdrawals for agricultural use typically are high. The cumulative average rainfall of 48.53 inches for west-central Florida (from June 2008 through May 2009) was 4.12 inches below the historical cumulative average of 52.65 inches (Southwest Florida Water Management District, 2009). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District. This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September since 1975. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during the period May 18-22, 2009. Supplemental water-level data were collected by other agencies and companies. A corresponding potentiometric-surface map was prepared for areas east and north of the Southwest Florida Water Management District boundary by the U.S. Geological Survey office in Orlando, Florida (Kinnaman and Dixon, 2009). Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a 'snapshot' of conditions at a specific time, nor do they necessarily coincide with the seasonal low water-level condition. The potentiometric contours are generalized to synoptically portray the head in a dynamic hydrologic system, taking due account of the variations in hydrogeologic conditions, such as differing depths of wells, nonsimultaneous measurements of water levels, variable effects of pumping, and changing climatic influence. The potentiometric contours may not conform exactly with the individual measurements of water levels.
Analysis of Employment Outcomes and Leadership Practices for Middle Managers Completing a Leadership Development Program

ERIC Educational Resources Information Center

Cole, Tammy Denise

2017-01-01

The purpose of this study was to analyze employment outcomes and leadership practices of graduates from a Leadership Excellence for Middle Managers program conducted at a state-operated university from 2007 to 2014. The target population of the leadership development program graduates included representatives from the public and private sector,…
Mismanagement and Quality Circles: How Middle Managers Influence Direct Participation.

ERIC Educational Resources Information Center

Brennan, Maire

1991-01-01

Case studies of five Scottish companies found that four of their quality circles programs had ceased. Essential to the success of quality circles were changes in the systems of reward, communication, and decision making and the cooperation and support of middle managers, who may see quality circles as a threat and who control the resources they…
Development of a School-Wide Behavior Program in a Public Middle School: An Illustration of Deployment-Focused Intervention Development, Stage 1

ERIC Educational Resources Information Center

Molina, Brooke S. G.; Smith, Bradley H.; Pelham, William E., Jr.

2005-01-01

School-wide behavior management systems can improve academic performance and behavior in middle schools, and they should have positive effects on students with ADHD. Unfortunately, evidence-based, school-wide behavior management systems have not been widely adopted because of problems with feasibility, acceptability, and sustainability. The…
Those Who Just Said "NO!": Career-Life Decisions of Middle Management Women in Student Affairs Administration

ERIC Educational Resources Information Center

Collins, Kathy M.

2009-01-01

This study examined the experiences of six female middle managers in student affairs who, while otherwise qualified with experience and an earned doctorate, turned down the opportunity to serve as vice president of student affairs. In-depth purposeful interviews were conducted with each participant, using naturalistic qualitative research methods…
Ohio's Middle Childhood Licensure Study

ERIC Educational Resources Information Center

White, Paula M.; Ross, Diane; Miller, Jennifer; Dever, Robin; Jones, Karen A.

2013-01-01

The purpose of this qualitative study was to describe middle level prepared teachers' perceptions of their practices after completing an Ohio Middle Childhood: Grades 4-9 teacher education program. Using the National Middle School Association/National Council of Accreditation of Teacher Education Initial Level Teacher Preparation Standards (2001)…
Electronic data collection and management system for global adult tobacco survey.

PubMed

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

2012-01-01

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

PubMed

Sibley, Margaret H; Campez, Mileini; Perez, Analay; Morrow, Anne S; Merrill, Brittany M; Altszuler, Amy R; Coxe, Stefany; Yequez, Carlos E

2016-06-01

Organization, Time Management, and Planning (OTP) problems are a key mechanism of academic failure for adolescents with ADHD. Parents may be well positioned to promote remediation of these deficits; yet, almost nothing is known about OTP management behaviors among parents of middle and high school students with ADHD. In a sample of 299 well-diagnosed adolescents with ADHD, a measure of parental OTP management was psychometrically validated. Latent Class Analysis was conducted to detect distinct patterns of parental OTP management and yielded four unique classes: Parental Control (18.7 %), Parent-Teen Collaboration (20.4 %), Homework Assistance (20.4 %), and Uninvolved (40.5 %). Logistic Regression analyses indicated that maladaptive parental OTP strategies were related to higher levels of parent and adolescent psychopathology. Parental OTP management did not relate to current adolescent OTP skills or GPA, indicating that parents did not select OTP management strategies in immediate response to adolescent functioning. Implications for parent-directed intervention are discussed.
Parent Management of Organization, Time Management, and Planning Deficits among Adolescents with ADHD

PubMed Central

Campez, Mileini; Perez, Analay; Morrow, Anne S.; Merrill, Brittany M.; Altszuler, Amy R.; Coxe, Stefany; Yequez, Carlos E.

2015-01-01

Organization, Time Management, and Planning (OTP) problems are a key mechanism of academic failure for adolescents with ADHD. Parents may be well positioned to promote remediation of these deficits; yet, almost nothing is known about OTP management behaviors among parents of middle and high school students with ADHD. In a sample of 299 well-diagnosed adolescents with ADHD, a measure of parental OTP management was psychometrically validated. Latent Class Analysis was conducted to detect distinct patterns of parental OTP management and yielded four unique classes: Parental Control (18.7 %), Parent-Teen Collaboration (20.4 %), Homework Assistance (20.4 %), and Uninvolved (40.5 %). Logistic Regression analyses indicated that maladaptive parental OTP strategies were related to higher levels of parent and adolescent psychopathology. Parental OTP management did not relate to current adolescent OTP skills or GPA, indicating that parents did not select OTP management strategies in immediate response to adolescent functioning. Implications for parent-directed intervention are discussed. PMID:28553010
Optimizing community case management strategies to achieve equitable reduction of childhood pneumonia mortality: An application of Equitable Impact Sensitive Tool (EQUIST) in five low- and middle-income countries.

PubMed

Waters, Donald; Theodoratou, Evropi; Campbell, Harry; Rudan, Igor; Chopra, Mickey

2012-12-01

The aim of this study was to populate the Equitable Impact Sensitive Tool (EQUIST) framework with all necessary data and conduct the first implementation of EQUIST in studying cost-effectiveness of community case management of childhood pneumonia in 5 low- and middle-income countries with relation to equity impact. Wealth quintile-specific data were gathered or modelled for all contributory determinants of the EQUIST framework, namely: under-five mortality rate, cost of intervention, intervention effectiveness, current coverage of intervention and relative disease distribution. These were then combined statistically to calculate the final outcome of the EQUIST model for community case management of childhood pneumonia: US$ per life saved, in several different approaches to scaling-up. The current 'mainstream' approach to scaling-up of interventions is never the most cost-effective. Community-case management appears to strongly support an 'equity-promoting' approach to scaling-up, displaying the highest levels of cost-effectiveness in interventions targeted at the poorest quintile of each study country, although absolute cost differences vary by context. The relationship between cost-effectiveness and equity impact is complex, with many determinants to consider. One important way to increase intervention cost-effectiveness in poorer quintiles is to improve the efficiency and quality of delivery. More data are needed in all areas to increase the accuracy of EQUIST-based estimates.
The middle ear mass: a rare but important diagnosis.

PubMed

Pankhania, Miran; Rourke, Thomas; Draper, Mark R

2011-12-02

The authors report a rare case of primary intracranial meningioma presenting as a middle ear mass with conductive hearing loss. The authors aim to highlight the importance of diagnosing a middle ear mass, which although rare, may have a substantial impact on ongoing patient management. A discussion of other middle ear pathologies is made in order to demonstrate the subtle differences in presentation.
Role of Laryngopharyngeal Reflux in the Pathogenesis of Otitis Media with Effusion.

PubMed

Doğru, Mehmet; Kuran, Gökhan; Haytoğlu, Süheyl; Dengiz, Ramazan; Arıkan, Osman Kürşat

2015-04-01

To determine whether there is an association between otitis media with effusion and laryngopharyngeal reflux in children. This study included 31 children with otitis media with effusion. The pepsinogen level in the middle ear fluid of all patients was measured by sandwich enzyme-linked immunosorbent assay. Each patient's middle ear fluid was investigated for Helicobacter pylori (H. pylori) using the Campylobacter-like organism (CLO) test. The middle ear pepsinogen levels were compared with those in the serum. The correlation between pepsinogen levels and H. pylori positivity in the middle ear fluid was investigated. The mean middle ear pepsinogen level (211.69 ng/mL) was significantly higher than that in the serum (24.18 ng/mL) in patients with otitis media with effusion. The middle ear aspirates of six patients (19%) were positive for H. pylori, and the correlation between H. pylori positivity and increased pepsinogen levels in the middle ear fluid was statistically significant in patients with otitis media with effusion. We detected higher pepsinogen levels and H. pylori positivity rates in the middle ear fluid than in the serum of patients with otitis media with effusion. These results support the role of laryngopharyngeal reflux in the pathogenesis of otitis media with effusion.
Leading in the Middle: Leadership Behaviors of Middle Level Principals that Promote Student Achievement

ERIC Educational Resources Information Center

Minus, Eric L.

2010-01-01

This study sought to investigate the relationship between middle school principals' instructional leadership behaviors and student achievement. In particular, this study investigated the specific principal leadership behaviors of middle level principals that promote student achievement in school. A secondary variable for consideration was student…
Future of management of multiple sclerosis in the middle East: a consensus view from specialists in ten countries.

PubMed

Aljumah, Mohammed; Alroughani, Raed; Alsharoqi, I; Bohlega, Saeed A; Dahdaleh, Maurice; Deleu, Dirk; Esmat, Khaled; Khalifa, Ahmad; Sahraian, Mohammad A; Szólics, Miklós; Altahan, Abdulrahman; Yamout, Bassem I; Rieckmann, Peter; Daif, Abdulkader

2013-01-01

The prevalence of multiple sclerosis (MS) is now considered to be medium-to-high in the Middle East and is rising, particularly among women. While the characteristics of the disease and the response of patients to disease-modifying therapies are generally comparable between the Middle East and other areas, significant barriers to achieving optimal care for MS exist in these developing nations. A group of physicians involved in the management of MS in ten Middle Eastern countries met to consider the future of MS care in the region, using a structured process to reach a consensus. Six key priorities were identified: early diagnosis and management of MS, the provision of multidisciplinary MS centres, patient engagement and better communication with stakeholders, regulatory body education and reimbursement, a commitment to research, and more therapy options with better benefit-to-risk ratios. The experts distilled these priorities into a single vision statement: "Optimization of patient-centred multidisciplinary strategies to improve the quality of life of people with MS." These core principles will contribute to the development of a broader consensus on the future of care for MS in the Middle East.
Comprehensive Auditing in Nuclear Medicine Through the International Atomic Energy Agency Quality Management Audits in Nuclear Medicine (QUANUM) Program. Part 1: the QUANUM Program and Methodology.

PubMed

Dondi, Maurizio; Torres, Leonel; Marengo, Mario; Massardo, Teresa; Mishani, Eyal; Van Zyl Ellmann, Annare; Solanki, Kishor; Bischof Delaloye, Angelika; Lobato, Enrique Estrada; Miller, Rodolfo Nunez; Paez, Diana; Pascual, Thomas

2017-11-01

An effective management system that integrates quality management is essential for a modern nuclear medicine practice. The Nuclear Medicine and Diagnostic Imaging Section of the International Atomic Energy Agency (IAEA) has the mission of supporting nuclear medicine practice in low- and middle-income countries and of helping them introduce it in their health-care system, when not yet present. The experience gathered over several years has shown diversified levels of development and varying degrees of quality of practice, among others because of limited professional networking and limited or no opportunities for exchange of experiences. Those findings triggered the development of a program named Quality Management Audits in Nuclear Medicine (QUANUM), aimed at improving the standards of NM practice in low- and middle-income countries to internationally accepted standards through the introduction of a culture of quality management and systematic auditing programs. QUANUM takes into account the diversity of nuclear medicine services around the world and multidisciplinary contributions to the practice. Those contributions include clinical, technical, radiopharmaceutical, and medical physics procedures. Aspects of radiation safety and patient protection are also integral to the process. Such an approach ensures consistency in providing safe services of superior quality to patients. The level of conformance is assessed using standards based on publications of the IAEA and the International Commission on Radiological Protection, and guidelines from scientific societies such as Society of Nuclear Medicine and Molecular Imaging (SNMMI) and European Association of Nuclear Medicine (EANM). Following QUANUM guidelines and by means of a specific assessment tool developed by the IAEA, auditors, both internal and external, will be able to evaluate the level of conformance. Nonconformances will then be prioritized and recommendations will be provided during an exit briefing. The same tool could then be applied to assess any improvement after corrective actions are taken. This is the first comprehensive audit program in nuclear medicine that helps evaluate managerial aspects, safety of patients and workers, clinical practice, and radiopharmacy, and, above all, keeps them under control all together, with the intention of continuous improvement. Copyright © 2017. Published by Elsevier Inc.
Nonlinear Control and Discrete Event Systems

NASA Technical Reports Server (NTRS)

Meyer, George; Null, Cynthia H. (Technical Monitor)

1995-01-01

As the operation of large systems becomes ever more dependent on extensive automation, the need for an effective solution to the problem of design and validation of the underlying software becomes more critical. Large systems possesses much detailed structure, typically hierarchical, and they are hybrid. Information processing at the top of the hierarchy is by means of formal logic and sentences; on the bottom it is by means of simple scalar differential equations and functions of time; and in the middle it is by an interacting mix of nonlinear multi-axis differential equations and automata, and functions of time and discrete events. The lecture will address the overall problem as it relates to flight vehicle management, describe the middle level, and offer a design approach that is based on Differential Geometry and Discrete Event Dynamic Systems Theory.

Applying RE-AIM to the evaluation of FUEL Your Life : a worksite translation of DPP.

PubMed

Brace, Andrea M; Padilla, Heather M; DeJoy, David M; Wilson, Mark G; Vandenberg, Robert J; Davis, Marsha

2015-01-01

Weight management programs are becoming increasingly common in workplace settings; however, few target middle-aged men. The purpose of this article is to describe the process evaluation of a worksite translation of the Diabetes Prevention Program in a predominantly middle-aged male population. The translated program, FUEL Your Life, was largely self-directed, with support from peer health coaches and occupational health nurses. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to examine the factors that influenced program implementation using data from an environmental assessment, participant surveys, peer health coach surveys, and occupational health nurse interviews. An overwhelming majority of the employees who enrolled in the study were overweight or obese (92%). Overall, the program was effective for weight maintenance; those with higher levels of participation and engagement had better weight loss outcomes. The peer health coach and family elements of the intervention were underused. The program was successful in reaching the intended population; however, the program had limited success in engaging this population. Not surprisingly, weight loss was a function of participant engagement and participation. Increasing participant engagement and participation is important to the success of weight management interventions translated to the worksite setting. Garnering buy-in and support from management can serve to increase the perceived importance of weight management in worksites. With management support, weight management protocols could be integrated as a component of the mandatory safety and health assessments already in place, fostering promotion of healthy weight in the workforce. © 2014 Society for Public Health Education.
From boundaries to boundary work: middle managers creating inter-organizational change.

PubMed

Oldenhof, Lieke; Stoopendaal, Annemiek; Putters, Kim

2016-11-21

Purpose In healthcare, organizational boundaries are often viewed as barriers to change. The purpose of this paper is to show how middle managers create inter-organizational change by doing boundary work: the dual act of redrawing boundaries and coordinating work in new ways. Design/methodology/approach Theoretically, the paper draws on the concept of boundary work from Science and Technology Studies. Empirically, the paper is based on an ethnographic investigation of middle managers that participate in a Dutch reform program across health, social care, and housing. Findings The findings show how middle managers create a sense of urgency for inter-organizational change by emphasizing "fragmented" service provision due to professional, sectoral, financial, and geographical boundaries. Rather than eradicating these boundaries, middle managers change the status quo gradually by redrawing composite boundaries. They use boundary objects and a boundary-transcending vocabulary emphasizing the need for societal gains that go beyond production targets of individual organizations. As a result, work is coordinated in new ways in neighborhood teams and professional expertise is being reconfigured. Research limitations/implications Since boundary workers create incremental change, it is necessary to follow their work for a longer period to assess whether boundary work contributes to paradigm change. Practical implications Organizations should pay attention to conditions for boundary work, such as legitimacy of boundary workers and the availability of boundary spaces that function as communities of practice. Originality/value By shifting the focus from boundaries to boundary work, this paper gives valuable insights into "how" boundaries are redrawn and embodied in objects and language.
Recruiting Middle Management in Industry: What Kinds of Change in France, Germany and the United Kingdom?

ERIC Educational Resources Information Center

Mobus, Martine

2000-01-01

Major British, French, and German industrial companies are increasingly recruiting higher education graduates (HEGs) for middle management posts, traditionally filled through promotion of operatives. This new form of recruitment does not occur on the same scale or at the same rate in all the companies using it, and it is closely tied to the…
An Exploration of Administrative Heuristics in the United States and the United Kingdom

ERIC Educational Resources Information Center

English, Fenwick W.; Bolton, Cheryl L.

2008-01-01

This article is a report on a study of the use of heuristics, shortcuts, and rules of thumb by middle-line managers in institutions of higher education in the United States and the United Kingdom. Using a nonprobability convenience sample, the coinvestigators interviewed 13 middle-line managers over 5 months from eight institutions. The results…
Ten Years of Timber Management in the Middle Coastal Plain of Georgia

Treesearch

E.P. Jones; F.A. Bennett

1965-01-01

The pilot forest on the George Walton Experimental Forest represents the medium-size forest ownership in the middle coastal plain of Georgia. Tbis 2,200-acre forest of slash and longleaf pine has been under planned management for 10 years. Gross earnings have been $7.03 per acre per year, with an annual cost of $1.15 per acre.
Influences of Formal Learning, Personal Characteristics, and Work Environment Characteristics on Informal Learning among Middle Managers in the Korean Banking Sector

ERIC Educational Resources Information Center

Choi, Woojae

2010-01-01

The purpose of this study was to investigate the influences of formal learning, personal characteristics, and work environment characteristics on informal learning among middle managers in the Korean banking sector. The conceptual framework identified three factors influencing informal learning. For this study, data collection was conducted in the…
Anger Management Effects on Middle School Students with Emotional/Behavioral Disorders: Anger Log Use, Aggressive and Prosocial Behavior

ERIC Educational Resources Information Center

Kellner, Millicent H.; Bry, Brenna H.; Salvador, Diana S.

2008-01-01

This study examined the impact of a classroom-based, 10-week, cognitive-behavioral, anger management program plus booster sessions on middle school students with emotional disorders attending a therapeutic day school. Forty-five students were in the study; 20 received the program. The program group completed significantly more anger logs compared…
Improving Curriculum Development Practices in a Technical Vocational Community College: Examining Effects of a Professional Development Arrangement for Middle Managers

ERIC Educational Resources Information Center

Albashiry, Nabeel M.; Voogt, Joke M.; Pieters, Jules M.

2015-01-01

Learning about curriculum development is critical for middle managers of technical vocational institutions in order to assume curriculum leadership in maintaining and enhancing the quality and relevance of their educational programs. This case study reports on the design and effects of a professional development arrangement (PDA), with such a…
Middle Managers' Experience of Policy Implementation and Mediation in the Context of the Scottish Quality Enhancement Framework

ERIC Educational Resources Information Center

Saunders, Murray; Sin, Cristina

2015-01-01

This paper analyses how middle managers perform and experience their role in enacting policy in Scottish higher education institutions. The policy focus is the quality enhancement framework (QEF) for learning and teaching in higher education, which was launched in 2003. The data-set was collected between 2008 and 2010, during the evaluation of the…
A Foot in the Revolving Door? Women Academics in Lower-Middle Management

ERIC Educational Resources Information Center

Acker, Sandra

2014-01-01

This article looks at a small group of women in Canadian faculties of education who hold what I call "lower-middle management" positions and considers whether they are on the ladder to recognized academic leadership or are in a revolving-door situation that will take them back to the ranks from whence they came. These nine women are…
Job stress and mental well-being: similarities and differences among American, Japanese, and Indian managers.

PubMed

DeFrank, R S; Ivancevich, J M; Schweiger, D M

1988-01-01

The sources and mediators of occupational stress have been assessed frequently but rarely from a cross-cultural perspective. The present study examined responses to a number of stress, social support, job satisfaction, and personal characteristics measures and their relationships to mental well-being among samples of lower-, middle-, and upper-level managers in the United States, Japan, and India. These data suggested basic similarities between 178 U.S. and 306 Indian managers; the 222 Japanese managers tended to report more negative reactions than the other two groups. Variability among these groups was seen, however, in the relative weights given to the factors of the mental well-being measure and in the association of these factors with the various independent variables. Implications and shortcomings of these results are discussed, along with suggestions for future research priorities.
Transforming Middle Level Education: Perspectives and Possibilities.

ERIC Educational Resources Information Center

Irvin, Judith L., Ed.

This book addresses the critical issues of curriculum and instruction as they pertain to the restructuring of middle-level education. The first part deals with developing a sense of identity both with the middle-school movement and with young adolescents. Chapters include the following: "Perspectives on the Middle School Movement" (John H.…
Deferred but Not Deterred: A Middle School Manifesto

ERIC Educational Resources Information Center

Lounsbury, John H.

2009-01-01

In this article, the author provides a historical perspective on the middle level movement, examines its past successes and failures, and envisions future improvements. The middle school movement has been a prime target for those forces that do not share the belief middle level advocates hold about the importance of a democratic, student-centered…
Active Learning in the Middle Grades Classroom: Overcoming the Barriers to Implementation

ERIC Educational Resources Information Center

Edwards, Susan

2015-01-01

The Association for Middle Level Education advocates for instruction that incorporates active learning and multiple learning approaches in middle grades classrooms. The aim of this qualitative study was to examine middle level teachers who are able to implement active learning and multiple learning approaches within the standardized testing and…
Effective Middle Level Teaching: Perceptions on the Preparedness of Newly Hired Teachers

ERIC Educational Resources Information Center

Howell, Penny B.; Cook, Chris; Faulkner, Shawn A.

2013-01-01

This interpretive, exploratory study utilized survey methodology to document middle level principals' perceptions of effective teaching practices and the preparedness of newly hired middle level teachers. The findings suggest that principals' descriptions of effective teaching differ from their descriptions of effective teachers. Additionally,…
"A Step Above the Rest..." Specialized Middle Level Preparation.

ERIC Educational Resources Information Center

Giebelhaus, Carmen R.

Teachers who had received a specialized preparation for middle level teaching were studied to determine the effectiveness of such a preparation program and to help form a knowledge base from which teacher education institutions could document, design, and implement middle level preparation programs. The paper reviews the literature investigating…
Toward Middle-Level Manpower Education for Colombia. A Report to USAID Colombia.

ERIC Educational Resources Information Center

Johnson, B. Lamar

Education for middle-level manpower, a high-priority need in Colombia, is discussed. The current programs of five educational agencies--universities, university institutes, SENA (National Apprentice Service), industrial schools, and agricultural schools--that are providing some preparation for middle-level manpower positions are described. A…
Middle Level Leadership Handbook. National Leadership Camp Curriculum--Student Guide.

ERIC Educational Resources Information Center

Jensen, Jacquie; And Others

Activities and exercises to enhance student leadership are included in this curriculum guide for middle-level student leaders and their advisors. Because students in intermediate grades are not "little high school students," this separate leadership curriculum guide for middle-level student leaders was developed. Although the achieved skills are…
Atrial fibrillation in the Middle East: unmapped, underdiagnosed, undertreated.

PubMed

Al-Shamkhani, Warkaa; Ayetey, Harold; Lip, Gregory Y H

2018-05-01

Atrial fibrillation (AF) is the commonest persistent cardiac arrhythmia with an estimated incidence rate of between 1.5-2% and an important cause of strokes. Few epidemiological studies and clinical trials on the management of AF have been conducted outside Europe and North America. These gaps in our understanding of AF likely lead to sub-optimal management of patients with AF in the rest of the world. Areas covered: We discuss the epidemiology, treatment and clinical outcomes for AF in the Middle East after systematic review of published work for AF from the Middle East. We also discuss important clinical trials on AF conducted in the West in the same period to help contextualize our findings. Expert commentary: The few available Middle East studies suggest important epidemiological differences between Middle Eastern and Western AF populations. In particular, the Middle Eastern AF population is younger and have more co-morbidities than patients in the West. We find that significant numbers of moderate to high risk patients with AF are either undertreated or untreated placing them at increased risk of complications such as stroke. More studies in the Middle Eastern population are required to aid the development of region-specific clinical guidelines to improve patient care.
Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report.

PubMed

Bhatt, Jiten B; Glaser, Randal; Chavez, Andre; Yung, Emmanuel

2013-11-01

Case report. Addressing weakness of the shoulder region, especially the rotator cuff and scapular musculature, is often suggested clinically for the treatment of individuals with lateral epicondylalgia. However, to our knowledge, the clinical effectiveness of this approach has not been established. The patient was a 54-year-old woman with a 5-month history of right lateral elbow pain, whose symptoms were reproduced with clinical tests typically used to diagnose lateral elbow tendinopathy. The patient also demonstrated weakness in her middle and lower trapezius muscles, and the medial border of her scapula, measured with a tape measure, was 11 cm lateral from the spinous processes of the thoracic spine with the patient standing in relaxed stance. Based on improved grip strength and reduced associated elbow pain when tested with the scapula manually corrected in a more adducted position, treatment focused solely on strengthening of the middle and lower trapezius muscles over a 10-week period. Following the intervention, the patient presented with improved scapular position, with the medial border of the scapula being 9 cm lateral to the midthoracic spine. The patient's middle and lower trapezius strength improved from 3+/5 and 4-/5, respectively, to 5/5, and her grip strength from 26.1 to 42.2 kg. The patient's scores on the Disabilities of the Arm, Shoulder and Hand questionnaire also improved from 44.2 at the initial evaluation to 0 at the completion of therapy, with the patient being able to perform all of her daily activities in a pain-free manner. The results of this case report suggest that assessment and treatment of scapular musculature warrant consideration in the management of individuals with lateral epicondylalgia. Therapy, level 4.

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition.

PubMed

Prabhakaran, Dorairaj; Anand, Shuchi; Watkins, David; Gaziano, Thomas; Wu, Yangfeng; Mbanya, Jean Claude; Nugent, Rachel

2018-03-24

Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action. Copyright © 2018 Elsevier Ltd. All rights reserved.
Master Middle Ware: A Tool to Integrate Water Resources and Fish Population Dynamics Models

NASA Astrophysics Data System (ADS)

Yi, S.; Sandoval Solis, S.; Thompson, L. C.; Kilduff, D. P.

2017-12-01

Linking models that investigate separate components of ecosystem processes has the potential to unify messages regarding management decisions by evaluating potential trade-offs in a cohesive framework. This project aimed to improve the ability of riparian resource managers to forecast future water availability conditions and resultant fish habitat suitability, in order to better inform their management decisions. To accomplish this goal, we developed a middleware tool that is capable of linking and overseeing the operations of two existing models, a water resource planning tool Water Evaluation and Planning (WEAP) model and a habitat-based fish population dynamics model (WEAPhish). First, we designed the Master Middle Ware (MMW) software in Visual Basic for Application® in one Excel® file that provided a familiar framework for both data input and output Second, MMW was used to link and jointly operate WEAP and WEAPhish, using Visual Basic Application (VBA) macros to implement system level calls to run the models. To demonstrate the utility of this approach, hydrological, biological, and middleware model components were developed for the Butte Creek basin. This tributary of the Sacramento River, California is managed for both hydropower and the persistence of a threatened population of spring-run Chinook salmon (Oncorhynchus tschawytscha). While we have demonstrated the use of MMW for a particular watershed and fish population, MMW can be customized for use with different rivers and fish populations, assuming basic data requirements are met. This model integration improves on ad hoc linkages for managing data transfer between software programs by providing a consistent, user-friendly, and familiar interface across different model implementations. Furthermore, the data-viewing capabilities of MMW facilitate the rapid interpretation of model results by hydrologists, fisheries biologists, and resource managers, in order to accelerate learning and management decision making.
Lipid levels among African and Middle-Eastern Bedouin populations.

PubMed

Dreiher, Jacob; Cohen, Arnon D; Weitzman, Shimon; Sharf, Amir; Shvartzman, Pesach

2008-06-01

Previous studies observed higher high-density lipoprotein (HDL) levels and lower triglycerides levels among people of African ancestry. The goal of this study was to characterize lipid levels in Bedouins of African vs. Middle-Eastern ethnicity. A cross-sectional study was conducted in a Bedouin primary care clinic in southern Israel, with 4470 listed individuals over the age of 21, of whom 402 (9%) were of African origin. A stratified random sample was included in the analysis. Associations between ethnicity, age, gender and lipid levels were assessed. Multiple linear regression and logistic regression models were used for multivariate analysis. The study included 261 African Bedouins and 406 Middle-Eastern Bedouins. (median age: 37 years, 58.6% females). The average total cholesterol and low-density lipoprotein (LDL) levels were 10 mg/dl lower among African Bedouins as compared to Middle-Eastern Bedouins (total cholesterol: 168.6 vs. 179.6 mg/dl, p<0.001; LDL: 99.5 vs. 109.0 mg/dl, respectively, p<0.001). Average triglycerides levels were 36 mg/dl lower among African Bedouins as compared to Middle-Eastern Bedouins (102.8 vs. 138.9 mg/dl, respectively, p<0.001). Average HDL levels were 3 mg/dl higher among African Bedouins as compared to Middle-Eastern Bedouins (48.3 vs. 44.6 mg/dl, respectively, p<0.001). A lower prevalence of dyslipidemia was found in African Bedouins, as compared with Middle-Eastern Bedouins.
Cooperative Learning in Middle Schools: Interrelationship of Relationships and Achievement

ERIC Educational Resources Information Center

Johnson, David W.; Johnson, Roger T.; Roseth, Cary

2010-01-01

When students enter middle school, they face 2 major challenges, one involving the biological, cognitive, and socioemotional changes they are going through, and another involving the transition from elementary to middle school. Peer learning has considerable influence on how well they manage these challenges. The research that exists on peer…
[Distribution and main influential factors of mental workload of middle school teachers in Nanchang City].

PubMed

Xiao, Yuanmei; Li, Weijuan; Ren, Qingfeng; Ren, Xiaohui; Wang, Zhiming; Wang, Mianzhen; Lan, Yajia

2015-01-01

To investigate the distribution and main influential factors of mental workload of middle school teachers in Nanchang City. A total of 504 middle school teachers were sampled by random cluster sampling from middle schools in Nanchang City, and the mental workload level was assessed with National Aeronautics and Space Administration-Task Load Index (NASA-TLX) which was verified in reliability and validity. The mental workload scores of middle school teachers in Nanchang was approximately normal distribution. The mental workload level of middle school teachers aged 31 -35 years old was the highest. For those no more than 35 years old, there was positive correlation between mental workload and age (r = 0.146, P < 0.05). For those more than 35 years old, the levels of their mental workload had no statistically significant difference. There was a negative correlation between mental workload and educational level(r = -0.172, P < 0.05). The middle school teachers with lower educational level seemed to have a higher mental workload (P < 0.01). The longer a middle school teacher worked per day, the higher the mental workload was. Working hours per day was the most influential factor on mental workload in all influential factors (P < 0.001). Mental workload of middle school teachers was closely related to age, educational level and work hours per day. Working hours per day was the important risk factor of mental workload. Reducing working hours per day, especially reducing it to be no more than 8 hours per day, may be a significant and useful approach alleviating mental workload of middle school teachers in Nanchang City.
The Intersection between 1:1 Laptop Implementation and the Characteristics of Effective Middle Level Schools

ERIC Educational Resources Information Center

Downes, John M.; Bishop, Penny A.

2015-01-01

The number of middle level schools adopting 1:1 laptop programs has increased considerably during the past decade (e.g., Lowther, Strahl, Inan, & Bates, 2007; Storz & Hoffman, 2013; Texas Center for Educational Research, 2009). The cornerstone practices of the middle school concept (National Middle School Association, 2010), therefore,…
Water in the Middle East, a Secondary and College Level Multi-Media Study.

ERIC Educational Resources Information Center

Manneberg, Eliezer

The secondary and college level guide outlines a course of study on the Middle East, with emphasis on water problems of the area. Among the course objectives are the following: (1) make generalizations about particular Middle Eastern cultures and support them with evidence; (2) interpret environmental and social data from specific Middle Eastern…
Different and Similar at the Same Time. Cultural Competence through the Leans of Healthcare Providers.

PubMed

Dell'Aversana, Giuseppina; Bruno, Andreina

2017-01-01

Cultural competence (CC) for professionals and organizations has been recognized as a key strategy to reduce health care inequalities for migrants and to promote responsiveness to diversity. For decades its main aim has been matching health services to the cultural needs of migrant users. Otherwise literature highlighted the need to find a pragmatic middle way between the 'static' and the 'dynamic' views of culture that are recognizable in CC approaches. A pragmatic middle way to CC will be proposed as the way to respect diversity, even responding to cultural issues, without stereotyping or discriminating. To understand conditions that favor this pragmatic middle way this study aims to explore: (1) perceptions of healthcare providers in managing diversity; (2) strategies used to meet health needs at a professional and organizational level. A qualitative case study was conducted in a healthcare service renowned for its engagement in migrant sensitive care. Four different professional figures involved in CC strategies at different levels, both managerial and non-managerial, were interviewed. Data were analyzed using thematic analysis. Findings indicated that dealing with diversity poses challenges for healthcare providers, by confronting them with multilevel barriers to quality of care. A pragmatic middle way to CC seems to rely on complex understanding of the interaction between patients social conditions and the capacity of the institutional system to promote equity. Professional and organizational strategies, such as inter-professional and intersectional collaboration, cultural food adaptation and professional training can enhance quality of care, patient compliance responding to social and cultural needs.
Middle-Level Collegiate Administration in a Period of Retrenchment.

ERIC Educational Resources Information Center

Scott, Robert A.

Middle-level administrative costs and personnel are increasing at a time when other areas are being forced to cut back. These middle-level positions are the deans and directors and assistants of support services in the areas of admissions, counseling, business, accounting and personnel offices, fund raising, safety, public information, alumni…
The Professional Preparation of Middle Level Teachers: Profiles of Successful Programs.

ERIC Educational Resources Information Center

McEwin, C. Kenneth; Dickinson, Thomas S.

This publication focuses on 14 colleges and universities that are successfully meeting the challenge of preparing middle level teachers. After the Foreword (John H. Swaim), the 16 chapters are: (1) "Middle Level Teacher Preparation in Perspective"; (2) "Elizabeth City State University" (Eloise B. Roberts); (3) "Georgia Southwestern College" (Lynn…
Seizing Teachable Moments to Develop Integrative Middle Level Curriculum

ERIC Educational Resources Information Center

Virtue, David C.

2007-01-01

September 11, 2001, was a critical teachable moment that provided the author of this article and his team with an avenue to middle level curriculum that was relevant, challenging, integrative, and exploratory. Hurricane Katrina opened a similar window of opportunity for middle level educators to focus the minds of young adolescents on important…
Middle-Level Preservice Mathematics Teachers' Mental Representations of Classroom Floor Plans

ERIC Educational Resources Information Center

Matteson, Shirley M.; Ganesh, Bibi S.; Coward, Fanni L.; Patrick, Patricia

2012-01-01

This study reports the results of an innovative assignment in which preservice teachers' mental representations were examined through drawing floor plans of an "ideal middle-level mathematics classroom." The 41 middle-level mathematics preservice teachers created two floor plans, one at the beginning of the semester and the other for the…
An Analysis of Factors Related to Retirement Intentions of Upper Level Civil Service Employees in the Air Force.

DTIC Science & Technology

1986-09-01

workforce that is incapable of performing organizational objectives (Humple and Lyons , 1983; Tucker, 1985). . Research into retirement within the federal...organization (Donnelly, Gibson, Ivancevich ; 1984). The present study focuses on civilian middle managers, GM13 to GMI5, within technical career fields...Masson, Demestree, and Lyon ; 1979). The second study performed a factorial analysis on data from 457 respondents between the ages of 25 to 64 that worked
Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?

PubMed Central

Uzun, Metin; Kara, Adnan; Adaş, Müjdat; Karslioğlu, Bülent; Bülbül, Murat; Beksaç, Burak

2014-01-01

Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level) managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disability Index Score (FADI). Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%). Fibular shortening was identified in 42 fractures (68%). Mean fibular shortening was 1.2 cm (range, 0.5–2 cm). Clinical exams showed increased hindfoot valgus in 42 fractures (68%). The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening. PMID:25544899
Money in the Middle: Personal Finance Economics 6-8. Money in the Middle. Teacher Resource Manual. EconomicsAmerica.

ERIC Educational Resources Information Center

Forgue, Raymond E.; Randolph, Beth; Farley, Mary Ann

This book is designed to help students in grades 6-8 make better decisions as spenders, savers, borrowers, and managers of money. The learning experiences focus on personal finance and money management. The 10 lessons divided into 4 units include: (1) "Check It Out"; (2) "Party Planners"; (3) "What Would You Do?"; (4)…
Principals' instructional management skills and middle school science teacher job satisfaction

NASA Astrophysics Data System (ADS)

Gibbs-Harper, Nzinga A.

The purpose of this research study was to determine if a relationship exists between teachers' perceptions of principals' instructional leadership behaviors and middle school teacher job satisfaction. Additionally, this study sought to assess whether principal's instructional leadership skills were predictors of middle school teachers' satisfaction with work itself. This study drew from 13 middle schools in an urban Mississippi school district. Participants included teachers who taught science. Each teacher was given the Principal Instructional Management Rating Scale (PIMRS; Hallinger, 2011) and the Teacher Job Satisfaction Questionnaire (TJSQ; Lester, 1987) to answer the research questions. The study was guided by two research questions: (a) Is there a relationship between the independent variables Defining the School's Mission, Managing the Instructional Program, and Developing the School Learning Climate Program and the dependent variable Work Itself?; (b) Are Defining the School's Mission, Managing the Instructional Program, and Developing the School Learning Climate Program predictors of Work Itself? The Pearson's correlation and multiple regression analysis were utilized to examine the relationship between the three dimensions of principals' instructional leadership and teacher satisfaction with work itself. The data revealed that there was a strong, positive correlation between all three dimensions of principals' instructional leadership and teacher satisfaction with work itself. However, the multiple regression analysis determined that teachers' perceptions of principals' instructional management skills is a slight predictor of Defining the School's Mission only.
A system dynamics model of a large R&D program

NASA Astrophysics Data System (ADS)

Ahn, Namsung

Organizations with large R&D activities must deal with a hierarchy of decision regarding resource allocation. At the highest level of allocation, the decision is related to the total allocation to R&D as some portion of revenue. The middle level of allocation deals with the allocation among phases of the R&D process. The lowest level of decisions relates to the resource allocation to specific projects within a specific phase. This study focuses on developing an R&D model to deal with the middle level of allocation, i.e., the allocation among phases of research such as basic research, development, and demonstration. The methodology used to develop the R&D model is System Dynamics. Our modeling concept is innovative in representing each phase of R&D as consisting of two parts: projects under way, and an inventory of successful but not-yet- exploited projects. In a simple world, this concept can yield an exact analytical solution for allocation of resources among phases. But in a real world, the concept should be improved by adding more complex structures with nonlinear behaviors. Two particular nonlinear feedbacks are incorporated into the R&D model. The probability of success for any specific project is assumed partly dependent upon resources allocated to the project. Further, the time required to reach a conclusion regarding the success or failure of a project is also assumed dependent upon the level of resources allocated. In addition, the number of successful projects partly depends on the inventory of potential ideas in the previous stage that can be exploited. This model can provide R&D management with insights into the effect of changing allocations to phases whether those changes are internally or externally driven. With this model, it is possible to study the effectiveness of management decisions in a continuous fashion. Managers can predict payoffs for a host of different policies. In addition, as new research results accumulate, a re- assessment of program goals can be implemented easily and allocations adjusted to enhance continuously the likelihood of success, and to optimize payoffs. Finally, this model can give managers a quantitative rationale for program evaluation and permit the quantitative assessment of various externally imposed changes. (Copies available exclusively from MIT Libraries, Rm. 14-0551, Cambridge, MA 02139-4307. Ph. 617-253-5668; Fax 617-253-1690.)
Serum thyrotropin and thyroid hormone levels in elderly and middle-aged euthyroid persons.

PubMed

Hershman, J M; Pekary, A E; Berg, L; Solomon, D H; Sawin, C T

1993-08-01

To determine whether serum thyrotropin (TSH) levels are altered in euthyroid older persons compared with middle-aged adults. Serum TSH and thyroid hormone levels were measured in a large group of older persons (> 70 years old, n = 216) and their middle-aged offspring (40-60 years old, n = 211) after excluding those with clinical or historical evidence of thyroid disease or abnormal thyroid function. Serum TSH, thyroxine (T4), free T4 index, estimated free T4, triiodothyronine (T3), estimated free T3, and ferritin levels were measured on the Abbott IMx instrument. Peroxidase and thyroglobulin antibodies were measured by radioimmunoassay using Kronus kits. Overall, serum TSH showed a log-normal distribution. The geometric mean TSH (mU/L) and 95% confidence limits in the older persons, 1.24 (0.29-5.4), did not differ significantly from that in the middle-aged, 1.45 (0.54-3.9). The mean TSH in the 264 women, 1.37 (0.34-5.5), was similar to that of the 163 men, 1.30 (0.48-3.5). The mean TSH in older women, 1.21 (0.22-6.6), was slightly but significantly lower than that in middle-aged women, 1.52 (0.55-4.2). However, when euthyroid women with positive antibodies were excluded, this difference was not significant. Four of the 123 older women had TSH < 0.1 mU/L, but none of the men or middle-aged women had a suppressed serum TSH. The mean TSH in older men, 1.28 (0.43-3.8), was similar to that in middle-aged men, 1.32 (0.55-3.2). Free T4 was slightly higher in older women than middle-aged women. There were no significant correlations between TSH and any thyroid hormone level. Serum ferritin, measured as a potential marker for the action of thyroid hormone, did not correlate with any measure of thyroid function. At least one antibody level was > 10 U/mL in 14.6% of older women, 15.6% of middle-aged women, 4.3% of older men, and no middle-aged men. When those with milder elevations of antibody levels were included (at least one level > 1 U/mL), the prevalence was 32% of older women, 43.3% of middle-aged women, 15% of older men, and 11.4% of middle-aged men. Euthyroid older persons have about the same levels of serum TSH as younger ones, although older euthyroid women have a slightly lower serum TSH than middle-aged women. We recommend that the normal range of serum TSH in the elderly be considered to be the same as that in healthy middle-aged subjects.
Natural-derived contaminants and their resolution in transboundary water resources in the Middle East

NASA Astrophysics Data System (ADS)

Vengosh, A.; Weinthal, E.

2005-12-01

The rapidly growing population in the Middle East and the ensuing increase in exploitation have led to the degradation its renewable aquifers. In turn, countries in the Middle East have been forced to search for alternative resources like non- renewable (fossil) groundwater and to develop new technologies such as desalination. Here, we show that most of the contamination of the transboundary water resources in the Middle East is due to natural processes. We integrate hydrogeological, geochemical, and isotopic investigations to show that salinization of groundwater in the Gaza Strip, the Jordan River, and the groundwater along the Jordan and Arava valleys are natural phenomena triggered by over-exploitation and distraction of the fragile balance of the hydrological systems in the region. Recent investigations also show that fresh and brackish groundwater from the Nubian Sandstone aquifer in Israel and Jordan contains high level of natural radioactivity. Groundwater from similar basins in Egypt and Libya may also suffer from similar problems of high natural radioactivity in the groundwater. The scientific evidences that most of the contamination is natural raises new challenges for political and legal solutions for such transboundary water resources. Unlike the traditional upstream/downstream conflicts associated with transboundary water resources, the natural contamination demands a reevaluation of water resource management approaches in the Middle East. We argue that regional cooperation must be based upon political bargaining and side-payments rather than just international water law in order to not only foster cooperation, but, more important, to address the poor water quality situation in the Middle East.
Middle Years. For Middle Level Educators.

ERIC Educational Resources Information Center

Hechinger, Fred M.; And Others

1992-01-01

This supplement offers 10 articles focusing on middle school education. Topics include remembering adolescence, resources and teaching tips, active middle school students, adolescent development, challenges in middle school education, integrated studies, planning middle school special events, a writing-science-consumerism miniunit on popcorn,…

The Rationale for the Middle Level School. Practitioner's Monograph No. 9.

ERIC Educational Resources Information Center

Lake, Sara

Almost from the beginning, the junior high school was based on the same vision driving today's middle level schooling: the creation of a unique middle tier of education that bridges the gap between elementary and secondary education and focuses on meeting early adolescent students' academic and personal needs. In the 1950s and 1960s, middle school…
Urban Middle School African American Girls' Attitudes toward Physical Education and Out-of-School Physical Activity Levels

ERIC Educational Resources Information Center

Ramsey, Victor

2012-01-01

The purposes of this two-part study were (1) to investigate urban middle school African American girls' physical activity levels and their relationships to attitudes and, (2) to explore urban middle school African American girls' attitude toward physical education. A total of (N = 649) African American girls from 14 New York City middle schools…
Career stress and female managers' health in Taiwan's hospitals: a multilevel model approach.

PubMed

Chen, Duan-Rung; Lin, Yeh-Yun; Chung, Kuo-Piao

2008-01-01

This study investigates how perception-induced stress (barrier) and social capital (facilitator) affect the health of female managers. On the basis of the responses of 229 valid questionnaires of middle- and high-level female managers in large-scale hospitals, using a multilevel data analysis approach, this study investigates how perception-induced stress and social capital influence self-reported poor health of female managers. Analysis results indicate that all 3 perception-induced stresses (i.e., promotion-related procedural justice, promotion rate, and work-family conflict) and 2 social capital variables (i.e., mentor-assisted promotion and higher ranking mentor in other departments) are significantly associated with the health of female mangers. Factors involving the career success of women also affect their health. Health care organizations expecting to benefit from the long-term contribution of female elites must promote organizational equity and more heavily emphasize flexible work schedules, family-friendly policies, and perception management practices. In addition, adequately designed mentorship practices can greatly benefit female managers.
Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries.

PubMed

Palafox, Benjamin; McKee, Martin; Balabanova, Dina; AlHabib, Khalid F; Avezum, Alvaro Jr; Bahonar, Ahmad; Ismail, Noorhassim; Chifamba, Jephat; Chow, Clara K; Corsi, Daniel J; Dagenais, Gilles R; Diaz, Rafael; Gupta, Rajeev; Iqbal, Romaina; Kaur, Manmeet; Khatib, Rasha; Kruger, Annamarie; Kruger, Iolanthe Marike; Lanas, Fernando; Lopez-Jaramillo, Patricio; Minfan, Fu; Mohan, Viswanathan; Mony, Prem K; Oguz, Aytekin; Palileo-Villanueva, Lia M; Perel, Pablo; Poirier, Paul; Rangarajan, Sumathy; Rensheng, Lei; Rosengren, Annika; Soman, Biju; Stuckler, David; Subramanian, S V; Teo, Koon; Tsolekile, Lungiswa P; Wielgosz, Andreas; Yaguang, Peng; Yeates, Karen; Yongzhen, Mo; Yusoff, Khalid; Yusuf, Rita; Yusufali, Afzalhussein; Zatońska, Katarzyna; Yusuf, Salim

2016-12-08

Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household's ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study. A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples. Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden). Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level.
Results of a Program Effectiveness Survey Used to Guide Curriculum Revision in a Middle Level Teacher Education Program

ERIC Educational Resources Information Center

Knorr, Ron; Medord, Lienne

2013-01-01

Teacher education programs are under extreme scrutiny as the demands for effectiveness and efficiency increase in the current political and operational environment. Within the framework established by This We Believe (AMLE, 2010) and the Position Statement on the Professional Preparation of Middle Level Teachers (AMLE, 2011), middle level teacher…
Building Level Administrators' Attitudes toward Teacher Effectiveness at the High School and Middle School Levels

ERIC Educational Resources Information Center

Hanson, Nathan K.

2010-01-01

This study investigated the attitudes of administrators about differences and similarities between middle and high school teachers. The research question that guided the study was, "Do attitudes about what makes an effective educator differ between building administrators at the middle and high school levels?" A formal, sequential, mixed-methods…
Teaching Future Middle Level Educators to Craft Learning Activities That Enhance Young Adolescent Creativity

ERIC Educational Resources Information Center

Hilton, Jason T.

2016-01-01

As social and academic forces begin to collide for young adolescents at the beginning of the middle level experience, students experience an unfortunate drop in their creativity. Appropriately trained middle level teachers have the potential to lessen this problem through the use of carefully selected open-ended learning activities that increase…
Optimizing Burn Treatment in Developing Low-and Middle-Income Countries with Limited Health Care Resources (Part 3)

PubMed Central

Atiyeh, B.; Masellis, A.; Conte, F.

2010-01-01

Summary The present review of the literature aims at analysing the challenges facing burn management in low- and middleincome countries and exploring probable modalities to optimize burn management in these countries. In Part I, epidemiology of burns injuries and the formidable challenges for proper management due to limited resources and inaccessibility to sophisticated skills and technologies in low- and middle income countries (LMICs) were presented. Part II discussed the actual state of burn injuries management in LMICs. In Part III of this review strategies for proper prevention and burn care in LMICs will be presented. PMID:21991190
Anomalies of the middle and inner ear.

PubMed

Rodriguez, Kimsey; Shah, Rahul K; Kenna, Margaret

2007-02-01

The development of the middle and inner ear highlights the intricacy of embryology. As early as 3 weeks after fertilization, the inner ear begins taking form. This process, along with development of the middle ear, continues throughout gestation. At birth, the middle ear, inner ear, and associated structures are almost adult size. An understanding of the embryologic development of the ear serves as a foundation for evaluating and managing congenital malformations of these structures. The focus of this article is the normal, abnormal, and arrested development of the middle and inner ear, with a clinical emphasis on malformed middle and inner ear structures and a discussion of associated syndromes.
Team behaviors: working effectively in teams.

PubMed

Wilson, C K

1998-12-01

The work of building and sustaining teams is often underestimated by middle managers. A manager must have the ability to develop and evolve staff toward a new level of competence, required because of radically upgraded expectations. Managers must be clear about what it means to empower teams, to avoid the trappings of giving "lip service" to authority boundaries, which may exist only on paper. Achieving this clarity means understanding the characteristics of effective teams: a high degree of interdependence, strong sense of organizational empowerment, self-determination, competence, commitment, and genuine concern about the quality of work being performed. An important tool for the manager interested in team development is the creation of a performance model, grounded in the foundational relationship competencies necessary for team success. Performance modeling assists not only in identifying of competency gaps that can be addressed by training but also in determining the workplace barriers to team success.
Effects of human management on black carbon sorption/desorption during a water transfer project: Recognizing impacts and identifying mitigation possibilities.

PubMed

Hao, Rong; Zhang, Jinliang; Wang, Peichao; Hu, Ronggui; Song, Yantun; Wu, Yupeng; Qiu, Guohong

2018-05-15

Water resources management is an important public concern. In this study, we examined the extent of sorption/desorption of trace pollutants to soil black carbon (BC) in the water level fluctuation zone (WLFZ) of the middle route of the South to North Water Transfer Project in China. In addition, we investigated the main management measures affecting these processes during the project. The results showed that the pseudo second-order model adequately describes the sorption/desorption of phenanthrene on the soil BC in the WLFZ. Water level fluctuation may indirectly influenced BC sorption/desorption by altering water chemistry. Water level residence time had negative effects on BC sorption in short-term experiments (days to months), but the impact gradually diminished with increased residence time. The results suggested that long-term field monitoring of water chemistry is urgent. During the initial period of water transfer, delaying the water supplies as drinking water source or directly irrigating crops could mitigate the adverse impacts. Future research should focus on the water-soluble products of BC degradation. The findings of this study should be useful in improving sustainable management of water resources for water transfer projects. Copyright © 2018 Elsevier Ltd. All rights reserved.
Land Use/Cover Change in the Middle Reaches of the Heihe River Basin over 2000-2011 and Its Implications for Sustainable Water Resource Management

PubMed Central

Hu, Xiaoli; Lu, Ling; Li, Xin; Wang, Jianhua; Guo, Ming

2015-01-01

The Heihe River Basin (HRB) is a typical arid inland river basin in northwestern China. From the 1960s to the 1990s, the downstream flow in the HRB declined as a result of large, artificial changes in the distribution of water and land and a lack of effective water resource management. Consequently, the ecosystems of the lower reaches of the basin substantially deteriorated. To restore these degraded ecosystems, the Ecological Water Diversion Project (EWDP) was initiated by the Chinese government in 2000. The project led to agricultural and ecological changes in the middle reaches of the basin. In this study, we present three datasets of land use/cover in the middle reaches of the HRB derived from Landsat TM/ETM+ images in 2000, 2007 and 2011. We used these data to investigate changes in land use/cover between 2000 and 2011 and the implications for sustainable water resource management. The results show that the most significant land use/cover change in the middle reaches of the HRB was the continuous expansion of farmland for economic interests. From 2000 to 2011, the farmland area increased by 12.01%. The farmland expansion increased the water resource stress; thus, groundwater was over-extracted and the ecosystem was degraded in particular areas. Both consequences are negative and potentially threaten the sustainability of the middle reaches of the HRB and the entire river basin. Local governments should therefore improve the management of water resources, particularly groundwater management, and should strictly control farmland reclamation. Then, water resources could be ecologically and socioeconomically sustained, and the balance between upstream and downstream water demands could be ensured. The results of this study can also serve as a reference for the sustainable management of water resources in other arid inland river basins. PMID:26115484
Combining glyphosate with burning or mowing improves control of Yellow Bluestem (Bothriochloa ischaemum)

USGS Publications Warehouse

Robertson, S.; Hickman, Karen R.; Harmoney, Keith R.; Leslie,, David M.

2013-01-01

The invasive yellow bluestem (Bothriochloa ischaemum [L.] Keng) threatens native biodiversity, and its control is of interest to land managers involved in restoration of invaded grasslands. We used single, double, and triple applications of glyphosate (2.125 kg ai.ha-1.application-1) over the course of one growing season in combinations at different timings (early, middle, late season) with and without a mechanical treatment of mowing or burning to determine the most effective control method. One year after treatment, burning and mowing prior to a mid-season single or double early, middle, and/or late season herbicide application resulted in a similar level of control of yellow bluestem relative to a triple herbicide application, all of which had greater control relative to herbicide treatment alone. Reproductive tiller density and visual obstruction increased 2 yr after treatment with two herbicide treatments applied either early and middle season or early and late season, but it was prevented with burning and mowing prior to herbicide application. With the exception of three herbicide applications, combining burning or mowing with herbicide applications provided more effective control of yellow bluestem than any individual herbicide applications. Burning or mowing likely improves glyphosate effectiveness by altering the invasive grass structure so that plants are clear of standing dead and have shorter, active regrowth to enhance herbicide effectiveness. During restoration projects requiring control of invasive yellow bluestem, an effective management option is a combination of mechanical and chemical control.
Design and validation of a critical pathway for hospital management of patients with severe traumatic brain injury.

PubMed

Espinosa-Aguilar, Amilcar; Reyes-Morales, Hortensia; Huerta-Posada, Carlos E; de León, Itzcoatl Limón-Pérez; López-López, Fernando; Mejía-Hernández, Margarita; Mondragón-Martínez, María A; Calderón-Téllez, Ligia M; Amezcua-Cuevas, Rosa L; Rebollar-González, Jorge A

2008-05-01

Critical pathways for the management of patients with severe traumatic brain injury (STBI) may contribute to reducing the incidence of hospital complications, length of hospitalization stay, and cost of care. Such pathways have previously been developed for departments with significant resource availability. In Mexico, STBI is the most important cause of complications and length of stay in neurotrauma services at public hospitals. Although current treatment is designed basically in accordance with the Brain Trauma Foundation guidelines, shortfalls in the availability of local resources make it difficult to comply with these standards, and no critical pathway is available that accords with the resources of public hospitals. The purpose of the present study was to design and to validate a critical pathway for managing STBI patients that would be suitable for implementation in neurotrauma departments of middle-income level countries. The study comprised two phases: design (through literature review and design plan) and validation (content, construct, and appearance) of the critical pathway. The validated critical pathway for managing STBI patients entails four sequential subprocesses summarizing the hospital's care procedures, and includes three components: (1) nodes and criteria (in some cases, indicators are also included); (2) health team members in charge of the patient; (3) maximum estimated time for compliance with recommendations. This validated critical pathway is based on the current scientific evidence and accords with the availability of resources of middle-income countries.
Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health

PubMed Central

Bergström, Anna; Hoa, Dinh Thi Phuong; Nga, Nguyen Thu; Eldh, Ann Catrine

2017-01-01

Background In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial. Methods In 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis. Results To achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital–prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking. Conclusions The current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond the project lifetime, and engagement of key stakeholders, in order to promote and sustain knowledge implementation. PMID:28806744
Project NANO (nanoscience and nanotechnology outreach): a STEM training program that brings SEM's and stereoscopes into high-school and middle-school classrooms

NASA Astrophysics Data System (ADS)

Cady, Sherry L.; Blok, Mikel; Grosse, Keith; Wells, Jennifer

2014-09-01

The program Project NANO (Nanoscience and Nanotechnology Outreach) enables middle and high school students to discover and research submicroscopic phenomena in a new and exciting way with the use of optical and scanning electron microscopes in the familiar surroundings of their middle or high school classrooms. Project NANO provides secondary level professional development workshops, support for classroom instruction and teacher curriculum development, and the means to deliver Project NANO toolkits (SEM, stereoscope, computer, supplies) to classrooms with Project NANO trained teachers. Evaluation surveys document the impact of the program on student's attitudes toward science and technology and on the learning outcomes for secondary level teachers. Project NANO workshops (offered for professional development credit) enable teachers to gain familiarity using and teaching with the SEM. Teachers also learn to integrate new content knowledge and skills into topic-driven, standards-based units of instruction specifically designed to support the development of students' higher order thinking skills that include problem solving and evidence-based thinking. The Project NANO management team includes a former university science faculty, two high school science teachers, and an educational researcher. To date, over 7500 students have experienced the impact of the Project NANO program, which provides an exciting and effective model for engaging students in the discovery of nanoscale phenomena and concepts in a fun and engaging way.
Optimising the medical management of hyperglycaemia in type 2 diabetes in the Middle East: pivotal role of metformin

PubMed Central

Al-Maatouq, M; Al-Arouj, M; Assaad, S H; Assaad, S N; Azar, S T; Hassoun, A A K; Jarrah, N; Zatari, S; Alberti, K G M M

2009-01-01

Aims: Increases in the prevalence of type 2 diabetes will likely be greater in the Middle East and other developing countries than in most other regions during the coming two decades, placing a heavy burden on regional healthcare resources. Methodology: Medline search, examination of data from major epidemiological studies in the Middle Eastern countries. Results: The aetiology and pathophysiology of diabetes appears comparable in Middle Eastern and other populations. Lifestyle intervention is key to the management of diabetes in all type 2 diabetes patients, who should be encouraged strongly to diet and exercise. The options for pharmacologic therapy in the management of diabetes have increased recently, particularly the number of potential antidiabetic combinations. Metformin appears to be used less frequently to initiate antidiabetic therapy in the Middle East than in other countries. Available clinical evidence, supported by current guidelines, strongly favours the initiation of antidiabetic therapy with metformin in Middle Eastern type 2 diabetes patients, where no contraindications exist. This is due to its equivalent or greater efficacy relative to other oral antidiabetic treatments, its proven tolerability and safety profiles, its weight neutrality, the lack of clinically significant hypoglycaemia, the demonstration of cardiovascular protection for metformin relative to diet in the UK Prospective Diabetes Study and in observational studies, and its low cost. Additional treatments should be added to metformin and lifestyle intervention as diabetes progresses, until patients are receiving an intensive insulin regimen with or without additional oral agents. Conclusions: The current evidence base strongly favours the initiation of antidiabetic therapy with metformin, where no contraindications exist. However, metformin may be under-prescribed in the Middle East. PMID:20089006
Middle-Level Secondary School Leaders: Potential, Constraints and Implications for Leadership Preparation and Development

ERIC Educational Resources Information Center

Gurr, David; Drysdale, Lawrie

2013-01-01

Purpose: The aim of this paper is to bring together for the first time three studies of middle-level leaders in secondary schools in Victoria, Australia. The studies span more than a decade and allow consideration of the progress in developing middle-level leadership roles. Design/methodology/approach: All studies followed a consistent approach…
Leading organisational learning in health care.

PubMed

Carroll, J S; Edmondson, A C

2002-03-01

As healthcare organisations seek to enhance safety and quality in a changing environment, organisational learning practices can help to improve existing skills and knowledge and provide opportunities to discover better ways of working together. Leadership at executive, middle management, and local levels is needed to create a sense of shared purpose. This shared vision should help to build effective relationships, facilitate connections between action and reflection, and strengthen the desirable elements of the healthcare culture while modifying outdated assumptions, procedures, and structures.
Leadership Profile of a Successful Military Middle Manager.

DTIC Science & Technology

1979-12-01

Curriculum (consideration) HS 7 HC 7 H0 Ust2- s PS E C t 1UCE 26 H. Concerning birth order, the hypotheses are: HS 8: First born (fb) children would...it to say that first-born children are significantly less structured than their siblings as measured by the instrument used in this study. B. REMARKS...counterparts on two very important dimensions of leadership: consideration and structure. And, whether any key background factors impact on the levels of 0 DOI

The Challenge of Stress-Related Non-Communicable Diseases.

PubMed

Fricchione, Gregory L

2018-06-15

The greatest challenge facing medicine today involves the so-called non-communicable diseases (NCDs). This is true regardless of whether one's location is considered high-income, middle-income, or low-income. Basic research at all "OMICs" system levels will be significant in uncovering causal links that create NCD vulnerabilities in mind, brain, body, and society. Therefore, meeting this 21st century challenge by improving NCD management and prevention around the world will rely on advancement in this type of basic research.
Socio-economic disadvantage is associated with heavier drinking in high but not middle-income countries participating in the International Alcohol Control (IAC) Study.

PubMed

Huckle, Taisia; Romeo, Jose S; Wall, Martin; Callinan, Sarah; Holmes, John; Meier, Petra; Mackintosh, Anne-Maree; Piazza, Marina; Chaiyasong, Surasak; Cuong, Pham Viet; Casswell, Sally

2018-04-30

To investigate if socio-economic disadvantage, at the individual- and country-level, is associated with heavier drinking in some middle- and high-income countries. Surveys of drinkers were undertaken in some high- and middle-income countries. Participating countries were Australia, England, New Zealand, Scotland (high-income) and Peru, Thailand and Vietnam (middle-income). Disadvantage at the country-level was defined as per World Bank (categorised as middle-or high-income); individual-level measures were (i) years of education and (ii) whether and individual was under or over the poverty line in each country. Measures of heavier drinking were (i) proportion of drinkers that consumed 8+ drinks and (ii) three drinking risk groups (lower, increasing and higher). Multi-level logistic regression models were used. Individual-level measures of disadvantage, lower education and living in poverty, were associated with heavier drinking, consuming 8+ drinks on a typical occasion or drinking at the higher risk level, when all countries were considered together. Drinkers in the middle-income countries had a higher probability of consuming 8+ drinks on a typical occasion relative to drinkers in the high-income countries. Interactions between country-level income and individual-level disadvantage were undertaken: disadvantaged drinkers in the middle-income countries were less likely to be heavier drinkers relative to those with less disadvantage in the high-income countries. Associations between socio-economic disadvantage and heavier drinking vary depending on country-level income. These findings highlight the value of exploring cross-country differences in heavier drinking and disadvantage and the importance of including country-level measurements to better elucidate relationships. © 2018 Australasian Professional Society on Alcohol and other Drugs.
Middle Level Learning, 1999-2000.

ERIC Educational Resources Information Center

Social Education, 2000

2000-01-01

Intended for middle school social studies classrooms, this publication features articles that spotlight diverse and innovative learning activities. This document includes the three issues of the "Middle Level Learning" supplement published in 1999 and the three that were published in 2000. Articles and classroom activities highlighted in this…
Effects of inclusion level on nutrient digestibility and energy content of wheat middlings and soya bean meal for growing pigs.

PubMed

Huang, Qiang; Piao, Xiangshu; Liu, Ling; Li, Defa

2013-01-01

Two experiments were conducted to determine the effects of inclusion level of wheat middlings and soya bean meal on apparent total tract digestibility (ATTD) of energy and chemical components of these ingredients in growing pigs. Furthermore, the effects of the inclusion level on their contents of digestible energy (DE) and metabolisable energy (ME) were also determined by the difference method. In Experiment 1, six diets were fed to 36 growing pigs according to a completely randomised design. The basal diet was a corn-soya bean meal diet while the other five diets contained 9.6%, 19.2%, 28.8%, 38.4% or 48.0% of wheat middlings added at the expense of corn and soya bean meal. The measured digestibility of energy and most nutrients of wheat middlings increased (p < 0.05) with increasing levels of that ingredient. Equations were obtained to predict digestibility by inclusion level. At an inclusion level of 9.6% wheat middlings, their DE contents were significantly lower (8.9 MJ/kg DM) than for the higher levels (10.7 to 11.9 MJ/kg DM, p < 0.01). In Experiment 2, three diets were fed to 18 growing pigs according to a completely randomised block design. The basal diet was a corn-based diet while the other two diets were based on corn and two levels of soya bean meal (22.2% and 33.6%). The content of DE in soya bean meal did not differ at 22.2% and 33.6% inclusion levels (16.2 and 16.3 MJ/kg DM, respectively), but the digestibility of dry matter (DM), organic matter and carbohydrates was increased at a higher inclusion level (p < 0.05). This study revealed that the estimated digestibility of nutrients from soya bean meal and wheat middlings was affected by their dietary inclusion levels. For soya bean meal, the estimated energy contents was independent of its inclusion level, but not for wheat middlings. Therefore, the inclusion level of wheat middlings has to be considered for estimating their energy value.
Resource Allocation Practices in Three Charter Middle Schools in Relation to Student Achievement Improvement Strategies

ERIC Educational Resources Information Center

Campo-Contreras, Susana

2013-01-01

The purpose of the study was to develop a better understanding of the allocation of resources used to improve student learning outcomes in three middle schools within a Charter Management Organization (CMO). The three middle schools that participated in the study have similar demographics and serve students in low socio-economic areas of Los…
Effects of a spirituality training program on the spiritual and psychosocial well-being of hospital middle manager nurses in Korea.

PubMed

Yong, Jinsun; Kim, Juhu; Park, Junyang; Seo, Imsun; Swinton, John

2011-06-01

This study examined the effect of a spirituality training program on the spiritual well-being, spiritual integrity, leadership practice, job satisfaction, and burnout of hospital middle manager nurses in Korea. In an experimental study with a two-group (experimental vs. control) design, participants were enrolled for 5 weeks, with 24 nurses in the spirituality program and 27 in the control group. After the spirituality training program, spiritual well-being, spiritual integrity, and leadership practice improved and burnout was reduced significantly in the experimental group compared with the control group. The program was effective in improving psychosocial and spiritual well-being of middle manager nurses. Thus, this program could be a resource for continuing education and staff development offerings to enhance the well-being of nurses and the spiritual care of patients. Copyright 2011, SLACK Incorporated.
Organizational Health Directly Influences Student Performance at the Middle Level.

ERIC Educational Resources Information Center

Brown, Kathleen M.; Roney, Kathleen; Anfara, Vincent A., Jr.

2003-01-01

Explored the implementation of middle level reform components in both high- and low-performing middle schools, seeking to identify factors linked to student achievement. Found that organizational health, which includes academic focus, teacher affiliation, and resource support, more directly influences student performance than simple implementation…
Ghost Children: Invisible Middle Level Students

ERIC Educational Resources Information Center

Matteson, Shirley M.

2014-01-01

For this study, 119 middle level teacher candidates identified, observed, and documented their interactions with middle school "ghost children" as part of their field placement activities. About two thirds of the 124 ghost children identified for this study were male. The teacher candidates documented additional characteristics of ghost…
What Current Research Says to the Middle Level Practitioner.

ERIC Educational Resources Information Center

Irvin, Judith L., Ed.

This volume provides recent research findings on important topics related to the still-expanding middle school movement. They are divided into seven parts, addressing teaching/learning, curriculum, teacher education, social context, organization, leaderships, and issues and future directions. Following an introduction to middle level education…
A 21st Century Research Agenda: Issues, Topics & Questions Guiding Inquiry into Middle Level Theory & Practice.

ERIC Educational Resources Information Center

National Middle School Association, Columbus, OH.

The purpose of this document is to widen the conversation and include all the stakeholders in the further development and use of enlightened and relevant research on middle level schooling. The research agenda it presents is meant to be a guide to topics, themes, and questions central to a number of middle level issues. The agenda consists of sets…
Guess Again: Will Changing the Grades Save Middle-Level Education?

ERIC Educational Resources Information Center

Beane, James; Lipka, Richard

2006-01-01

Blaming unsatisfactory student achievement on the middle school concept is a case of mistaken identity. Too many middle schools have failed to fully implement the middle school concept. Based on statements from the Carnegie Council and the National Middle School Association, the middle school concept calls for improved academic achievement for all…
A Middle-Range Theory for Diabetes Self-management Mastery.

PubMed

Fearon-Lynch, Jennifer A; Stover, Caitlin M

2015-01-01

Diabetes mellitus is the seventh leading cause of death in America and affects 382 million people worldwide. Individuals with diabetes must manage the complexity of the disease, its treatment, and complications to avert deleterious consequences associated with the illness. However, not all patients with diabetes successfully gain mastery to positively impact self-management. A new middle-range theory is proposed that merges 2 extant theories, theory of mastery and organismic integration theory, to better understand this human response. The theories' philosophical, theoretical, and conceptual perspectives were examined and relational properties synthesized to provide a conceptual representation of the phenomenon of interest.
Organizational Factors that Affect the Implementation of Information Technology: Perspectives of Middle Managers in Iran.

PubMed

Barzekar, Hosein; Karami, Mahtab

2014-10-01

to examine the organizational factors affecting the application of information technology in hospitals. Since the organizational factors are one of the most important determinants of successful projects, by understanding their impact and identifying them it can help planning a systematic IT implementation. In this cross-sectional descriptive study 110 middle managers were chosen from teaching hospitals. Structured questionnaire was used for the data collection. There was a significant relationship between organization resource, organizational knowledge, process, management structure and values and goals with implementation of information technology. Findings showed that organizational factors had a considerable impact on implementation of information technology. Top managers must consider the important aspects of effective organizational factors.
Welcome to Clipper Camp!

ERIC Educational Resources Information Center

Holler, Edward W.

2008-01-01

Rising middle level students face many new situations when they enter middle school. Stress is not uncommon for new students in any grade, but it is most acute during middle level years when students are dealing with the rapidly changing physical characteristics and emotions associated with early adolescence. The community of adults at a middle…
Supporting Diverse Young Adolescents: Cooperative Grouping in Inclusive Middle-Level Settings

ERIC Educational Resources Information Center

Miller, Nicole C.; McKissick, Bethany R.; Ivy, Jessica T.; Moser, Kelly

2017-01-01

The middle level classroom presents unique challenges to educators who strive to provide opportunities that acknowledge learner diversity in terms of social, cognitive, physical, and emotional development. This is confounded even further within inclusive middle-school classrooms where the responsibility to differentiate instruction is even more…
Booktalking Across the Curriculum: The Middle Years.

ERIC Educational Resources Information Center

Keane, Nancy J.

This book contains booktalks for 170 titles that appeal to middle school readers and relate to middle school curriculum. Approximately 90% of the books are fiction. Each entry includes author, title, publisher, date of publication, suggested interest level, suggested reading level, the booktalk, and learning extension ideas. The selections are…
Managing the public-private mix to achieve universal health coverage.

PubMed

McPake, Barbara; Hanson, Kara

2016-08-06

The private sector has a large and growing role in health systems in low-income and middle-income countries. The goal of universal health coverage provides a renewed focus on taking a system perspective in designing policies to manage the private sector. This perspective requires choosing policies that will contribute to the performance of the system as a whole, rather than of any sector individually. Here we draw and extrapolate main messages from the papers in this Series and additional sources to inform policy and research agendas in the context of global and country level efforts to secure universal health coverage in low-income and middle-income countries. Recognising that private providers are highly heterogeneous in terms of their size, objectives, and quality, we explore the types of policy that might respond appropriately to the challenges and opportunities created by four stylised private provider types: the low-quality, underqualified sector that serves poor people in many countries; not-for-profit providers that operate on a range of scales; formally registered small-to-medium private practices; and the corporate commercial hospital sector, which is growing rapidly and about which little is known. Copyright © 2016 Elsevier Ltd. All rights reserved.
[Interview study on autonomous chemical management system and the contribution of occupational health specialists in companies].

PubMed

Mori, Koji; Takebayashi, Toru

2004-09-01

Under the circumstance that autonomous risk management for chemicals is required in Japan, it is necessary to define fundamental steps for developing chemical management system that are applicable in various types of companies and to understand the effective contribution of chemical or occupational health specialists to the system. For the purposes, we conducted interviews with companies which have an advanced chemical management system in Japan. As the result, each company had a certain policy about detailedness level of collected hazard and exposure information, and also had an efficient risk management system to ensure workers' health in depending on the business type and situations. Moreover, it was commonly observed that the specialists played major roles in developing tools for risk assessment and control, and then business lines led execution of the risk management with their supports. Based on the interviews, we showed a hypothesis of basic steps in introducing autonomous chemical risk management system at the workplaces. It is necessary to verify the hypothesis and to develop a simple system that is applicable to middle or small size companies as the next step.
Electronic Data Collection and Management System for Global Adult Tobacco Survey

PubMed Central

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

2012-01-01

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

ERIC Educational Resources Information Center

Li, Manli; Zhang, Yu; Wang, Yihan

2017-01-01

This study examines the gender gaps in mathematics and physics in Chinese middle schools. The data is from the Education Bureau management database which includes all middle school students who took high school entrance exam in a district of Beijing from 2006-2013. The ordinary least square model and quantile regression model are applied. This…

Climate-mediated changes in zooplankton community structure for the eastern Bering Sea

NASA Astrophysics Data System (ADS)

Eisner, Lisa B.; Napp, Jeffrey M.; Mier, Kathryn L.; Pinchuk, Alexei I.; Andrews, Alexander G.

2014-11-01

Zooplankton are critical to energy transfer between higher and lower trophic levels in the eastern Bering Sea ecosystem. Previous studies from the southeastern Bering Sea shelf documented substantial differences in zooplankton taxa in the Middle and Inner Shelf Domains between warm and cold years. Our investigation expands this analysis into the northern Bering Sea and the south Outer Domain, looking at zooplankton community structure during a period of climate-mediated, large-scale change. Elevated air temperatures in the early 2000s resulted in regional warming and low sea-ice extent in the southern shelf whereas the late 2000s were characterized by cold winters, extensive spring sea ice, and a well-developed pool of cold water over the entire Middle Domain. The abundance of large zooplankton taxa such as Calanus spp. (C. marshallae and C. glacialis), and Parasagitta elegans, increased from warm to cold periods, while the abundance of gelatinous zooplankton (Cnidaria) and small taxa decreased. Biomass followed the same trends as abundance, except that the biomass of small taxa in the southeastern Bering Sea remained constant due to changes in abundance of small copepod taxa (increases in Acartia spp. and Pseudocalanus spp. and decreases in Oithona spp.). Statistically significant changes in zooplankton community structure and individual species were greatest in the Middle Domain, but were evident in all shelf domains, and in both the northern and southern portions of the eastern shelf. Changes in community structure did not occur abruptly during the transition from warm to cold, but seemed to begin gradually and build as the influence of the sea ice and cold water temperatures persisted. The change occurred one year earlier in the northern than the southern Middle Shelf. These and previous observations demonstrate that lower trophic levels within the eastern Bering Sea respond to climate-mediated changes on a variety of time scales, including those shorter than the commonly accepted quasi-decadal time periods. This lack of resilience or inertia at the lowest trophic levels affects production at higher trophic levels and must be considered in management strategy evaluations of living marine resources.
Potentiometric Surface of the Upper Floridan Aquifer, West-Central Florida, May 2006

USGS Publications Warehouse

Ortiz, A.G.

2007-01-01

Introduction Hydrologic Conditions in West-Central Florida The Floridan aquifer system consists of the Upper and Lower Floridan aquifers separated by the middle confining unit. The middle confining unit and the Lower Floridan aquifer in west-central Florida generally contain highly mineralized water. The water-bearing units containing fresh water are herein referred to as the Upper Floridan aquifer. The Upper Floridan aquifer is the principal source of water in the Southwest Florida Water Management District and is used for major public supply, domestic use, irrigation, and brackish water desalination in coastal communities (Southwest Florida Water Management District, 2000). This map report shows the potentiometric surface of the Upper Floridan aquifer measured in May 2006. The potentiometric surface is an imaginary surface connecting points of equal altitude to which water will rise in tightly-cased wells that tap a confined aquifer system (Lohman, 1979). This map represents water-level conditions near the end of the dry season, when ground-water levels usually are at an annual low and withdrawals for agricultural use typically are high. The cumulative average rainfall of 50.23 inches for west-central Florida (from June 2005 through May 2006) was 2.82 inches below the historical cumulative average of 53.05 inches (Southwest Florida Water Management District, 2006). Historical cumulative averages are calculated from regional rainfall summary reports (1915 to most recent complete calendar year) and are updated monthly by the Southwest Florida Water Management District. This report, prepared by the U.S. Geological Survey in cooperation with the Southwest Florida Water Management District, is part of a semi-annual series of Upper Floridan aquifer potentiometric-surface map reports for west-central Florida. Potentiometric-surface maps have been prepared for January 1964, May 1969, May 1971, May 1973, May 1974, and for each May and September since 1975. Water-level data are collected in May and September each year to show the approximate annual low and high water-level conditions, respectively. Most of the water-level data for this map were collected by the U.S. Geological Survey during the period May 15-19, 2006. Supplemental water-level data were collected by other agencies and companies. A corresponding potentiometric-surface map was prepared for areas east and north of the Southwest Florida Water Management District boundary by the U.S. Geological Survey office in Altamonte Springs, Florida (Kinnaman, 2006). Most water-level measurements were made during a 5-day period; therefore, measurements do not represent a 'snapshot' of conditions at a specific time, nor do they necessarily coincide with the seasonal low water-level condition. Water-Level Changes Water levels in about 95 percent of the wells measured in May 2006 were lower than the May 2005 water levels (Ortiz and Blanchard, 2006). May 2006 water levels in 403 wells ranged from about 26 feet below to about 6 feet above May 2005 water levels (fig. 1). Significant water level declines occurred in eastern Manatee County, southwestern Polk County, southeastern Hillsborough County, and in all of Hardee County. The largest water level declines occurred in southwestern Hardee County. The largest water level rises occurred in south-central Pasco County, northeastern Levy County, northwestern Marion County, and along the gulf coast from Pasco County to Citrus County (fig. 1). Water levels in about 96 percent of the wells measured in May 2006 were lower than the September 2005 water levels (Ortiz, 2006). May 2006 water levels in 397 wells ranged from about 31 feet below to 3 feet above the September 2005 water levels. The largest water level decline was in west-central Hardee County and the largest rise in water levels was in south-central Pasco County.
Challenges in the management of breast cancer in low- and middle-income countries.

PubMed

Yip, Cheng-Har; Taib, Nur Aishah

2012-12-01

The incidence of breast cancer is rising in low- and middle-income countries (LMICs) due to 'westernization' of risk factors for developing breast cancer. However, survival remains low because of barriers in early detection and optimal access to treatment, which are the two main determinants of breast cancer outcome. A multidisciplinary approach to treatment gives the best results. An accurate diagnosis is dependent on a reliable pathology service, which will provide an adequate pathology report with prognostic and predictor information to allow optimal oncological treatment. Stratification of clinical practice guidelines based on resource level will ensure that women will have access to treatment even in a low-resource setting. Advocacy and civil society play a role in galvanizing the political will required to meet the challenge of providing opportunities for breast cancer control in LMICs. Collaboration between high-income countries and LMICs could be a strategy in facing these challenges.
Configuration of the top of the Floridan aquifer, Southwest Florida Water Management District and adjacent areas

USGS Publications Warehouse

Buono, A.; Rutledge, A.T.

1978-01-01

This map depicts the approximate top of the rock that composes the Floridan aquifer. The contours represent the elevation of the top of the Floridan aquifer to mean sea level. Rock units recognized to be part of the Floridan aquifer are limestone and dolomite ranging from middle Eocene to early Miocene. They are Lake City Limestone, Avon Park Limestone, Ocala Limestone, Suwannee Limestone, and Tampa Limestone. In this report, the top of the Floridan aquifer is a limestone defined as the first consistent rock of early Miocene age or older below which occur no clay confining beds. Although the Hawthorn formation of middle Miocene is considered part of the Floridan aquifer when it is in direct hydrologic contact with lower lying rock units, it is not considered here because of a lack of detailed delineation of areas where contact exists. (Woodard-USGS)
Endurance Training-Induced Increase in Circulating Irisin Levels Is Associated with Reduction of Abdominal Visceral Fat in Middle-Aged and Older Adults

PubMed Central

Miyamoto-Mikami, Eri; Sato, Koji; Kurihara, Toshiyuki; Hasegawa, Natsuki; Fujie, Shumpei; Fujita, Satoshi; Sanada, Kiyoshi; Hamaoka, Takafumi; Tabata, Izumi; Iemitsu, Motoyuki

2015-01-01

To elucidate the effects of endurance training on circulating irisin levels in young and middle-aged/older adults, and to determine the association between endurance training-induced alteration of irisin and reduction in body fat. Twenty-five healthy young (age 21 ± 1 years; 16 men, 9 women) and 28 healthy middle-aged/older adults (age 67 ± 8 years; 12 men, 16 women) participated in the study. Each age cohort was divided into two groups: the endurance-training group (14 young, 14 middle-aged/older) and the control group. Subjects in the training groups completed an 8-week endurance-training program (cycling at 60-70% peak oxygen uptake [V˙O2peak] for 45 min, 3 days/week). Before and after the intervention, we evaluated serum irisin level, V˙O2peak, and body composition. The increase in V˙O2peak in the young and middle-aged/older training groups after the intervention period was significantly greater than those in the young and middle-aged/older control groups (P < 0.05). Serum irisin level was significantly increased in the middle-aged/older training group after the intervention period (P < 0.01), but not in the young training group. Furthermore, in the middle-aged/older training group, the endurance training-induced reduction in visceral adipose tissue area was negatively correlated with the change in serum irisin level (r = −0.54, P < 0.05). These results suggest a possible role for secreted irisin in the exercise-induced alteration of abdominal visceral fat in middle-aged and older adults. PMID:25793753
Clinical Assessment and Management of Spondyloarthritides in the Middle East: A Multinational Investigation.

PubMed

Hammoudeh, Mohammed; Al Rayes, Hanan; Alawadhi, Adel; Gado, Kamel; Shirazy, Khalid; Deodhar, Atul

2015-01-01

Data on spondyloarthritis (SpA) from the Middle East are sparse and the management of these diseases in this area of the world faces a number of challenges, including the relevant resources to enable early diagnosis and referral and sufficient funds to aid the most appropriate treatment strategy. The objective was to report on the characteristics, disease burden, and treatment of SpA in the Middle East region and to highlight where management strategies could be improved, with the overall aim of achieving better patient outcomes. This multicenter, observational, cross-sectional study collected demographic, clinical, laboratory, and treatment data on 169 consecutive SpA patients at four centers (Egypt, Kuwait, Qatar, and Saudi Arabia). The data collected presents the average time from symptom onset to diagnosis along with the presence of comorbidities in the region and comparisons between treatment with NSAIDs and biologics. In the absence of regional registries of SpA patients, the data presented here provide a rare snapshot of the characteristics, disease burden, and treatment of these patients, highlighting the management challenges in the region.
Enhancing Middle-Level General Music: Suggestions from the Literature

ERIC Educational Resources Information Center

Gerrity, Kevin W.

2009-01-01

In his book "Teaching Music in the Secondary Schools," Charles Hoffer reported a lack of consensus among music educators when considering the essential components of a middle-level general music course. Today, this condition persists. The increasingly diverse nature of students and schools makes a singular, model curriculum for middle-level…
Gender Equity in Middle School Science Teaching: Being "Equitable" Should Be the Goal.

ERIC Educational Resources Information Center

Subrahmanyan, Lalita; Bozonie, Heath

1996-01-01

Examines level at which gender issues are addressed in middle school science classes. Argues that in the crucial area of science education, particularly for girls at the middle school level, "equal" rather than "equitable" as a dominant teacher attitude may be inadequate to ensure that gender imbalances are rectified. (SD)
Looking Back, Looking Ahead

ERIC Educational Resources Information Center

Doda, Nancy M.

2009-01-01

School leadership has always been wrought with high-stakes moral dilemmas. For today's middle level leaders, the stakes are about as high as they get. Beyond the challenges that all school leaders expect, middle level leaders must balance the demands of high-stakes accountability with the core principles of the middle school concept. No doubt all…
Considering the Virtual Classroom: A Call to Middle Level Education Programs

ERIC Educational Resources Information Center

Eisenbach, Brooke B.

2016-01-01

Today's classrooms are changing and moving beyond the walls of a traditional school environment. With each passing year, a growing population of middle level learners are logging into full-time or blended learning virtual courses. However, teachers often lack the training and experience necessary to address the developmental needs of middle level…
Middle School Principals' Perceptions and Preferences When Hiring Teachers

ERIC Educational Resources Information Center

Mee, Molly; Haverback, Heather Rogers

2017-01-01

The purpose of this study was to investigate middle school principals' knowledge of the state's new middle level teacher certification, their hiring preferences for newly certified teachers, and their perceptions of middle certified teacher' competencies in teaching various subject areas to middle school students. Survey data indicated that the…
CT measurement of glenoid erosion in arthritis.

PubMed

Mullaji, A B; Beddow, F H; Lamb, G H

1994-05-01

We studied serial CT scans of 45 arthritic shoulders (34 rheumatoid, 11 osteoarthritic) and 19 normal shoulders, making measurements at three levels on axial images. The maximum anteroposterior diameter of the glenoid was increased in rheumatoid glenoids at the upper and middle levels by 6 mm and in osteoarthritic glenoids at all levels by 5 to 8 mm as compared with normal. In rheumatoid cases, nearly half the available surface of the glenoid was of unsupported bone, mainly posteriorly at the upper and middle levels. In osteoarthritic glenoids, the best supported bone was anterior at the upper level and central at the middle and lower levels. The depth of the rheumatoid glenoid was reduced by a mean of 6 mm at the upper and middle levels and by 3 mm at the lower level. This inclined the surface of the glenoid superiorly. The depth at the middle level in osteoarthritis was reduced by a mean of 5 mm, suggesting central protrusion. Osteoarthritic glenoids were retroverted by a mean of 12.5 degrees, but of rheumatoid glenoids two-thirds were retroverted (mean 15.1 degrees) and one-third anteverted (mean 8.2 degrees). Our findings have important implications for the planning and placement of the glenoid component of total shoulder replacements; CT can provide useful information.
School-based asthma disease management.

PubMed

Tinkelman, David; Schwartz, Abby

2004-06-01

Asthma is the most common chronic childhood illness and the leading cause of missed school days. School is a potential location for establishing an asthma education program for children and their parents/caregivers designed to improve disease management. To determine whether a comprehensive, school-based asthma management program, in addition to a conventional disease management program, can reduce measures of asthma control, student absenteeism, and caregiver lost workdays. School nurses recruited parents/caregivers of students with asthma from three urban elementary and middle schools. Children were identified as having asthma by a previous diagnosis from their personal physician. Parents were invited to attend educational sessions about the program. Students received peak flow meters and training in their use and had access to an interactive asthma diary to record symptoms, peak flow, and medicine usage. They received monthly asthma education at school and had access to an online asthma education program and additional handouts. Parents received several educational calls regarding asthma and had a 24-hour, 7-days-a-week emergency number to call if problems arose. At 6 months, missed school days and unscheduled doctor visits were reduced by two thirds (n = 41; p< 0.01 for each). Caregivers' perception of children's activity level increased by 11% (n = 26; p = 0.037). Daytime and nighttime frequency of symptoms dropped by 62% and 34%, respectively (n = 32; p < 0.007 and p<0.03 for each). These trends continued at 12 months, although only reduction in frequency of symptoms attained statistical significance. A comprehensive, school-based asthma management program can successfully improve asthma control and reduce absenteeism in elementary and middle school students and caregiver lost workdays.
Middle lobe syndrome in children today.

PubMed

Romagnoli, Vittorio; Priftis, Kostas N; de Benedictis, Fernando M

2014-06-01

Middle lobe syndrome in children is a distinct clinical and radiographic entity that has been well described in the pediatric literature. However, issues regarding its etiology, clinical presentation, and management continue to puzzle the clinical practitioner. Pathophysiologically, there are two forms of middle lobe syndrome, namely obstructive and nonobstructive. Middle lobe syndrome may present as symptomatic or asymptomatic, as persistent or recurrent atelectasis, or as pneumonitis or bronchiectasis of the middle lobe and/or lingula. A lower threshold of performing a chest radiograph is warranted in children with persistent or recurrent nonspecific respiratory symptoms, particularly if there is clinical deterioration, in order to detect middle lobe syndrome and to initiate a further diagnostic and therapeutic workup. Copyright © 2014 Elsevier Ltd. All rights reserved.
Motivation and Job Satisfaction for Middle Level Career Army Officers

DTIC Science & Technology

1975-06-06

Improves performance and performance ultimately leads to reward in the form of need satisfaction . The individual’s perception of this assumption and the... Satisfaction for Middle Level Career Army Officers Colin 0. Halvorson, CPT, USA U.S. Army Command and General Staff College Fort Leavenworth, Kansas...FORM 3. RECIPIENT’S CAT ALOG NUMBER V TI^LE (onJ Sublltta) Motivation and Job Satisfaction for Middle Level Career Army Officers 7
The impact of acculturation and religious identification on perceived discrimination for Arab/Middle Eastern Americans.

PubMed

Awad, Germine H

2010-01-01

The aim of the current study was to determine the impact of acculturation, ethnic identity, and religious affiliation on perceived discrimination for persons of Arab and Middle Eastern descent. Two aspects of acculturation (ethnic society immersion and dominant society immersion), religious affiliation, and ethnic identity were measured using a final sample of 177 individuals of Arab or Middle Eastern descent. Results indicated that Arab/Middle Eastern Americans who reported lower levels of dominant society immersion tended to report higher levels of discrimination. Furthermore, Muslims reported a higher level of discrimination than Christians but this finding was moderated by level of acculturation. Specifically, Muslims who reported a high level of dominant society immersion experienced the most discrimination, whereas Christians who reported a high level of dominant society immersion reported less discrimination. Study implications are discussed. (c) 2009 APA, all rights reserved.
Contrasting outcomes of older versus middle-aged and younger adult chemical dependency patients in a managed care program.

PubMed

Satre, Derek D; Mertens, Jennifer; Areán, Patricia A; Weisner, Constance

2003-07-01

This study examined how well older chemical dependency patients succeed in treatment relative to middle-aged and younger patients in a mixed-age private HMO outpatient program. To predict successful outcome, we tested a model incorporating age group differences in individual, treatment and extratreatment factors. The sample included 89 patients aged 55 and over, 379 patients aged 40 to 54, and 736 patients aged 18-39 (N = 1,204). Baseline measures included DSM-IV substance misuse diagnoses, Addiction Severity Index (ASI), psychiatric symptom checklist, sources of suggestion to enter treatment, treatment history and motivation. Outcome measures were abstinence rates and ASI score 6 months posttreatment. At baseline, older adults showed higher levels of alcohol dependence, lower rates of drug dependence and lower psychiatric symptoms relative to younger individuals. Source of suggestions to enter treatment differed by age. Older and middle-aged patients were more likely to have an abstinence goal and to stay in treatment longer than younger adults. At 6 months posttreatment, 55% of older adults reported abstinence in the preceding 30 days, versus 59% of middle-aged adults and 50% of younger adults (p = .035). Lower rates of dependence and hostility, and greater abstinence motivation and length of stay in treatment--all of which were associated with greater age--positively affect prognosis of older adults in treatment.
Naturalistic distraction and driving safety in older drivers.

PubMed

Aksan, Nazan; Dawson, Jeffrey D; Emerson, Jamie L; Yu, Lixi; Uc, Ergun Y; Anderson, Steven W; Rizzo, Matthew

2013-08-01

In this study, we aimed to quantify and compare performance of middle-aged and older drivers during a naturalistic distraction paradigm (visual search for roadside targets) and to predict older drivers performance given functioning in visual, motor, and cognitive domains. Distracted driving can imperil healthy adults and may disproportionally affect the safety of older drivers with visual, motor, and cognitive decline. A total of 203 drivers, 120 healthy older (61 men and 59 women, ages 65 years and older) and 83 middle-aged drivers (38 men and 45 women, ages 40 to 64 years), participated in an on-road test in an instrumented vehicle. Outcome measures included performance in roadside target identification (traffic signs and restaurants) and concurrent driver safety. Differences in visual, motor, and cognitive functioning served as predictors. Older drivers identified fewer landmarks and drove slower but committed more safety errors than did middle-aged drivers. Greater familiarity with local roads benefited performance of middle-aged but not older drivers.Visual cognition predicted both traffic sign identification and safety errors, and executive function predicted traffic sign identification over and above vision. Older adults are susceptible to driving safety errors while distracted by common secondary visual search tasks that are inherent to driving. The findings underscore that age-related cognitive decline affects older drivers' management of driving tasks at multiple levels and can help inform the design of on-road tests and interventions for older drivers.
Community and household socioeconomic factors associated with pesticide-using, small farm household members' health: a multi-level, longitudinal analysis

PubMed Central

2011-01-01

Background Longitudinal studies using multi-level models to examine health inequalities in lower and middle income countries (LMICs) are rare. We explored socio-economic gradients in health among small farm members participating in a pesticide-related health and agriculture program in highland Ecuador. Methods We profiled 24 communities through key informant interviews, secondary data (percent of population with unsatisfied basic needs), and intervention implementation indicators. Pre (2005) and post (2007) surveys of the primary household and crop managers included common questions (education, age, and the health outcome - digit span scaled 0-10)) and pesticide-related practice questions specific to each. Household assets and pesticide use variables were shared across managers. We constructed multi-level models predicting 2007 digit span for each manager type, with staged introduction of predictor variables. Results 376 household managers (79% of 2005 participants) and 380 crop managers (76% of 2005 participants) had complete data for analysis. The most important predictor of 2007 digit span was 2005 digit span: β (Standard Error) of 0.31(0.05) per unit for household and 0.17(0.04) for crop managers. Household asset score was next most important: 0.14(0.06) per unit for household and 0.14(0.05) for crop managers. Community percent with unsatisfied basic needs was associated with reductions in 2007 digit span: -0.04(0.01) per percent for household and -0.03(0.01) for crop managers. Conclusions The important roles of life endowments and/or persistent neurotoxicity were exemplified by limited change in the health outcome. Gradients by household assets and community deprivation were indicative of ongoing, structural inequities within this LMIC. PMID:22094171
Peer-to-peer shadowing as a technique for the development of nurse middle managers clinical leadership.

PubMed

Lalleman, Pieterbas; Bouma, Joanne; Smid, Gerhard; Rasiah, Jananee; Schuurmans, Marieke

2017-10-02

Purpose The purpose of this study was to explore the experiences and impact of peer-to-peer shadowing as a technique to develop nurse middle managers' clinical leadership practices. Design/methodology/approach A qualitative descriptive study was conducted to gain insight into the experiences of nurse middle managers using semi-structured interviews. Data were analysed into codes using constant comparison and similar codes were grouped under sub-themes and then into four broader themes. Findings Peer-to-peer shadowing facilitates collective reflection-in-action and enhances an "investigate stance" while acting. Nurse middle managers begin to curb the caring disposition that unreflectively urges them to act, to answer the call for help in the here and now, focus on ad hoc "doings", and make quick judgements. Seeing a shadowee act produces, via a process of social comparison, a behavioural repertoire of postponing reactions and refraining from judging. Balancing the act of stepping in and doing something or just observing as well as giving or withholding feedback are important practices that are difficult to develop. Originality/value Peer-to-peer shadowing facilitates curbing the caring disposition, which is essential for clinical leadership development through unlocking a behavioural repertoire that is not easy to reveal because it is, unreflectively, closely knit to the professional background of the nurse managers. Unlike most leadership development programmes, that are quite introspective and detached from context, peer-to-peer shadowing does have the potential to promote collective learning while acting, which is an important process.

Organizational Factors that Affect the Implementation of Information Technology: Perspectives of Middle Managers in Iran

PubMed Central

Barzekar, Hosein; Karami, Mahtab

2014-01-01

ABSTRACT Objective: to examine the organizational factors affecting the application of information technology in hospitals. Since the organizational factors are one of the most important determinants of successful projects, by understanding their impact and identifying them it can help planning a systematic IT implementation. Methods: In this cross-sectional descriptive study 110 middle managers were chosen from teaching hospitals. Structured questionnaire was used for the data collection. Results: There was a significant relationship between organization resource, organizational knowledge, process, management structure and values and goals with implementation of information technology. Conclusion: Findings showed that organizational factors had a considerable impact on implementation of information technology. Top managers must consider the important aspects of effective organizational factors. PMID:25568582
Broncho-esophageal fistula leading to lung abscess: A life-threatening emergency detected on FDG PET/CT in a case of carcinoma of middle third esophagus.

PubMed

Puranik, Ameya D; Purandare, Nilendu C; Agrawal, Archi; Shah, Sneha; Rangarajan, Venkatesh

2013-07-01

Sinister undesirable pathologies often accompany malignancies. Though the entire emphasis is on cancer management, these benign conditions are more life-threatening than the primary malignancy itself. We report an interesting imaging finding of broncho-esophageal fistula leading to lung abscess on (18)F- fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) in large middle esophageal cancer, which due to early detection, was promptly managed.
The impact of mindfulness on leadership effectiveness in a health care setting: a pilot study.

PubMed

Wasylkiw, Louise; Holton, Judith; Azar, Rima; Cook, William

2015-01-01

The purpose of this paper is to examine the impact of mindfulness awareness practice (MAP) on mid-level health-care managers' leadership. In total, 11 mid-level health-care managers in eastern Canada took part in an intensive weekend retreat and a follow-up webinar on mindfulness awareness. Perceived stress and leadership effectiveness were assessed pre- and post-intervention (i.e. four and eight weeks). A control group (n=10) also completed the same measures twice. Additionally, informants (n=28) provided assessments of participants' leadership pre- and post-intervention. Follow-up interviews were carried out with eight participants 12-16 weeks post-intervention. In comparison to controls, retreat participants showed significant increases in mindfulness and corresponding decreases in stress that were sustained across eight weeks post-retreat; retreat participants reported significant positive changes in their leadership effectiveness that were corroborated by informants. Qualitative data, however, suggest that sustaining a mindfulness practice presents significant challenges to middle managers in a health care setting. The findings are useful to management working in health services that are plagued by increasing demands and changes. Despite the small sample and lack of random assignment, the pilot data support the efficacy of MAP in improving leadership. Little empirical research supports the claim that MAP enhances leadership. The present study employed a mixed methods approach to address this gap and demonstrates the potential benefits of MAP among mid-level managers.
[Dynamic changes of landscape connectivity for ecological lands and distance thresholds in the middle reaches of the Heihe River, Northwest China.

PubMed

Meng, Ji Jun; Wang, Xiao Dong; You, Nan Shan; Zhu, Li Kai

2016-06-01

Landscape connectivity describes the organic connections of landscape components in terms of landscape pattern, process, and function. We used land-cover data in 1986, 2000, and 2011, to study the changes of landscape connectivity for ecological lands (forest, grassland, and wetland) in the middle reaches of the Heihe River based on graph theory. The appropriate landscape threshold was determined by analyzing landscape connectivity changes for different thresholds. Our results indicated that the area of ecological patches, which strongly influenced landscape connectivity, decreased from 1986 to 2011 in our study area. For wetland patches, the area declined more significantly from 2000 to 2011. For grassland, the number of patches decreased and then increased. The area of grassland patches changed slightly, but some patches were fragmented. Distance thresholds had a positive relationship with landscape connectivity. 400 to 800 m was the appropriate distance threshold for the research on species dispersal and ecological flows in the middle reaches of the Heihe River. When 600 m was chosen as the distance threshold, the large patches exerted the most significant influence on regional landscape connectivity level, suggesting they played a key role in regional ecosystem stability and health. Although small ecological patches occupied a small proportion of the total area of ecological patches, it was still necessary to protect and manage these small patches given that they also influenced the maintenance and improvement of regional ecological security pattern. The research was of great importance for ecosystem management in arid areas.
Daily physical activity enhances resilient resources for symptom management in middle-aged women.

PubMed

Kishida, Moé; Elavsky, Steriani

2015-07-01

The aim of the present study was to evaluate the direct and indirect associations between physical activity and menopausal symptoms. Community-dwelling middle-aged women (N = 103; age range 40-60 years) completed daily Internet surveys at the end of the day and wore an accelerometer for the objective assessment of physical activity for 21-days. 1-1-1 multilevel mediation models were estimated to test whether resilient resources (i.e., positive affect and coping efficacy) mediated the association between physical activity and symptom burden at the between- and within-person level. Analyses demonstrated physical activity had an indirect effect (-0.16) on symptom burden through the enhancement of positive affect at the within-person level (p < .05; 95% confidence interval [CI] based on 20,000 Monte Carlo replications [-0.25, -0.08]). In models that tested coping efficacy as the mediator, it was found that the indirect effect of physical activity on symptom burden at the within-person level was -0.08 (p < .05; 95% CI based on 20,000 Monte Carlo replications [-0.14, -0.03]). These effects were nonsignificant at the between-person level, suggesting one route in which physical activity may help a woman to cope with her symptoms is through the enhancement of positive affect and coping efficacy on a day-to-day basis. (c) 2015 APA, all rights reserved.
Middle School Students' Statistical Literacy: Role of Grade Level and Gender

ERIC Educational Resources Information Center

Yolcu, Ayse

2014-01-01

This study examined the role of gender and grade level on middle school students' statistical literacy. The study was conducted in the spring semester of the 2012-2013 academic year with 598 middle-school students (grades 6-8) from three public schools in Turkey. The data were collected using the Statistical Literacy Test, developed based on…
Middle School Curriculum, Instruction, and Assessment. The Handbook of Research in Middle Level Education.

ERIC Educational Resources Information Center

Anfara, Vincent A., Jr., Ed.; Stacki, Sandra L., Ed.

This volume theorizes, describes, and explains practices and some specific programs designed to help meet the needs and demands of a diverse student population. The central point of this volume is that curriculum, instruction, and assessment in middle-level education is a dynamic, interrelated system undergoing change. The book contains the…
An Analysis of the Relationship between Organizational Servant Leadership and Student Achievement in Middle Level Schools

ERIC Educational Resources Information Center

Babb, Corbett A.

2012-01-01

The purpose of this exploratory quantitative research study was to determine if middle schools in which higher levels of servant leadership are evident perform better on school effectiveness measures than middle schools that exhibit lower degrees of servant leadership. Furthermore, it sought to identify contextual factors that were correlated with…
Academic Achievement and Transcendental Meditation: A Study with At-Risk Urban Middle School Students

ERIC Educational Resources Information Center

Nidich, Sanford; Mjasiri, Shujaa; Nidich, Randi; Rainforth, Maxwell; Grant, James; Valosek, Laurent; Chang, Walter; Zigler, Ronald L.

2011-01-01

The middle school level is of particular concern to educators because of poor standardized test performance. This study evaluated change in academic achievement in public middle school students practicing the Transcendental Meditation[R] program compared to controls. A total of 189 students who were below proficiency level at baseline in English…
Derailing Intragroup Management Conflict.

ERIC Educational Resources Information Center

Bonar, John; Vaughn, Glen

1994-01-01

Discussion of management conflict highlights differing job perceptions held by middle managers. The Malcolm Baldrige National Quality Assessment Program is described, and a management structure that requires members of each group to experience job perceptions and tasks of the other group is recommended for performance improvement. (Contains three…
Classroom Management in Diverse Classrooms

ERIC Educational Resources Information Center

Milner, H. Richard, IV; Tenore, F. Blake

2010-01-01

Classroom management continues to be a serious concern for teachers and especially in urban and diverse learning environments. The authors present the culturally responsive classroom management practices of two teachers from an urban and diverse middle school to extend the construct, culturally responsive classroom management. The principles that…
“So We Adapt Step by Step”: Acculturation Experiences Affecting Diabetes Management and Perceived Health for Chinese American Immigrants

PubMed Central

Chun, Kevin M.; Chesla, Catherine A.; Kwan, Christine M.L.

2011-01-01

This study examines how acculturation affects type 2 diabetes management and perceived health for Chinese American immigrants in the U.S. Acculturation experiences or cultural adaptation experiences affecting diabetes management and health were solicited from an informant group of immigrant patients and their spouses (N=40) during group, couple and individual interviews conducted in 2005 to 2008. A separate respondent group of immigrant patients and their spouses (N=19) meeting inclusion criteria reviewed and confirmed themes generated by the informant group. Using interpretive phenomenology, three key themes in patients’ and spouses’ acculturation experiences were identified: a) utilizing health care, b) maintaining family relations and roles, and c) establishing community ties and groundedness in the U.S. Acculturation experiences reflecting these themes were broad in scope and not fully captured by current self-report and proxy acculturation measures. In the current study, shifting family roles and evaluations of diabetes care and physical environment in the U.S. significantly affected diabetes management and health, yet are overlooked in acculturation and health investigations. Furthermore, the salience and impact of specific acculturation experiences respective to diabetes management and perceived health varied across participants due to individual, family, developmental, and environmental factors. In regards to salience, maintaining filial and interdependent family relations in the U.S. was of particular concern for older participants and coping with inadequate health insurance in the U.S. was especially distressing for self-described lower-middle to middle-class participants. In terms of impact, family separation and relocating to ethnically similar neighborhoods in the U.S. differentially affected diabetes management and health due to participants’ varied family relations and pre-migration family support levels and diverse cultural and linguistic backgrounds, respectively. Implications for expanding current conceptualizations and measures of acculturation to better comprehend its dynamic and multidimensional properties and complex effects on health are discussed. Additionally, implications for developing culturally-appropriate diabetes management recommendations for Chinese immigrants and their families are outlined. PMID:21147509
(Un)organizing equal collaboration between users and professionals: on management of patient education in Norway.

PubMed

Stokken, Roar

2013-03-01

This is an article about how patient education is managed in Norway, but it also addresses a matter of broader relevance that of how an organization imbued with a request for rational choices is able to take on board a contradictory ideology. In Norway, patient education under the auspice of hospitals is to be conducted as an equal collaboration between users and professionals, posing challenges to the ethos of rationally justified choices within the hospital sector. This calls for an exploration of how the organization copes with the contradictory demands. A theoretical approach on the basis of theories from Scandinavian institutional theory and science and technology studies, informed by documents, interviews and experiences from national, regional and local levels in Norway. The field of patient education is divided into three decoupled domains: one at management level, one at the practical level, and in the middle a domain that acts as an interface between management and practice. This interface mediates the relationship between ideas and practice, without making overt the fact that ideas might not be possible to put into practice and that practice might not reflect ideas. The decoupling of practice and management allows patient education as equal collaboration between users and professionals to thrive as an idea, not subjugated by practical challenges. Thus, it can exist as a guiding star that both management and practitioners can attune to, but this situation might now be threatened by the demand for quality assurance in the field. © 2011 Blackwell Publishing Ltd.
(Un)organizing equal collaboration between users and professionals: on management of patient education in Norway

PubMed Central

Stokken, Roar

2011-01-01

Abstract Background This is an article about how patient education is managed in Norway, but it also addresses a matter of broader relevance that of how an organization imbued with a request for rational choices is able to take on board a contradictory ideology. In Norway, patient education under the auspice of hospitals is to be conducted as an equal collaboration between users and professionals, posing challenges to the ethos of rationally justified choices within the hospital sector. This calls for an exploration of how the organization copes with the contradictory demands. Methods A theoretical approach on the basis of theories from Scandinavian institutional theory and science and technology studies, informed by documents, interviews and experiences from national, regional and local levels in Norway. Discussion The field of patient education is divided into three decoupled domains: one at management level, one at the practical level, and in the middle a domain that acts as an interface between management and practice. This interface mediates the relationship between ideas and practice, without making overt the fact that ideas might not be possible to put into practice and that practice might not reflect ideas. Conclusions The decoupling of practice and management allows patient education as equal collaboration between users and professionals to thrive as an idea, not subjugated by practical challenges. Thus, it can exist as a guiding star that both management and practitioners can attune to, but this situation might now be threatened by the demand for quality assurance in the field. PMID:21624027
76 FR 13172 - Placer County Water Agency

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-10

... Water Agency Notice of Application Tendered for Filing with the Commission and Establishing Procedural... County Water Agency e. Name of Project: Middle Fork American River Project f. Location: The Middle Fork...) h. Applicant Contact: Andy Fecko, Project Manager, Placer County Water Agency, 144 Ferguson Road...
A Community of Practice: Web Portals and Faculty Development.

ERIC Educational Resources Information Center

Carlson, Patricia A.

2002-01-01

Describes a Web portal constructed by Rose-Hulman Institute of Technology dedicated to improving middle school science, mathematics, and technology instruction. The portal emulates emerging corporate practices of knowledge management and process reinvention through information technology, and offers middle school teachers across Indiana a…
Empowering Middle School Teachers with Portable Computers.

ERIC Educational Resources Information Center

Weast, Jerry D.; And Others

1993-01-01

A Sioux Falls (South Dakota) project that supplied middle school teachers with Macintosh computers and training to use them showed gratifying results. Easy access to portable notebook computers made teachers more active computer users, increased teacher interaction and collaboration, enhanced teacher productivity regarding management tasks and…
Household solid waste characteristics and management in Chittagong, Bangladesh.

PubMed

Sujauddin, Mohammad; Huda, S M S; Hoque, A T M Rafiqul

2008-01-01

Solid waste management (SWM) is a multidimensional challenge faced by urban authorities, especially in developing countries like Bangladesh. We investigated per capita waste generation by residents, its composition, and the households' attitudes towards waste management at Rahman Nagar Residential Area, Chittagong, Bangladesh. The study involved a structured questionnaire and encompassed 75 households from five different socioeconomic groups (SEGs): low (LSEG), lower middle (LMSEG), middle (MSEG), upper middle (UMSEG) and high (HSEG). Wastes, collected from all of the groups of households, were segregated and weighed. Waste generation was 1.3 kg/household/day and 0.25 kg/person/day. Household solid waste (HSW) was comprised of nine categories of wastes with vegetable/food waste being the largest component (62%). Vegetable/food waste generation increased from the HSEG (47%) to the LSEG (88%). By weight, 66% of the waste was compostable in nature. The generation of HSW was positively correlated with family size (r xy=0.236, p<0.05), education level (r xy=0.244, p<0.05) and monthly income (r xy=0.671, p<0.01) of the households. Municipal authorities are usually the responsible agencies for solid waste collection and disposal, but the magnitude of the problem is well beyond the ability of any municipal government to tackle. Hence dwellers were found to take the service from the local waste management initiative. Of the respondents, an impressive 44% were willing to pay US dollars 0.3 to US dollars 0.4 per month to waste collectors and it is recommended that service charge be based on the volume of waste generated by households. Almost a quarter (22.7%) of the respondents preferred 12-1 pm as the time period for their waste to be collected. This study adequately shows that household solid waste can be converted from burden to resource through segregation at the source, since people are aware of their role in this direction provided a mechanism to assist them in this pursuit exists and the burden is distributed according to the amount of waste generated.
Household solid waste characteristics and management in Chittagong, Bangladesh

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

Sujauddin, Mohammad; Huda, S.M.S.; Hoque, A.T.M. Rafiqul

2008-07-01

Solid waste management (SWM) is a multidimensional challenge faced by urban authorities, especially in developing countries like Bangladesh. We investigated per capita waste generation by residents, its composition, and the households' attitudes towards waste management at Rahman Nagar Residential Area, Chittagong, Bangladesh. The study involved a structured questionnaire and encompassed 75 households from five different socioeconomic groups (SEGs): low (LSEG), lower middle (LMSEG), middle (MSEG), upper middle (UMSEG) and high (HSEG). Wastes, collected from all of the groups of households, were segregated and weighed. Waste generation was 1.3 kg/household/day and 0.25 kg/person/day. Household solid waste (HSW) was comprised of ninemore » categories of wastes with vegetable/food waste being the largest component (62%). Vegetable/food waste generation increased from the HSEG (47%) to the LSEG (88%). By weight, 66% of the waste was compostable in nature. The generation of HSW was positively correlated with family size (r{sub xy} = 0.236, p < 0.05), education level (r{sub xy} = 0.244, p < 0.05) and monthly income (r{sub xy} = 0.671, p < 0.01) of the households. Municipal authorities are usually the responsible agencies for solid waste collection and disposal, but the magnitude of the problem is well beyond the ability of any municipal government to tackle. Hence dwellers were found to take the service from the local waste management initiative. Of the respondents, an impressive 44% were willing to pay US$0.3 to US$0.4 per month to waste collectors and it is recommended that service charge be based on the volume of waste generated by households. Almost a quarter (22.7%) of the respondents preferred 12-1 pm as the time period for their waste to be collected. This study adequately shows that household solid waste can be converted from burden to resource through segregation at the source, since people are aware of their role in this direction provided a mechanism to assist them in this pursuit exists and the burden is distributed according to the amount of waste generated.« less
Quantifying the effect of changes in state-level adult smoking rates on youth smoking.

PubMed

Farrelly, Matthew C; Arnold, Kristin Y; Juster, Harlan R; Allen, Jane A

2014-01-01

Quantify the degree to which changes in state-level adult smoking prevalence subsequently influence youth smoking prevalence. Analysis of data from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) collected from 1995 to 2006 and the National Youth Tobacco Survey (NYTS) collected from 1999 to 2006. Adults 25 years or older who completed the TUS-CPS and youth in middle and high school who completed the NYTS. Current smoking among middle and high school students as a function of the change in state-level adult smoking, controlling for individual-level sociodemographic characteristics and state-level tobacco control policy variables. Among middle school students, declines in state-level adult smoking rates are associated with lower odds of current smoking (P < .05), and each doubling of the decline in adult smoking rates is associated with a 6.0% decrease in youth smoking. Among high school students, declines in state-level adult smoking rates are not associated with current smoking. Higher cigarette prices were associated with lower odds of smoking among middle and high school students. Greater population coverage by smoke-free air laws and greater funding for tobacco control programs were associated with lower odds of current smoking among high school students but not middle school students. Compliance with youth access laws was not associated with middle or high school smoking. By quantifying the effect of changes in state-level adult smoking rates on youth smoking, this study enhances the precision with which the tobacco control community can assess the return on investment for adult-focused tobacco control programs.

Differences between Brazilian Men and Women Managers in Their Managing of Conflicts with Employees.

ERIC Educational Resources Information Center

Rossi, Ana Maria; Todd-Mancillas, William R.

A study was conducted to compare Brazilian men and women managers' preferences for using communication versus power-centered strategies when resolving employer/employee disputes. Subjects were 40 men and 40 women in middle and top-management positions. Each manager read a packet of four scripts describing various problems that a manager might have…
Reasons of different colors in the ignimbrite lithology: micro-XRF and confocal Raman spectrometry method.

PubMed

Koralay, Tamer; Kadioglu, Yusuf Kagan

2008-03-01

Medium to large volume ignimbrites usually show vertical changes in terms of color, mineral components, texture and geochemistry. Determination of vertical changes in single extensive ignimbrite flow unit is difficult and requires careful studies. Color changes in ignimbrite flow units are very important for earth scientists. This may cause to identify the same ignimbrite series with different definition. Incesu ignimbrite has a wide distribution in the Central Anatolian Volcanic Province (CAVP). It is classified into three levels as lower, middle and upper according to color and welding degree. There is a sharp contact between the lower and middle level. The lower level is dark brown to black in color and the middle level has pinkish red to red color. The present paper focuses on the investigation of color changes between the ignimbrite levels by using micro-XRF and confocal Raman spectrometry. Micro-XRF and Raman spectrometry studies were performed on the polished thin sections of the lower and middle levels with different compositions. These differences were because of the compositional changes of K and slightly Fe elements distribution within the matrix. The dark brown to black color of the lower level was related to the high concentration of the K and Fe relatively to the middle level. Confocal Raman spectrometry investigations exhibited the matrix of the lower level mainly composed of anorthoclase, supporting the results of the micro-XRF.
The effect of continuous positive airway pressure on middle ear pressure.

PubMed

Lin, Fred Y; Gurgel, Richard K; Popelka, Gerald R; Capasso, Robson

2012-03-01

While continuous positive airway pressure (CPAP) is commonly used for obstructive sleep apnea treatment, its effect on middle ear pressure is unknown. The purpose of this study was to measure the effect of CPAP on middle ear pressure and describe the correlation between CPAP levels and middle ear pressures. Retrospective review of normal tympanometry values and a prospective cohort evaluation of subjects' tympanometric values while using CPAP at distinct pressure levels. A total of 3,066 tympanograms were evaluated to determine the normal range of middle ear pressures. Ten subjects with no known history of eustachian tube dysfunction or obstructive sleep apnea had standard tympanometry measurements while wearing a CPAP device. Measurements were taken at baseline and with CPAP air pressures of 0, 5, 10, and 15 cm H(2)O. The percentage of normal control patients with middle ear pressures above 40 daPa was 0.03%. In the study population, prior to a swallowing maneuver to open the eustachian tube, average middle ear pressures were 21.67 daPa, 22.63 daPa, 20.42, daPa, and 21.58 daPa with CPAP pressures of 0, 5, 10, and 15 cm H(2) 0, respectively. After swallowing, average middle ear air pressures were 18.83 daPa, 46.75 daPa, 82.17 daPa, and 129.17 daPa with CPAP pressures of 0, 5, 10, and 15 cm H(2)0, respectively. The postswallow Pearson correlation coefficient correlating CPAP and middle ear pressures was 0.783 (P < 0.001). Middle ear air pressure is directly proportional to CPAP air pressure in subjects with normal eustachian tube function. Middle ear pressure reaches supraphysiologic levels at even minimal CPAP levels. Although further investigation is necessary, there may be otologic implications for patients who are chronically CPAP dependent. These findings may also influence the perioperative practice of otologic and skull base surgeons. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
A new flight control and management system architecture and configuration

NASA Astrophysics Data System (ADS)

Kong, Fan-e.; Chen, Zongji

2006-11-01

The advanced fighter should possess the performance such as super-sound cruising, stealth, agility, STOVL(Short Take-Off Vertical Landing),powerful communication and information processing. For this purpose, it is not enough only to improve the aerodynamic and propulsion system. More importantly, it is necessary to enhance the control system. A complete flight control system provides not only autopilot, auto-throttle and control augmentation, but also the given mission management. F-22 and JSF possess considerably outstanding flight control system on the basis of pave pillar and pave pace avionics architecture. But their control architecture is not enough integrated. The main purpose of this paper is to build a novel fighter control system architecture. The control system constructed on this architecture should be enough integrated, inexpensive, fault-tolerant, high safe, reliable and effective. And it will take charge of both the flight control and mission management. Starting from this purpose, this paper finishes the work as follows: First, based on the human nervous control, a three-leveled hierarchical control architecture is proposed. At the top of the architecture, decision level is in charge of decision-making works. In the middle, organization & coordination level will schedule resources, monitor the states of the fighter and switch the control modes etc. And the bottom is execution level which holds the concrete drive and measurement; then, according to their function and resources all the tasks involving flight control and mission management are sorted to individual level; at last, in order to validate the three-leveled architecture, a physical configuration is also showed. The configuration is distributed and applies some new advancement in information technology industry such line replaced module and cluster technology.
Integrating Art and History: A Model for the Middle School Classroom

ERIC Educational Resources Information Center

Kahn, Brian

2017-01-01

One of the major challenges facing middle level social studies teachers is to help young adolescents understand the relevance of the past in the present day. As middle level learners are primed to develop their cognitive abilities and to view people and events from the past from multiple perspectives, it is imperative that teachers go beyond the…
The Implementation Process of Two Multigrade/Multiyear Teams in Two Middle Schools in South Florida: A Cross-Site Case Study.

ERIC Educational Resources Information Center

Heeney, Margaret R.

Multigrade grouping is the practice of intentionally grouping two or more grade levels in the same classroom to enhance learning. It is becoming a much discussed and implemented alternative grouping practice in middle level education. This paper describes the implementation process of two multigrade "teams" in two Florida middle schools,…
The Impact of Single-Gender Scheduling on Students in a Title I School

ERIC Educational Resources Information Center

Moss, Janet L.

2011-01-01

This dissertation was designed to examine the impact that single-gender scheduling would have on students who attend a struggling Title I middle school. The importance of the middle level cannot be denied. Strong research points to this time in a student's life as the pivotal crux on which success and failure are balanced. Middle level educators…
Results and Recommendations from the 2009 National Surveys of Randomly Selected and Highly Successful Middle Level Schools

ERIC Educational Resources Information Center

McEwin, C. Kenneth; Greene, Melanie W.

2010-01-01

While a number of studies have yielded useful information regarding the status of middle level schools in the United States, four linked national surveys provide a longitudinal perspective on the degree of implementation of key middle grades programs and practices. These studies were conducted in 1968 (Alexander, 1968), 1988 (Alexander &…
The Impact of Problem-Based Learning with Computer Simulation on Middle Level Educators' Instructional Practices and Understanding of the Nature of Middle Level Learners

ERIC Educational Resources Information Center

Huelskamp, Lisa M.

2009-01-01

The need for effective teachers is growing while national and state standards are putting ever-increasing demands on teachers and raising expectations for student achievement. Low science and mathematics standardized test scores, particularly in the middle grades, reflect unprepared adolescents, perhaps because of ineffective teaching strategies…
Epidemiology and Management of Otitis Media in Children.

ERIC Educational Resources Information Center

Giebink, G. Scott; Daly, Kathy

1990-01-01

This article focuses on definitions of middle ear inflammation (otitis media), the epidemiology of this disorder, brief considerations of pathophysiology and management, and possible future therapies. (DB))
A comparison of strength-training, self-management and the combination for early osteoarthritis of the knee

PubMed Central

McKnight, Patrick E.; Kasle, Shelley; Going, Scott; Villaneuva, Isidro; Cornett, Michelle; Farr, Josh; Wright, Jill; Streeter, Clara; Zautra, Alex

2010-01-01

Objective To assess the relative effectiveness of combining self-management and strength-training for improving functional outcomes in early knee osteoarthritis patients. Methods A randomized intervention trial lasting 24 months conducted at an academic medical center. Community dwelling middle-aged adults (N=273), aged 34 to 65 with knee osteoarthritis, pain and self-reported physical disability completed a strength-training program, a self-management program, or a combined program. Outcomes included five physical function tests (leg press, range of motion, work capacity, balance, and stair climbing) and two self-reported measures of pain and disability. Results A total of 201 (73.6 %) participants completed the 2-year trial. Overall compliance was modest - strength-training (55.8 %), self-management (69.1 %), and combined (59.6 %) programs. The three groups showed a significant and large increase from pre- to post-treatment in all physical functioning measures including leg press (d =.85), range of motion (d=1.00), work capacity (d=.60), balance (d=.59), and stair climbing (d=.59). Additionally, all three groups showed decreased self-reported pain (d=-.51) and disability (d=-.55). There were no significant differences among groups. Conclusions Middle-aged, sedentary persons with mild early knee osteoarthritis benefited from strength-training, self-management, and the combination. These results suggest that both strength-training and self-management are suitable treatments for early onset of knee osteoarthritis in middle-aged adults. Self-management alone may offer the least burdensome treatment for early osteoarthritis. PMID:20191490
Dillard Drive Middle & Elementary School, Raleigh, North Carolina.

ERIC Educational Resources Information Center

Design Cost Data, 2001

2001-01-01

Presents design features of the Dillard Drive Middle & Elementary School (North Carolina) that incorporates daylighting in the majority of the classrooms, the gymnasium, dining room, and media center. The design also uses advanced lighting controls, fiber optic networking, automatic environmental controls, and an energy management system that…
Making sense of mobile- and web-based wellness information technology: cross-generational study.

PubMed

Kutz, Daniel; Shankar, Kalpana; Connelly, Kay

2013-05-14

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

PubMed Central

Shankar, Kalpana; Connelly, Kay

2013-01-01

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

PubMed

Nwadiaro, H C; Ozoilo, K N; Nwadiaro, P O; Kidmas, A T; Oboiren, M

2008-01-01

Traditional bone setting is a practice that is common in our environment. This is a community based survey of opinions concerning orthodox and traditional fracture management in four states of the middle belt of Nigeria. We set out to ascertain the factors influencing preference of treatment of fractures among populations in the middle belt of Nigeria. A community based questionnaire survey of randomly selected adults regarding preference of choice of treatment between orthodox and traditional fracture management. One hundred and eighty-six questionnaires were found analyzable with a male to female ratio of 2:1. There was a preponderance of preference for orthodox fracture management (70.4%). Decisions were mainly collegiate, outside the influence of the individual; only 9.9% decided to attend traditional bone setters on their own. Reasons adduced for preference of traditional bone setters were incongruous and inconsistent. A fixated cultural outlook was recognized as being the motivating factor for patronage of traditional bone setters. Need for enlightenment campaign of the public against patronage of traditional bone setters is emphasized. A gradual phasing out of traditional bone setting with a road map towards making orthodox fracture management available to all is advocated.
A quality improvement approach to capacity building in low- and middle-income countries.

PubMed

Bardfield, Joshua; Agins, Bruce; Akiyama, Matthew; Basenero, Apollo; Luphala, Patience; Kaindjee-Tjituka, Francina; Natanael, Salomo; Hamunime, Ndapewa

2015-07-01

To describe the HEALTHQUAL framework consisting of the following three components: performance measurement, quality improvement and the quality management program, representing an adaptive approach to building capacity in national quality management programs in low and middle-income countries. We present a case study from Namibia illustrating how this approach is adapted to country context. HEALTHQUAL partners with Ministries of Health to build knowledge and expertise in modern improvement methods, including data collection, analysis and reporting, process analysis and the use of data to implement quality improvement projects that aim to improve systems and processes of care. Clinical performance measures are selected in each country by the Ministry of Health on the basis of national guidelines. Patient records are sampled using a standardized statistical table to achieve a minimum confidence interval of 90%, with a spread of ±8% in participating facilities. Data are routinely reviewed to identify gaps in patient care, and aggregated to produce facility mean scores that are trended over time. A formal organizational assessment is conducted at facility and national levels to review the implementation progress. Aggregate mean rates of performance for 10 of 11 indicators of HIV care improved for adult HIV-positive patients between 2008 and 2013. Quality improvement is an approach to capacity building and health systems strengthening that offers adaptive methodology. Synergistic implementation of elements of a national quality program can lead to improvements in care, in parallel with systematic capacity development for measurement, improvement and quality management throughout the healthcare delivery system.
Decision support model for assessing aquifer pollution hazard and prioritizing groundwater resources management in the wet Pampa plain, Argentina.

PubMed

Lima, M Lourdes; Romanelli, Asunción; Massone, Héctor E

2013-06-01

This paper gives an account of the implementation of a decision support system for assessing aquifer pollution hazard and prioritizing subwatersheds for groundwater resources management in the southeastern Pampa plain of Argentina. The use of this system is demonstrated with an example from Dulce Stream Basin (1,000 km(2) encompassing 27 subwatersheds), which has high level of agricultural activities and extensive available data regarding aquifer geology. In the logic model, aquifer pollution hazard is assessed as a function of two primary topics: groundwater and soil conditions. This logic model shows the state of each evaluated landscape with respect to aquifer pollution hazard based mainly on the parameters of the DRASTIC and GOD models. The decision model allows prioritizing subwatersheds for groundwater resources management according to three main criteria including farming activities, agrochemical application, and irrigation use. Stakeholder participation, through interviews, in combination with expert judgment was used to select and weight each criterion. The resulting subwatershed priority map, by combining the logic and decision models, allowed identifying five subwatersheds in the upper and middle basin as the main aquifer protection areas. The results reasonably fit the natural conditions of the basin, identifying those subwatersheds with shallow water depth, loam-loam silt texture soil media and pasture land cover in the middle basin, and others with intensive agricultural activity, coinciding with the natural recharge area to the aquifer system. Major difficulties and some recommendations of applying this methodology in real-world situations are discussed.
What Counts When it Comes to School Enjoyment and Aspiration in the Middle Grades.

PubMed

Smith, Megan L; Mann, Michael J; Georgieva, Zornitsa; Curtis, Reagan; Schimmel, Christine J

2016-01-01

Young adolescents, and the middle level educators who work with them, face many exciting but demanding challenges during this key period of development. According to stage-environment fit theory, the degree to which middle grades students perceive a good fit between their school environment and their needs impacts their academic and life outcomes. The authors endeavored to build on middle level research by studying the extent to which students' needs are supported by school environment factors and how this "fit" relates to two academic outcome variables: school enjoyment and aspiration. The sample consisted of middle grades students ( N = 1,027) between the ages of 10 and 14. Hierarchical logistic regression analyses were conducted. After controlling for age, ethnicity, and gender, four subscales (Social Skills Needs, Mental Health Needs, Academic and Career Needs, and School Support) were entered as potential predictors. Both models were significant and accounted for ~20% of the variance. This study suggests that middle level educators, counselors, and administrators may benefit from considering ways to enhance the match between students' and the middle grades' learning environment, especially by considering non-academic factors as a way to provide indirect, but powerful, support for academic and life success.
Promoting safe motherhood through the private sector in low- and middle-income countries.

PubMed Central

Brugha, Ruair; Pritze-Aliassime, Susanne

2003-01-01

The formal private sector could play a significant role in determining whether success or failure is achieved in working towards goals for safe motherhood in many low- and middle-income settings. Established private providers, especially nurses/midwives, have the potential to contribute to safe motherhood practices if they are involved in the care continuum. However, they have largely been overlooked by policy-makers in low-income settings. The private sector (mainly doctors) contributes to overprovision and high Caesarean section rates in settings where it provides care to wealthier segments of the population; such care is often funded through third-party payment schemes. In poorer settings, especially rural areas, private nurses/midwives and the women who choose to use them are likely to experience similar constraints to those encountered in the public sector - for example, poor or unaffordable access to higher level facilities for the management of obstetrical emergencies. Policy-makers at the country-level need to map the health system and understand the nature and distribution of the private sector, and what influences it. This potential resource could then be mobilized to work towards the achievement of safe motherhood goals. PMID:14576894
Measuring the space between vagina and rectum as it relates to rectocele

PubMed Central

Liu, Jin; Zhai, Li-Dong; Li, Yun-Sheng; Liu, Wan-Xiang; Wang, Rui-Hua

2009-01-01

AIM: To measure the normal space between the posterior wall of the vagina and the anterior wall of the respectively rectum using computed tomography (CT) and reveal its were relationship to rectocele. METHODS: A total of twenty female volunteers without rectocele were examined by CT scan. We performed a middle level continuous horizontal pelvic scan from the upper part to the lower part and collected the measurement data to analyze the results using t-test. RESULTS: Twenty volunteers were enrolled in the study. The space between the posterior wall of the vagina and the anterior wall of the rectum was measured at three levels (upper 1/3, middle, lower 1/3 level of vagina). The results showed that the space from the posterior wall of the vagina to the anterior wall of the rectum at the upper 1/3 level and the middle level was 3.896 ± 0.3617 mm and 4.6575 ± 0.3052 mm, respectively. When the two groups of data were compared, we found the space at the upper 1/3 level was shorter than at the middle level (P < 0.01). Moreover, at the lower 1/3 level the space measured was 10.058 ± 0.4534 mm. The results revealed that the space at the lower 1/3 level was longer than that at the middle level (P < 0.01). CONCLUSION: These measurement data may be helpful in assessing rectocele clinical diagnosis and functional outcomes of rectocele repair. PMID:19554660

Office management of gait disorders in the elderly

PubMed Central

Lam, Robert

2011-01-01

Abstract Objective To provide family physicians with an approach to office management of gait disorders in the elderly. Sources of information Ovid MEDLINE was searched from 1950 to July 2010 using subject headings for gait or neurologic gait disorders combined with physical examination. Articles specific to family practice or family physicians were selected. Relevant review articles and original research were used when appropriate and applicable to the elderly. Main message Gait and balance disorders in the elderly are difficult to recognize and diagnose in the family practice setting because they initially present with subtle undifferentiated manifestations, and because causes are usually multifactorial, with multiple diseases developing simultaneously. To further complicate the issue, these manifestations can be camouflaged in elderly patients by the physiologic changes associated with normal aging. A classification of gait disorders based on sensorimotor levels can be useful in the approach to management of this problem. Gait disorders in patients presenting to family physicians in the primary care setting are often related to joint and skeletal problems (lowest-level disturbances), as opposed to patients referred to neurology specialty clinics with sensory ataxia, myelopathy, multiple strokes, and parkinsonism (lowest-, middle-, and highest-level disturbances). The difficulty in diagnosing gait disorders stems from the challenge of addressing early undifferentiated disease caused by multiple disease processes involving all sensorimotor levels. Patients might present with a nonspecific “cautious” gait that is simply an adaptation of the body to disease limitations. This cautious gait has a mildly flexed posture with reduced arm swing and a broadening of the base of support. This article reviews the focused history (including medication review), practical physical examination, investigations, and treatments that are key to office management of gait disorders. Conclusion Family physicians will find it helpful to classify gait disorders based on sensorimotor level as part of their approach to office management of elderly patients. Managing gait disorders at early stages can help prevent further deconditioning and mobility impairment. PMID:21753097
Office management of gait disorders in the elderly.

PubMed

Lam, Robert

2011-07-01

To provide family physicians with an approach to office management of gait disorders in the elderly. Ovid MEDLINE was searched from 1950 to July 2010 using subject headings for gait or neurologic gait disorders combined with physical examination. Articles specific to family practice or family physicians were selected. Relevant review articles and original research were used when appropriate and applicable to the elderly. Gait and balance disorders in the elderly are difficult to recognize and diagnose in the family practice setting because they initially present with subtle undifferentiated manifestations, and because causes are usually multifactorial, with multiple diseases developing simultaneously. To further complicate the issue, these manifestations can be camouflaged in elderly patients by the physiologic changes associated with normal aging. A classification of gait disorders based on sensorimotor levels can be useful in the approach to management of this problem. Gait disorders in patients presenting to family physicians in the primary care setting are often related to joint and skeletal problems (lowest-level disturbances), as opposed to patients referred to neurology specialty clinics with sensory ataxia, myelopathy, multiple strokes, and parkinsonism (lowest-, middle-, and highest-level disturbances). The difficulty in diagnosing gait disorders stems from the challenge of addressing early undifferentiated disease caused by multiple disease processes involving all sensorimotor levels. Patients might present with a nonspecific "cautious" gait that is simply an adaptation of the body to disease limitations. This cautious gait has a mildly flexed posture with reduced arm swing and a broadening of the base of support. This article reviews the focused history (including medication review), practical physical examination, investigations, and treatments that are key to office management of gait disorders. Family physicians will find it helpful to classify gait disorders based on sensorimotor level as part of their approach to office management of elderly patients. Managing gait disorders at early stages can help prevent further deconditioning and mobility impairment.
Operating room: relational spaces and microinstitutional change in surgery.

PubMed

Kellogg, Katherine C

2009-11-01

One of the great paradoxes of institutional change is that even when top managers in organizations provide support for change in response to new regulation, the employees whom new programs are designed to benefit often do not use them. This 15-month ethnographic study of two hospitals responding to new regulation demonstrates that using these programs may require subordinate employees to challenge middle managers with opposing interests. The article argues that relational spaces--areas of isolation, interaction, and inclusion that allow middle-manager reformers and subordinate employees to develop a cross-position collective for change--are critical to the change process. These findings have implications for research on institutional change and social movements.
In the Middle: Do We Share the Vision? Do Principals and Teachers Agree about the Middle School Concept?

ERIC Educational Resources Information Center

Watts, Cherry; Seed, Allen H.; Franceschini, Louis A., III

2013-01-01

In 2009, the Tennessee Professors of Middle Level Education (TPOMLE) examined how Tennessee schools implemented the middle school concept. Of concern was the impact that emphasis on accountability and achievement had on the middle school concept which emphasizes the development of the whole child. A survey was developed based on the tenets of…
Middle Management Time Usage.

ERIC Educational Resources Information Center

Dorin, Patrick C.; Mansergh, Gerald G.

1980-01-01

Elementary principals and industrial managers are involved in similar job activities, but they differ in the amount of time spent in each activity and in the degree of interaction with others. (Author/JM)
Managing menstruation in the workplace: an overlooked issue in low- and middle-income countries.

PubMed

Sommer, Marni; Chandraratna, Sahani; Cavill, Sue; Mahon, Therese; Phillips-Howard, Penelope

2016-06-06

The potential menstrual hygiene management barriers faced by adolescent girls and women in workplace environments in low- and middle-income countries has been under addressed in research, programming and policy. Despite global efforts to reduce poverty among women in such contexts, there has been insufficient attention to the water and sanitation related barriers, specifically in relation to managing monthly menstruation, that may hinder girls' and women's contributions to the workplace, and their health and wellbeing. There is an urgent need to document the specific social and environmental barriers they may be facing in relation to menstrual management, to conduct a costing of the implications of inadequate supportive workplace environments for menstrual hygiene management, and to understand the implications for girls' and women's health and wellbeing. This will provide essential evidence for guiding national policy makers, the private sector, donors and activists focused on advancing girls' and women's rights.
A Middle School Dilemma: Dealing with "I Don't Care"

ERIC Educational Resources Information Center

Walsh, Foster

2006-01-01

This article addresses the difficulty of engaging middle school students who don't seem to care about learning. Several classroom vignettes illustrate practical, classroom-based dilemmas generated from a university classroom management course. Three positive engagement principles are proposed to address the challenge of the reluctant learner: get…
Projecting avian responses to landscape managment along the middle RIO GRANDE, New Mexico

USDA-ARS?s Scientific Manuscript database

Lack of flooding due to river impoundments on the middle Rio Grande has contributed to the spread of exotic vegetation with dense understory fuel loads. Restoration has focused on understory vegetation thinning but it is unclear how these actions impact bird populations. We quantified densities of ...
Middle East Libraries in Focus

ERIC Educational Resources Information Center

Clausen, Beth; Ghafoori, Hamayoun; Azad, Rania

2018-01-01

The article written by three librarians who work in the Middle East, recount their experiences as library managers at academic institutions in Qatar, Afghanistan, and Iraq. While trying to provide services to the students and faculty of their academic institutions, they must also contend with security risks, such as kidnappings and bombings. They…
Redesigning Schools for 21st Century Technologies: A Middle School with the Power to Improve.

ERIC Educational Resources Information Center

Van Dam, Janet M.

1994-01-01

Describes the processes involved in redesigning and renovating Power Middle School (Michigan) for current and future educational technology, particularly for the media center. Topics discussed include planning; time management; wiring infrastructure; voice and video networks; teacher and student multimedia production rooms; and communications…
Teaching Disaffected Middle School Students: How Classroom Dynamics Shape Students' Experiences

ERIC Educational Resources Information Center

Kennedy, Brianna L.

2011-01-01

This article examines instruction at a school in California for expelled middle school students and illustrates the practices of its most and least effective teachers. Findings show that teachers' implementation of instructional practices, classroom management, and rapport building mutually reinforced each other to either facilitate or hinder…
Management of severe acute malnutrition in low-income and middle-income countries

USDA-ARS?s Scientific Manuscript database

Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environm...
Homework Emotion Regulation Scale: Psychometric Properties for Middle School Students

ERIC Educational Resources Information Center

Xu, Jianzhong; Fan, Xitao; Du, Jianxia

2016-01-01

The goal of the present investigation is to evaluate the psychometric properties of the Homework Emotion Regulation Scale (HERS) using 796 middle school students in China. Confirmatory factor analyses (CFAs) supported the existence of two distinct yet related subscales for the HERS: Emotion Management and Cognitive Reappraisal. Concerning the…
78 FR 77108 - Intent To Prepare a Draft Supplemental Environmental Impact Statement for the Middle Mississippi...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-20

... DEPARTMENT OF DEFENSE Department of the Army, Corps of Engineers Intent To Prepare a Draft Supplemental Environmental Impact Statement for the Middle Mississippi River Regulating Works Project, Missouri... stabilization and sediment management to ensure adequate navigation depth and width. Project improvements are...
Quality assurance and the need to evaluate interventions and audit programme outcomes.

PubMed

Zhao, Min; Vaartjes, Ilonca; Klipstein-Grobusch, Kerstin; Kotseva, Kornelia; Jennings, Catriona; Grobbee, Diederick E; Graham, Ian

2017-06-01

Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.
Health information and communication system for emergency management in a developing country, Iran.

PubMed

Seyedin, Seyed Hesam; Jamali, Hamid R

2011-08-01

Disasters are fortunately rare occurrences. However, accurate and timely information and communication are vital to adequately prepare individual health organizations for such events. The current article investigates the health related communication and information systems for emergency management in Iran. A mixed qualitative and quantitative methodology was used in this study. A sample of 230 health service managers was surveyed using a questionnaire and 65 semi-structured interviews were also conducted with public health and therapeutic affairs managers who were responsible for emergency management. A range of problems were identified including fragmentation of information, lack of local databases, lack of clear information strategy and lack of a formal system for logging disaster related information at regional or local level. Recommendations were made for improving the national emergency management information and communication system. The findings have implications for health organizations in developing and developed countries especially in the Middle East. Creating disaster related information databases, creating protocols and standards, setting an information strategy, training staff and hosting a center for information system in the Ministry of Health to centrally manage and share the data could improve the current information system.
How Do Children Behave Regarding Their Birth Order in Dental Setting?

PubMed

Ghaderi, Faezeh; Fijan, Soleiman; Hamedani, Shahram

2015-12-01

Prediction of child cooperation level in dental setting is an important issue for a dentist to select the proper behavior management method. Many psychological studies have emphasized the effect of birth order on patient behavior and personality; however, only a few researches evaluated the effect of birth order on child's behavior in dental setting. This study was designed to evaluate the influence of children ordinal position on their behavior in dental setting. A total of 158 children with at least one primary mandibular molar needing class I restoration were selected. Children were classified based on the ordinal position; first, middle, or last child as well as single child. A blinded examiner recorded the pain perception of children during injection based on Visual Analogue Scale (VAS) and Sound, Eye and Movement (SEM) scale. To assess the child's anxiety, the questionnaire known as "Dental Subscale of the Children's Fear Survey Schedule" (CFSS-DS) was employed. The results showed that single children were significantly less cooperative and more anxious than the other children (p<0.001). The middle children were significantly more cooperative in comparison with the other child's position (p< 0.001). Single child may behave less cooperatively in dental setting. The order of child birth must also be considered in prediction of child's behavior for behavioral management.
Assessing resident awareness on e-waste management in Bangalore, India: a preliminary case study.

PubMed

Awasthi, Abhishek Kumar; Li, Jinhui

2018-04-01

The generation of e-waste has increased significantly in India, and the informal recycling of e-waste has adverse effects on environment and public health. In this article, the E-waste management is evaluated in accordance from the resident's awareness perspective in Bangalore city, India. The survey data revealed that about 58% male and 42% female responded and 35% of the participants belong to age range between 18 and 25 years. About 60% of respondent's education level was either graduate or post graduate, 27% high school to higher school, 10% higher educated (> post graduate), and 3% primary to middle. Only 30% of the respondents were confident with e-waste rules and regulation, while 39% of the respondents were of very little information. Indian e-waste management has been improving for the last few years and it continues to develop. Therefore, the findings can be valuable for better understanding the resident's awareness for e-waste management and also need to promote the environmentally sound management of e-waste in Bangalore, India.
An introduction to autonomous control systems

NASA Technical Reports Server (NTRS)

Antsaklis, Panos J.; Passino, Kevin M.; Wang, S. J.

1991-01-01

The functions, characteristics, and benefits of autonomous control are outlined. An autonomous control functional architecture for future space vehicles that incorporates the concepts and characteristics described is presented. The controller is hierarchical, with an execution level (the lowest level), coordination level (middle level), and management and organization level (highest level). The general characteristics of the overall architecture, including those of the three levels, are explained, and an example to illustrate their functions is given. Mathematical models for autonomous systems, including 'logical' discrete event system models, are discussed. An approach to the quantitative, systematic modeling, analysis, and design of autonomous controllers is also discussed. It is a hybrid approach since it uses conventional analysis techniques based on difference and differential equations and new techniques for the analysis of the systems described with a symbolic formalism such as finite automata. Some recent results from the areas of planning and expert systems, machine learning, artificial neural networks, and the area restructurable controls are briefly outlined.
Inflammatory bowel disease in children of middle eastern descent.

PubMed

Naidoo, Christina Mai Ying; Leach, Steven T; Day, Andrew S; Lemberg, Daniel A

2014-01-01

Increasing rates of inflammatory bowel disease (IBD) are now seen in populations where it was once uncommon. The pattern of IBD in children of Middle Eastern descent in Australia has never been reported. This study aimed to investigate the burden of IBD in children of Middle Eastern descent at the Sydney Children's Hospital, Randwick (SCHR). The SCHR IBD database was used to identify patients of self-reported Middle Eastern ethnicity diagnosed between 1987 and 2011. Demographic, diagnosis, and management data was collected for all Middle Eastern children and an age and gender matched non-Middle Eastern IBD control group. Twenty-four patients of Middle Eastern descent were identified. Middle Eastern Crohn's disease patients had higher disease activity at diagnosis, higher use of thiopurines, and less restricted colonic disease than controls. Although there were limitations with this dataset, we estimated a higher prevalence of IBD in Middle Eastern children and they had a different disease phenotype and behavior compared to the control group, with less disease restricted to the colon and likely a more active disease course.

Inflammatory Bowel Disease in Children of Middle Eastern Descent

PubMed Central

Naidoo, Christina Mai Ying; Leach, Steven T.; Day, Andrew S.; Lemberg, Daniel A.

2014-01-01

Increasing rates of inflammatory bowel disease (IBD) are now seen in populations where it was once uncommon. The pattern of IBD in children of Middle Eastern descent in Australia has never been reported. This study aimed to investigate the burden of IBD in children of Middle Eastern descent at the Sydney Children's Hospital, Randwick (SCHR). The SCHR IBD database was used to identify patients of self-reported Middle Eastern ethnicity diagnosed between 1987 and 2011. Demographic, diagnosis, and management data was collected for all Middle Eastern children and an age and gender matched non-Middle Eastern IBD control group. Twenty-four patients of Middle Eastern descent were identified. Middle Eastern Crohn's disease patients had higher disease activity at diagnosis, higher use of thiopurines, and less restricted colonic disease than controls. Although there were limitations with this dataset, we estimated a higher prevalence of IBD in Middle Eastern children and they had a different disease phenotype and behavior compared to the control group, with less disease restricted to the colon and likely a more active disease course. PMID:24987422
Parental influences on students' self-concept, task value beliefs, and achievement in science.

PubMed

Senler, Burcu; Sungur, Semra

2009-05-01

The aim of this study was twofold: firstly, to investigate the grade level (elementary and middle school) and gender effect on students' motivation in science (perceived academic science self-concept and task value) and perceived family involvement, and secondly to examine the relationship among family environment variables (fathers' educational level, mothers' educational level, and perceived family involvement), motivation, gender and science achievement in elementary and middle schools. Multivariate Analysis of Variance (MANOVA) showed that elementary school students have more positive science self-concept and task value beliefs compared to middle school students. Moreover, elementary school students appeared to perceive more family involvement in their schooling. Path analyses also suggested that family involvement was directly linked to elementary school students' task value and achievement. Also, in elementary school level, significant relationships were found among father educational level, science self-concept, task value and science achievement. On the other hand, in middle school level, family involvement, father educational level, and mother educational level were positively related to students' task value which is directly linked to students' science achievement. Moreover, mother educational level contributed to science achievement through its effect on self-concept.
Reach for Reference: A New Early Encyclopedia

ERIC Educational Resources Information Center

Safford, Barbara Ripp

2005-01-01

This article reviews the new Grolier Student Encyclopedia, intended for grades three through eight. Good middle-level readers might become frustrated with this source, but primary and intermediate students, middle-level students reading below grade level, and English language learners of any age will find the style of information presentation…
Influence of School-Level Variables on Aggression and Associated Attitudes of Middle School Students

ERIC Educational Resources Information Center

Henry, David B.; Farrell, Albert D.; Schoeny, Michael E.; Tolan, Patrick H.; Dymnicki, Allison B.

2011-01-01

This study sought to understand school-level influences on aggressive behavior and related social cognitive variables. Participants were 5106 middle school students participating in a violence prevention project. Predictors were school-level norms opposing aggression and favoring nonviolence, interpersonal climate (positive student-teacher…
Marked hypertriglyceridemia in a woman receiving metoprolol succinate.

PubMed

Kim, Yeunjung; Miller, Michael

2014-01-01

β-blockers are commonly used therapies after acute myocardial infarction and in the management of congestive heart failure and hypertension. We report a case of a middle-aged woman with a history of mild hypertension who was placed on metoprolol succinate. Before initiation of the β-blocker, her triglyceride level was in the borderline-high range (150-199 mg/dL). On treatment, her triglyceride levels exceeded 1000 mg/dL. She developed fatigue and mild abdominal discomfort but without biochemical evidence of pancreatitis. After discontinuation of metoprolol succinate, her triglyceride levels receded. This case illustrates an uncommon side effect with a very commonly used therapy in clinical practice. Clinicians should closely evaluate medications and/or other therapies in patients presenting with new-onset hypertriglyceridemia especially when levels are sufficiently elevated to pose increased risk of pancreatitis. Copyright © 2014 National Lipid Association. Published by Elsevier Inc. All rights reserved.
Development of a scalable mental healthcare plan for a rural district in Ethiopia

PubMed Central

Fekadu, Abebaw; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Selamu, Medhin; Giorgis, Tedla W.; Shibre, Teshome; Teferra, Solomon; Tegegn, Teketel; Breuer, Erica; Patel, Vikram; Tomlinson, Mark; Thornicroft, Graham; Prince, Martin; Lund, Crick

2016-01-01

Background Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority. Aims To outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia. Method A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation). Results The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability. Conclusions The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC. PMID:26447174
Medical Physics Challenges for the Implementation of Quality Assurance Programmes in Radiation Oncology.

PubMed

Meghzifene, A

2017-02-01

The importance of quality assurance in radiation therapy, as well as its positive consequences on patient treatment outcome, is well known to radiation therapy professionals. In low- and middle-income countries, the implementation of quality assurance in radiation therapy is especially challenging, due to a lack of staff training, a lack of national guidelines, a lack of quality assurance equipment and high patient daily throughput. According to the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centres, the proportion of linear accelerators compared with Co-60 machines has increased significantly in recent years in low- and middle-income countries. However, this increase in the proportion of relatively more demanding technology is not always accompanied with the necessary investment in staff training and quality assurance. The IAEA provides supports to low- and middle-income countries to develop and strengthen quality assurance programmes at institutional and national level. It also provides guidance, through its publications, on quality assurance and supports implementation of comprehensive clinical audits to identify gaps and makes recommendations for quality improvement in radiation therapy. The new AAPM TG100 report suggests a new approach to quality management in radiation therapy. If implemented, it will lead to improved cost-effectiveness of radiation therapy in all income settings. Low- and middle-income countries could greatly benefit from this new approach as it will help direct their scarce resources to areas where they can produce the optimum impact on patient care, without compromising patient safety. Copyright © 2016. Published by Elsevier Ltd.
Naturalistic distraction and driving safety in older drivers

PubMed Central

Aksan, Nazan; Dawson, Jeffrey D.; Emerson, Jamie L.; Yu, Lixi; Uc, Ergun Y.; Anderson, Steven W.; Rizzo, Matthew

2013-01-01

Objective This study aimed to quantify and compare performance of middle-aged and older drivers during a naturalistic distraction paradigm (visual search for roadside targets) and predict older driver performance given functioning in visual, motor, and cognitive domains. Background Distracted driving can imperil healthy adults and may disproportionally affect the safety of older drivers with visual, motor, and cognitive decline. Methods Two hundred and three drivers, 120 healthy older (61 men and 59 women, ages 65 years or greater) and 83 middle-aged drivers (38 men and 45 women, ages 40–64 years), participated in an on-road test in an instrumented vehicle. Outcome measures included performance in roadside target identification (traffic signs and restaurants) and concurrent driver safety. Differences in visual, motor, and cognitive functioning served as predictors. Results Older drivers identified fewer landmarks and drove slower but committed more safety errors than middle-aged drivers. Greater familiarity with local roads benefited performance of middle-aged but not older drivers. Visual cognition predicted both traffic sign identification and safety errors while executive function predicted traffic sign identification over and above vision. Conclusion Older adults are susceptible to driving safety errors while distracted by common secondary visual search tasks that are inherent to driving. The findings underscore that age-related cognitive decline affects older driver management of driving tasks at multiple levels, and can help inform the design of on-road tests and interventions for older drivers. PMID:23964422
Comparison of quality of life among cardiac, hepatic, cancer, and dermatological patients.

PubMed

Dogar, Imtiaz Ahmad; Haider, Nighat; Ahmad, Maqsood; Naseem, Shazia; Bajwa, Asma

2012-03-01

To assess the level of quality of life (QOL) in patients suffering from various cardiac, cancer, hepatic, and dermatological diseases. A total of 339 patients of cardiac, cancer, hepatic, and dermatological diseases from DHQ/Allied hospitals of Faisalabad participated in this study through purposive convenient sampling technique. Quality of life was measured by WHO QOL-BREF (Validated Urdu Version) while demographic variables were recorded on a demographic sheet. The results were obtained by using analysis of variance (ANOVA) on SPSS 13. Out of 339, 156 (46%) patients were males while 183 (54%) patients were females. Of the total, 99 (29.2%) belonged to the lower socio economic status, 113 (33.3%) belonged to the lower middle, 62 (18.3%) belonged to the middle, and 65 (19.2%) belonged to the upper middle socio economic status. In terms of education, 49 (14.5%) were illiterate, 110 (32.3%) had primary level education, 118 (34.8%) had middle level education, 21 (6.2%) had done matriculation, 17 (5%) had intermediate, 14 (4.1%) were graduates, 8 (2.4%) had done masters. Of the whole lot, only 2 (0.6%) patients were professionals. Results showed that the quality of life was most deteriorated in the domain of physical health; while psychological health was the second most deteriorated domain. Social relationship was the least affected domain, while environment was the second least affected area. Quality of life of hepatic patients was significantly lower than dermatological patients with respect to physical health and environment, lower than cancer patients in relation to psychological health, and lower than cardiac patients in the social relationship domain. The quality of life of cardiac patients was noted to be significantly higher than the other three categories in the domains of psychological health and environment. In the face of the evidence of high deterioration in the quality of life of the patients in terms of physical and psychological health, medical units should be better equipped with facilities to enhance a sense of betterment in patients. The treating doctors should be better trained to give due consideration to this important aspect of management. Moreover, the role of liaison psychiatry should also be incorporated.
The Move to Faculty Middle Management Structures in Scottish Secondary Schools: A Case Study

ERIC Educational Resources Information Center

Anderson, Cherie; Nixon, Graeme

2010-01-01

This article looks at the move from a management structure based on discrete subject departments managed by subject specialist principal teachers within Scottish secondary schools towards groupings of subjects (faculties) with a single manager. This article examines the impact of this change upon the experiences of students and probationer…
Impact of a Career Intervention on At-Risk Middle School Students' Career Maturity Levels, Academic Achievement, and Self-Esteem

ERIC Educational Resources Information Center

Legum, Harry L.; Hoare, Carol H.

2004-01-01

The purpose of this study was to assess the effects of a 9-week career intervention program on at-risk middle school students' career maturity levels, self-esteem, and academic achievement. This study was based on a pretest and posttest design using a control group. Data were collected from 27 at-risk middle school students representing the…
Last Best Chance 2004: Educating Young Adolescents in the 21st Century. Middle Grades Task Force Report. Fall 2004

ERIC Educational Resources Information Center

North Carolina State Department of Education, 2004

2004-01-01

This study is a follow up to the Last Best Chance report published in 1989. A task force of 29 education leaders was challenged to help chart the course for middle level education in North Carolina. While examining middle level education (ages 11 through 14), task force members continuously asked, "What should it look like in order for all…
Conceptualizing Student Affect for Science and Technology at the Middle School Level: Development and Implementation of a Measure of Affect in Science and Technology (MAST)

ERIC Educational Resources Information Center

Romine, William L.; Sadler, Troy D.; Wulff, Eric P.

2017-01-01

We describe the development of the Measure of Affect in Science and Technology (MAST), and study its usefulness for measuring science affect in middle school students via both classical and Rasch measurement perspectives. We then proceed to utilize the measurement structure of the MAST to understand how middle school students at varying levels of…
Theory of forward and reverse middle-ear transmission applied to otoacoustic emissions in infant and adult ears

PubMed Central

Keefe, Douglas H.; Abdala, Carolina

2008-01-01

The purpose of this study is to understand why otoacoustic emission (OAE) levels are higher in normal-hearing human infants relative to adults. In a previous study, distortion product (DP) OAE input/output (I/O) functions were shown to differ at f2=6 kHz in adults compared to infants through 6 months of age. These DPOAE I/O functions were used to noninvasively assess immaturities in forward/reverse transmission through the ear canal and middle ear [Abdala, C., and Keefe, D. H., (2006). J. Acoust Soc. Am. 120, 3832–3842]. In the present study, ear-canal reflectance and DPOAEs measured in the same ears were analyzed using a scattering-matrix model of forward and reverse transmission in the ear canal, middle ear, and cochlea. Reflectance measurements were sensitive to frequency-dependent effects of ear-canal and middle-ear transmission that differed across OAE type and subject age. Results indicated that DPOAE levels were larger in infants mainly because the reverse middle-ear transmittance level varied with ear-canal area, which differed by more than a factor of 7 between term infants and adults. The forward middle-ear transmittance level was −16 dB less in infants, so that the conductive efficiency was poorer in infants than adults. PMID:17348521
Storm-rhine -simulation Tool For River Management

NASA Astrophysics Data System (ADS)

Heun, J. C.; Schotanus, T. D.; de Groen, M. M.; Werner, M.

The Simulation Tool for River Management (STORM), based on the River Rhine case, aims to provide insight into river and floodplain management, by (1) raising aware- ness of river functions, (2) exploring alternative strategies, (3) showing the links be- tween natural processes, spatial planning, engineering interventions, river functions and stakeholder interests, (4) facilitating the debate between different policy makers and stakeholders from across the basin and (5) enhancing co-operation and mutual un- derstanding. The simulation game is built around the new concepts of SRoom for the & cedil;RiverT, Flood Retention Areas, Resurrection of former River Channels and SLiving & cedil;with the FloodsT. The Game focuses on the Lower and Middle Rhine from the Dutch Delta to Maxau in Germany. Influences from outside the area are included as scenarios for boundary conditions. The heart of the tool is the hydraulic module, which calcu- lates representative high- and low water-levels for different hydrological scenarios and influenced by river engineering measures and physical planning in the floodplains. The water levels are translated in flood risks, navigation potential, nature development and land use opportunities in the floodplain. Players of the Game represent the institutions: National, Regional, Municipal Government and Interest Organisations, with interests in flood protection, navigation, agriculture, urban expansion, mining and nature. Play- ers take typical river and floodplain engineering, physical planning and administrative measures to pursue their interests in specific river functions. The players are linked by institutional arrangements and budgetary constraints. The game particularly aims at middle and higher level staff of local and regional government, water boards and members of interest groups from across the basin, who deal with particular stretches or functions of the river but who need (1) to be better aware of the integrated whole, (2) to understand the interests and considerations of others and (3) to experience the mu- tual benefits of co-operation. There is potential for using the game as one of the tools in support of interactive formulation of policy and participatory decision-making in actual plans.
Mental health treatment preferences and challenges of living with multimorbidity from the veteran perspective

PubMed Central

DiNapoli, Elizabeth A.; Cinna, Christopher; Whiteman, Karen L.; Fox, Lauren; Appelt, Cathleen J.; Kasckow, John

2017-01-01

Objective To explore middle-aged and older veterans’ current disease-management practices, mental health treatment preferences, and challenges of living with multiple chronic health conditions (i.e., multimorbidity). Methods Semi-structured qualitative interviews and self-report measures were collected from 28 middle-aged and older (50 years of age or older) veterans with multimorbidity. Results Our sample of veterans with multimorbidity was, on average, mildly depressed and anxious with elevated stress and disability. Veterans acknowledged the interaction of physical and emotional symptoms, which caused greater difficulty with health care management and daily functioning. Veterans had many concerns regarding their physical and emotional health conditions, such as continued disease progression and the addition of other emotional and physical health complications. Veterans also identified specific self-care approaches for disease management (e.g., medication, healthy lifestyle practices, and psychological stress management techniques), as well as barriers to engaging in care (e.g., money, transportation, and stigma). Participants preferred a combination of medication, psychotherapy, and healthy lifestyle practices for mental health treatment. The majority of participants (88.5%) agreed that these mental health treatments would be beneficial to integrate into disease management for older veterans with multimorbidity. Lastly, veterans provided an array of recommendations for improving Veteran’s Administration services and reducing mental health stigma. Conclusions These findings provide support for patient-centered approaches and integrated mental and physical health self-management in the Veteran’s Administration for middle-aged and older veterans with multiple chronic conditions. PMID:27442187
Quantitative Reporting Practices in Middle-Grades Research Journals: Lessons to Learn

ERIC Educational Resources Information Center

Capraro, Robert M.; Capraro, Mary Margaret

2009-01-01

This study examines two journals specific to the middles grades where original quantitative empirical articles are published, Research in Middle Level Education and Middle Grades Research Journal to determine what quantitative statistics are used, how they are used, and what study designs are used. Important for those who write for the…
How to support forest management in a world of change: results of some regional studies.

PubMed

Fürst, C; Lorz, C; Vacik, H; Potocic, N; Makeschin, F

2010-12-01

This article presents results of several studies in Middle, Eastern and Southeastern Europe on needs and application areas, desirable attributes and marketing potentials of forest management support tools. By comparing present and future application areas, a trend from sectoral planning towards landscape planning and integration of multiple stakeholder needs is emerging. In terms of conflicts, where management support tools might provide benefit, no clear tendencies were found, neither on local nor on regional level. In contrast, on national and European levels, support of the implementation of laws, directives, and regulations was found to be of highest importance. Following the user-requirements analysis, electronic tools supporting communication are preferred against paper-based instruments. The users identified most important attributes of optimized management support tools: (i) a broad accessibility for all users at any time should be guaranteed, (ii) the possibility to integrate iteratively experiences from case studies and from regional experts into the knowledge base (learning system) should be given, and (iii) a self-explanatory user interface is demanded, which is also suitable for users rather inexperienced with electronic tools. However, a market potential analysis revealed that the willingness to pay for management tools is very limited, although the participants specified realistic ranges of maximal amounts of money, which would be invested if the products were suitable and payment inevitable. To bridge the discrepancy between unwillingness to pay and the need to use management support tools, optimized financing or cooperation models between practice and science must be found.
How to Support Forest Management in a World of Change: Results of Some Regional Studies

NASA Astrophysics Data System (ADS)

Fürst, C.; Lorz, C.; Vacik, H.; Potocic, N.; Makeschin, F.

2010-12-01

This article presents results of several studies in Middle, Eastern and Southeastern Europe on needs and application areas, desirable attributes and marketing potentials of forest management support tools. By comparing present and future application areas, a trend from sectoral planning towards landscape planning and integration of multiple stakeholder needs is emerging. In terms of conflicts, where management support tools might provide benefit, no clear tendencies were found, neither on local nor on regional level. In contrast, on national and European levels, support of the implementation of laws, directives, and regulations was found to be of highest importance. Following the user-requirements analysis, electronic tools supporting communication are preferred against paper-based instruments. The users identified most important attributes of optimized management support tools: (i) a broad accessibility for all users at any time should be guaranteed, (ii) the possibility to integrate iteratively experiences from case studies and from regional experts into the knowledge base (learning system) should be given, and (iii) a self-explanatory user interface is demanded, which is also suitable for users rather inexperienced with electronic tools. However, a market potential analysis revealed that the willingness to pay for management tools is very limited, although the participants specified realistic ranges of maximal amounts of money, which would be invested if the products were suitable and payment inevitable. To bridge the discrepancy between unwillingness to pay and the need to use management support tools, optimized financing or cooperation models between practice and science must be found.
Push-out bond strengths of fiber-reinforced composite posts with various resin cements according to the root level

PubMed Central

Chang, Hoon-Sang; Noh, Young-Sin; Lee, Yoon; Min, Kyung-San

2013-01-01

PURPOSE The aim of this study was to determine whether the push-out bond strengths between the radicular dentin and fiber reinforced-composite (FRC) posts with various resin cements decreased or not, according to the coronal, middle or apical level of the root. MATERIALS AND METHODS FRC posts were cemented with one of five resin cement groups (RelyX Unicem: Uni, Contax with activator & LuxaCore-Dual: LuA, Contax & LuxaCore-Dual: Lu, Panavia F 2.0: PA, Super-Bond C&B: SB) into extracted human mandibular premolars. The roots were sliced into discs at the coronal, middle and apical levels. Push-out bond strength tests were performed with a universal testing machine at a crosshead speed of 0.5 mm/min, and the failure aspect was analyzed. RESULTS There were no significant differences (P>.05) in the bond strengths of the different resin cements at the coronal level, but there were significant differences in the bond strengths at the middle and apical levels (P<.05). Only the Uni and LuA cements did not show any significant decrease in their bond strengths at all the root levels (P>.05); all other groups had a significant decrease in bond strength at the middle or apical level (P<.05). The failure aspect was dominantly cohesive at the coronal level of all resin cements (P<.05), whereas it was dominantly adhesive at the apical level. CONCLUSION All resin cement groups showed decreases in bond strengths at the middle or apical level except LuA and Uni. PMID:24049569

77 FR 74223 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Middle...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-13

... DEPARTMENT OF LABOR Office of the Secretary Agency Information Collection Activities; Submission for OMB Review; Comment Request; Middle Class Tax Relief and Job Creation Act of 2012 State Monitoring... Creation Act of 2012 State Monitoring,'' to the Office of Management and Budget (OMB) for review and...
The Importance of Emotional Intelligence during Transition into Middle School. What Research Says.

ERIC Educational Resources Information Center

Richardson, Tommye Lou

2002-01-01

Recommends that teachers nurture students' emotional intelligence by teaching coping skills, how to acquire and use information, how to work with others, and how to manage personal growth. Discusses usefulness of emotional intelligence during transition to middle school, and suggests educators involve students in common activities that foster…
Systems Thinking among School Middle Leaders

ERIC Educational Resources Information Center

Shaked, Haim; Schechter, Chen

2017-01-01

Systems thinking is a holistic approach that puts the study of wholes before that of parts. This study explores systems thinking among school middle leaders--teachers who have management responsibility for a team of teachers or for an aspect of the school's work. Interviews were held with 93 school coordinators, among them year heads, heads of…
Videos for Teachers: Successful Teaching Strategies in Elementary and Middle School Classrooms. [CD-ROM].

ERIC Educational Resources Information Center

Teachers Network, New York, NY.

This CD-ROM provides information on successful teaching strategies for elementary and middle school teachers. One section offers links to curriculum and lesson planning strategies in the areas of English as a Second Language, library, arts, classroom management, English/language arts, foreign languages, global education, health/physical education,…
The Importance of "Wasta" in the Career Success of Middle Eastern Managers

ERIC Educational Resources Information Center

Tlaiss, Hayfaa; Kauser, Saleema

2011-01-01

Purpose: Frequently used in fostering the career progression of individuals this paper aims to explore the concept of "wasta" and its significance in the career advancement of individuals in the Middle Eastern region. The paper also seeks to compare "wasta" with networking and mentoring. Design/methodology/approach: The…
Middle School Improvement and Reform: Development and Validation of a School-Level Assessment of Climate, Cultural Pluralism, and School Safety.

ERIC Educational Resources Information Center

Brand, Stephen; Felner, Robert; Shim, Minsuk; Seitsinger, Anne; Dumas, Thaddeus

2003-01-01

Examines the structure of perceived school climate and the relationship of climate dimensions to adaptation of students who attend middle-grade-level schools. The climate scales exhibited a stable dimensional structure, high levels of internal consistency, and moderate levels of stability. Ratings of multiple climate dimensions were associated…
Early results of a simple distraction dynamic external fixator in management of comminuted intra-articular fractures of base of middle phalanx.

PubMed

Mansha, Muhammad; Miranda, Sanjay

2013-12-01

Treatment for comminuted fracture dislocations of the proximal interphalangeal joint (pilon injuries) remains a challenge. We present our short term results of twelve pilon fracture dislocations treated by closed reduction and application of a distraction dynamic external fixator. The aim of the study was to assess the clinical outcomes and compare them to the original description by Hynes and Giddins. A cohort of 12 consecutive patients with pilon fracture of the proximal interphalangeal joint (comminuted fracture of the base of middle phalanx, longitudinally unstable with joint subluxation), were treated with this method over the study period. Data was collected by an independent observer at last follow-up appointment in the clinic. The outcome measures recorded were; level of residual pain, arc of motion, X-ray appearance, return to work and satisfaction with the procedure. The study group comprises of 7 male and 5 female patients at a mean age of 38.1 years (range 21-70 years). The average range of movement achieved was 13-87° at a mean follow-up of 16.4 weeks (Range 12-42 weeks). Early return to work, good pain relief and high level of patient satisfaction were achieved. No serious complication was noted during this period. We used the construct with slight modification of the original description and we feel this modification may help to reduce the pin site infection. We found the results reproducible and based on our experience we recommend this technique to treat these complex intra-articular fractures of base of middle phalanx.
Factors affecting turnover intentions among public hospital doctors in a middle-level city in central China.

PubMed

Zhang, Fengfan; Luo, Zhenni; Chen, Ting; Min, Rui; Fang, Pengqian

2017-05-01

Objective The aim of the present study was to explore prominent factors affecting turnover intentions among public hospital doctors in urban areas, particularly in Xiangyang City, Hubei Province, a middle-level city in central China. Methods Questionnaires were used to collect data from 284 public hospital doctors. Pearson's Chi-squared was used to assess whether sociodemographic and other factors were related to the turnover intentions of public hospital doctors. Binary logistic regression was performed to determine the significant factors that influence turnover intentions. Results The analysis revealed that 28.2% of public hospital doctors intended to leave the hospital where they were currently employed. Dissatisfaction with working conditions and hospital management processes, as well as work pressures, were significant factors contributing to the turnover intentions of public hospital doctors. Conclusion Research into turnover intentions indicates that public hospital doctors surveyed in urban China give greater weight to their professional environment and career development rather than salary in their employment decisions. What is known about the topic? Turnover of medical staff is a concern to hospital administrators because it is costly and detrimental to organisational performance and quality of care. Most studies have focused on the effects of individual and organisational factors on nurses' intentions to leave their employment. Income dissatisfaction was one of the determining factors of turnover intentions in previous studies. What does this paper add? The satisfaction of public hospital doctors with regard to income is not a determining factor of turnover intentions. In contrast with findings of previous studies, the doctors in public hospitals in urban China in the present study gave greater weight to their professional environment and career development in their employment decisions. What are the implications for practitioners? The findings suggest that health service managers and policy makers should pay greater attention to the factors affecting public hospital doctors' turnover intentions. This study will be useful for optimising public hospital management and minimising the turnover of doctors in China.
Type 1 Diabetes Self-Management From Emerging Adulthood Through Older Adulthood.

PubMed

McCarthy, Margaret M; Grey, Margaret

2018-05-25

The purpose of this study of adults with type 1 diabetes was to analyze patterns of diabetes self-management behaviors and predictors of glycemic control across the adult life span. This study was a secondary cross-sectional analysis of data from of 7,153 adults enrolled in the Type 1 Diabetes Exchange clinic registry who were divided into four developmental stages (emerging, young, middle-aged, and older adults). Data were collected by questionnaire and medical record review at enrollment. Statistical analyses compared sociodemographic, clinical, and diabetes-related factors across groups. Logistic regressions were conducted for each group to identify factors associated with hemoglobin A 1c ≥7%. The sample was divided according to adult developmental stage: emerging adults, age 18 to <25 years ( n = 2,478 [35%]); young adults, age 25 to <45 years ( n = 2,274 [32%]); middle-aged adults, age 45 to <65 years ( n = 1,868 [26%]; and older adults, age ≥65 years ( n = 533 [7%]). Emerging adults had the highest mean hemoglobin A 1c level (8.4 ± 1.7% [68 mmol/mol]), whereas older adults had the lowest level (7.3 ± 0.97% [56 mmol/mol]; P < 0.0001). Emerging adults were less likely to use an insulin pump (56%) or a continuous glucose monitor (7%), but were more likely to miss at least one insulin dose per day (3%) and have had an episode of diabetic ketoacidosis in the past year (7%) (all P < 0.0001). Different factors were associated with hemoglobin A1c ≥7% in each age group, but two factors were noted across several groups: the frequency of blood glucose checks and missed insulin doses. When discussing diabetes self-management, providers may consider a patient's developmental stage, with its competing demands, such as work and family; psychosocial adjustments; and the potential burden of comorbidities. © 2018 by the American Diabetes Association.
Application of Porter's generic strategies in ambulatory health care: a comparison of managerial perceptions in two Israeli sick funds.

PubMed

Torgovicky, Refael; Goldberg, Avishay; Shvarts, Shifra; Bar Dayan, Yosefa; Onn, Erez; Levi, Yehezkel; BarDayan, Yaron

2005-01-01

A number of typologies have been developed in the strategic management literature to categorize strategies that an organization can pursue at the business level. Extensive research has established Porter's generic strategies of (1) cost leadership, (2) differentiation, (3) differentiation focus, (4) cost focus, and (5) stuck-in-the-middle as the dominant paradigm in the literature. The purpose of the current study was to research competitive strategies in the Israeli ambulatory health care system, by comparing managerial perceptions of present and ideal business strategies in two Israeli sick funds. We developed a unique research tool, which reliably examines the gap between the present and ideal status managerial views. We found a relation between the business strategy and performance measures, thus strengthening Porter's original theory about the nonviability of the stuck-in-the-middle strategy, and suggesting the applicability Porter's generic strategies to not-for-profit institutes in an ambulatory health care system.
Barriers and Facilitators to Integrating Health Service Responses to Intimate Partner Violence in Low- and Middle-Income Countries: A Comparative Health Systems and Service Analysis.

PubMed

Colombini, Manuela; Dockerty, Colleen; Mayhew, Susannah H

2017-06-01

This systematic review synthesizes 11 studies of health-sector responses to intimate partner violence (IPV) in low- and middle-income countries. The services that were most comprehensive and integrated in their responsiveness to IPV were primarily in primary health and antenatal care settings. Findings suggest that the following facilitators are important: availability of clear guidelines, policies, or protocols; management support; intersectoral coordination with clear, accessible on-site and off-site referral options; adequate and trained staff with accepting and empathetic attitudes toward survivors of IPV; initial and ongoing training for health workers; and a supportive and supervised environment in which to enact new IPV protocols. A key characteristic of the most integrated responses was the connection or "linkages" between different individual factors. Irrespective of their service entry point, what emerged as crucial was a connected systems-level response, with all elements implemented in a coordinated manner. © 2017 The Population Council, Inc.
Managing Inquiry-Based Classrooms

ERIC Educational Resources Information Center

Wolfgang, Christie Nicole

2009-01-01

Though it may seem that classroom management comes naturally to some teachers, upon closer examination you'll probably discover that preparation and adaptation are more important than any innate ability when it comes to successful classroom management. Any experienced middle school science teacher can tell you that successful classroom management…
Defeating the Islamic State at Three Levels of War

DTIC Science & Technology

2016-05-13

Middle East, Northern Africa , and Southeast Asia while using terrorism to attack the West. In order to fulfill the President’s end state of “ultimately...war. IS is expanding throughout the Middle East, Northern Africa , and Southeast Asia while using terrorism to attack the West. In order to...N-S) and theater-strategic (T-S) levels of war (See Figure 1). The insurgency is rapidly expanding throughout the Middle East, Northern Africa , and
Transaction costs and community-based natural resource management in Nepal.

PubMed

Adhikari, Bhim; Lovett, Jon C

2006-01-01

Transaction costs in community-based resource management are incurred by households attempting to enforce property right rules over common resources similar to those inherent in private property rights. Despite their importance, transaction costs of community-based management of common pool resources (CPRs) are often not incorporated into the economic analysis of participatory resource management. This paper examines the transaction costs incurred by forest users in community forestry (CF) based on a survey of 309 households belonging to eight different forest user groups (FUGs) in the mid hills of Nepal. The analysis reveals that the average 'poor' household incurred Nepalese rupees (NRS) 1265 in transaction costs annually, while wealthier 'rich' households incurred an average of NRS 2312 per year. Although richer households bear higher proportions of such costs, transaction costs for CF management as a percentage of resource appropriation costs are higher for poorer households (26%) than those of middle-wealth (24%) or rich households (14%). There are also village differences in the level of transaction costs. The results show that transaction costs are a major component of resource management costs and vary according to socio-economic status of resource users and characteristics of the community.
The epistemic integrity of NASA practices in the Space Shuttle Program.

PubMed

De Winter, Jan; Kosolosky, Laszlo

2013-01-01

This article presents an account of epistemic integrity and uses it to demonstrate that the epistemic integrity of different kinds of practices in NASA's Space Shuttle Program was limited. We focus on the following kinds of practices: (1) research by working engineers, (2) review by middle-level managers, and (3) communication with the public. We argue that the epistemic integrity of these practices was undermined by production pressure at NASA, i.e., the pressure to launch an unreasonable amount of flights per year. Finally, our findings are used to develop some potential strategies to protect epistemic integrity in aerospace science.
Organizing for Accountability

ERIC Educational Resources Information Center

Bennis, Warren

1975-01-01

A college president challenges personnel administrators to play a leadership role in human resource management. Notes the need for career development programs for middle managers particularly and recommends an organizational development approach to faculty and staff career development. (JT)
An evidence based protocol for managing neonatal middle ear effusions in babies who fail newborn hearing screening.

PubMed

Weber, Brittany C; Whitlock, Scott M; He, Kaidi; Kimbrell, Blake S; Derkay, Craig S

2018-04-12

To evaluate the prevalence of middle ear disease in infants referred for failed newborn hearing screening (NBHS) and to review patient outcomes after intervention in order to propose an evidence-based protocol for management of newborns with otitis media with effusion (OME) who fail NBHS. 85 infants with suspected middle ear pathology were retrospectively reviewed after referral for failed NBHS. All subjects underwent a diagnostic microscopic exam with myringotomy with or without placement of a ventilation tube in the presence of a middle ear effusion and had intra-operative auditory brainstem response (ABR) testing or testing at a later date. At the initial office visit, a normal middle ear space bilaterally was documented in 5 babies (6%), 29/85 (34%) had an equivocal exam while 51/85 (60%) had at least a unilateral OME. Myringotomy with or without tube placement due to presence of an effusion was performed on 65/85 (76%) neonates. Normal hearing was established in 17/85 (20%) after intervention, avoiding the need for any further audiologic workup. Bilateral or unilateral sensorineural hearing loss (SNHL) or mixed hearing loss was noted in 54/85 (64%) and these children were referred for amplification. Initially observation with follow up outpatient visits was initiated in 27/85 (32%) however, only 3/27 (11%) resolved with watchful waiting and 24/27 (89%) ultimately required at least unilateral tube placement due to OME and 14/24 (59%) were found to have at least a unilateral mixed or SNHL. An effective initial management plan for children with suspected middle ear pathology and failed NBHS is diagnostic operative microscopy with placement of a ventilation tube in the presence of a MEE along with either intra-operative ABR or close follow-up ABR. This allows for the identification and treatment of babies with a conductive component due to OME, accurate diagnosing of an underlying SNHL component and for prompt aural rehabilitation. Copyright © 2018 Elsevier Inc. All rights reserved.
Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

PubMed

2018-04-05

Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. NCT02179112.
Productivity of different cow genetic groups in dual-purpose cattle production systems in south-eastern Mexico.

PubMed

Magana, J G; Tewolde, A; Anderson, S; Segura, J C

2006-01-01

The objective was to evaluate the effect of cow genetic group, nutritional level and their interaction on some economically important traits of dual-purpose herds managed under field conditions. Nine herds were monitored during a production cycle in Yucatan, Mexico. Herds were grouped into four nutritional levels (NL) based on the metabolizable energy (ME) apparently available on pasture, nutritional management, and milk production. Cows were classified into three genetic groups (GG): low (< or = 25%), middle (25-75%) and high (> or = 75%) graded for Bos taurus inheritance. Total milk sold (TMS), days in milk (DIM), TMS adjusted to DIM within each NL (TMSA), body condition score (BCS) at calving, changes of BCS during lactation (CBCS), calf weaning weight (WW), age at weaning (AW), kg of calf weaned per cow (KWC) and calf mortality were studied. The statistical model included the fixed effects of NL, GG, month of calving (MC), parity number (PN) and BCS at calving and GG x NL interaction. The effects of NL, GG, MC, PN and GG x NL were significant (p < 0.05) for TMS, KWC. As expected, TMS increased with NL from 562.4 +/- 106 kg for NL1 to 2366.3 +/- 100.1 kg for NL4. KWC was greatest for NL2 (138.6 kg) followed by NL1 (135 kg); the lowest KWC corresponded to NL4 (96.0 kg) (p < 0.05). TMS values for the middle (1727 +/- 94.7 kg) and the high graded GG (1603.5 +/- 83.5 kg) were twice those for the low graded GG cows (828.5 +/- 95 kg) (p < 0.05). KWC was also higher for the middle graded group (152.8 kg) than for the low or (104 kg) or the high graded GG (118 kg) (p < 0.05). With better nutrition cows of all GG improved their milk performance but not the calf traits. CBCS was negative for all GG. The highest BCS lost was for cows in NL1 and NL2 and for cows in the high graded GG (p < 0.05).
Embolization of dural arteriovenous fistula of the anterior cranial fossa through the middle meningeal artery with Onyx.

PubMed

Deng, Jian-Ping; Li, Jiang; Zhang, Tao; Yu, Jia; Zhao, Zhen-Wei; Gao, Guo-Dong

2014-02-01

Dural arteriovenous fistula (DAVF) of the anterior cranial fossa is usually treated by surgical disconnection or endovascular embolization via the ophthalmic artery. The middle meningeal artery is a rarely used approach. This study investigated the safety and efficacy of embolization of DAVF of the anterior cranial fossa with Onyx through the middle meningeal artery. A retrospective review of a prospective cerebral vascular disease database was performed. Patients with DAVF of the anterior cranial fossa managed with embolization through the middle meningeal artery with Onyx were selected. Information on demography, symptoms and signs, angiographic examinations, interventional treatments, angiographic and clinical results, and follow-up was collected and analyzed. Five patients were included in this study, four of whom had hemorrhage. All fistulas were fed by the bilateral ethmoidal arteries arising from the ophthalmic artery and by the anterior branch of the middle meningeal artery. The abnormal shunt unilaterally drained into the superior sagittal sinus with interposition of the cortical veins all five patients. All endovascular treatments were successful with evidence of an angiographic cure. No complications occurred, and all patients recovered uneventfully without neurologic deficits. There were nearly no symptoms among the patients during follow-up. Embolization of DAVF of the anterior cranial fossa via the middle meningeal artery with Onyx is safe, effective, and a good choice for management of DAVF. More cases are needed to verify these findings. Copyright © 2013. Published by Elsevier B.V.

Ecosystem management decision support for federal forests in the United States: a review

Treesearch

H. Michael Rauscher

1999-01-01

Ecosystem management has been adopted as the philosophical paradigm guiding management on many Federal forests in the United States. The strategic goal of ecosystem management is to find a sensible middle ground between ensuring long-term protection of the environment while allowing an increasing population to use its natural resources for maintaining and improving...
School Location, Student Achievement, and Homework Management Reported by Middle School Students

ERIC Educational Resources Information Center

Xu, Jianzhong

2009-01-01

The aim of this study was to examine whether student achievement and school location may influence a range of homework management strategies. The participants were 633 rural and urban students in Grade 8. These homework management strategies include: (a) setting an appropriate work environment, (b) managing time, (c) handling distraction, (d)…
Beyond Being Present: Learning-Oriented Leadership in the Daily Work of Middle Managers

ERIC Educational Resources Information Center

Döös, Marianne; Johansson, Peter; Wilhelmson, Lena

2015-01-01

Purpose: This paper aims to contribute to the understanding of learning-oriented leadership as being integrated in managers' daily work. The particular focus is on managers' efforts to change how work is carried out through indirect acts of influence. In their daily work, managers influence the organisation's learning conditions in ways that go…
Cognitive Learning Theory Takes a Backseat: Consequences of a Management Development Program for Work Practice

ERIC Educational Resources Information Center

Moesby-Jensen, Cecilie K.

2008-01-01

This paper describes the consequences of a cognitive management development program for middle managers in a public organization. The objective was to teach transformational leadership and teamwork but it occasioned a very limited improved articulation of transformational leadership and teamwork and only a modest change in the managers' actions in…
WWC Quick Review of the Article "Impact of For-Profit and Nonprofit Management on Student Achievement: The Philadelphia Intervention, 2002-2008"

ERIC Educational Resources Information Center

What Works Clearinghouse, 2010

2010-01-01

"Impact of For-Profit and Nonprofit Management on Student Achievement: The Philadelphia Intervention, 2002-2008" examined whether shifting from traditional district management to management by a for-profit or nonprofit organization improves student achievement. The study analyzed data on six cohorts of elementary and middle school…
Teaching in the Middle Grades Today: Examining Teachers' Beliefs about Middle Grades Teaching

ERIC Educational Resources Information Center

DiCicco, Mike; Cook, Chris M.; Faulkner, Shawn A.

2016-01-01

Since the beginning of the middle school movement in the mid-1960s, middle level advocates have called for a school experience for young adolescents grounded in adolescent development that engages students in meaningful learning (Alexander & Williams, 1965; Eichhorn, 1966). The aim of this exploratory multicase study was to understand middle…
Promoting Academic Achievement in the Middle School Classroom: Integrating Effective Study Skills Instruction

ERIC Educational Resources Information Center

Thorpe, Christin

2010-01-01

This study aimed to discover what study skills are most useful for middle school students, as well as strategies for integrating study skills instruction into the four main content area classrooms (English, math, science, and social studies) at the middle school level. Twenty-nine in-service middle school teachers participated in the study by…
What Role for Middle School Sports?

ERIC Educational Resources Information Center

McEwin, C. Kenneth; Dickinson, Thomas S.

1998-01-01

Safe, developmentally appropriate play is difficult to achieve when middle schools move into the competitive interscholastic arena. Problems associated with middle-level sports programs include students' predisposition to physical injury, psychological unreadiness, high attrition rates, improper coaching, and liability issues. Improving…
Culture, food, and language: Perspectives from immigrant mothers in school science

NASA Astrophysics Data System (ADS)

Hagiwara, Sumi; Calabrese Barton, Angela; Contento, Isobel

2007-04-01

The article explores the role of immigrant parents in middle school science as both teachers and learners as part of an urban middle school curriculum, the Linking in Food and the Environment (LiFE) program. The curriculum engaged parents as partners with science teachers to teach science through food. Over a 2-year period, parents attended a series of bilingual workshops, collaborated with classroom teachers, managed activities, guided student inquiry, and assisted in classroom management. The following study analyzes the role of culture, language, and identity as four mothers navigated their position as `insiders' in a science classroom.
Influential Effects of Intrinsic-Extrinsic Incentive Factors on Management Performance in New Energy Enterprises.

PubMed

Wang, Ping; Lu, Zhengnan; Sun, Jihong

2018-02-08

Background : New energy has become a key trend for global energy industry development. Talent plays a very critical role in the enhancement of new energy enterprise competitiveness. As a key component of talent, managers have been attracting more and more attention. The increase in job performance relies on, to a certain extent, incentive mechanism. Based on the Two-factor Theory, differences in influences and effects of different incentives on management performance have been checked in this paper from an empirical perspective. Methods : This paper selects the middle and low level managers in new energy enterprises as research samples and classifies the managers' performance into task performance, contextual performance and innovation performance. It uses manager performance questionnaires and intrinsic-extrinsic incentive factor questionnaires to investigate and study the effects and then uses Amos software to analyze the inner link between the intrinsic-extrinsic incentives and job performance. Results : Extrinsic incentives affect task performance and innovation performance positively. Intrinsic incentives impose active significant effects on task performance, contextual performance, and innovation performance. The intrinsic incentive plays a more important role than the extrinsic incentive. Conclusions : Both the intrinsic-extrinsic incentives affect manager performance positively and the intrinsic incentive plays a more important role than the extrinsic incentive. Several suggestions to management should be given based on these results.
A New Approach of Measuring Hospital Performance for Low- and Middle-income Countries

PubMed Central

Sapkota, Vishnu Prasad; Supakankunti, Siripen

2015-01-01

Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance. PMID:26617448
Middle Level Learning.

ERIC Educational Resources Information Center

Wyman, Richard M., Jr.; Young, Katherine A.; Sliger, Bruce; Kafi, Patricia; Singer, Alan; Lamme, Linda Leonard

1998-01-01

Presents five brief articles related to middle-level learning. The articles are, "Using Children's Diaries to Teach the Oregon Trail"; "Living the Geography of Joseph and Temperance Brown"; "The ABCs of Small Grant Acquisition for Social Studies"; "Isomo Loruko: The Yoruba Naming Ceremony"; and "Child…
Using diaries to explore the work experiences of primary health care nursing managers in two South African provinces.

PubMed

Munyewende, Pascalia O; Rispel, Laetitia C

2014-01-01

South Africa is on the brink of another wave of major health system reforms that underscore the centrality of primary health care (PHC). Nursing managers will play a critical role in these reforms. The aim of the study was to explore the work experiences of PHC clinic nursing managers through the use of reflective diaries, a method hitherto under-utilised in health systems research in low- and middle-income countries. During 2012, a sub-set of 22 PHC nursing managers was selected randomly from a larger nurses' survey in two South African provinces. After informed consent, participants were requested to keep individual diaries for a period of 6 weeks, using a clear set of diary entry guidelines. Reminders consisted of weekly short message service reminders and telephone calls. Diary entries were analysed using thematic content analysis. A diary feedback meeting was held with all the participants to validate the findings. Fifteen diaries were received, representing a 68% response rate. The majority of respondents (14/15) were female, each with between 5 and 15 years of nursing experience. Most participants made their diary entries at home. Diaries proved to be cathartic for individual nursing managers. Although inter-related and not mutually exclusive, the main themes that emerged from the diary analysis were health system deficiencies; human resource challenges; unsupportive management environment; leadership and governance; and the emotional impact of clinic management. Diaries are an innovative method of capturing the work experiences of managers at the PHC level, as they allow for confidentiality and anonymity, often not possible with other qualitative research methods. The expressed concerns of nursing managers must be addressed to ensure the success of South Africa's health sector reforms, particularly at the PHC level.
Using diaries to explore the work experiences of primary health care nursing managers in two South African provinces

PubMed Central

Munyewende, Pascalia O.; Rispel, Laetitia C.

2014-01-01

Background South Africa is on the brink of another wave of major health system reforms that underscore the centrality of primary health care (PHC). Nursing managers will play a critical role in these reforms. Objective The aim of the study was to explore the work experiences of PHC clinic nursing managers through the use of reflective diaries, a method hitherto under-utilised in health systems research in low- and middle-income countries. Design During 2012, a sub-set of 22 PHC nursing managers was selected randomly from a larger nurses’ survey in two South African provinces. After informed consent, participants were requested to keep individual diaries for a period of 6 weeks, using a clear set of diary entry guidelines. Reminders consisted of weekly short message service reminders and telephone calls. Diary entries were analysed using thematic content analysis. A diary feedback meeting was held with all the participants to validate the findings. Results Fifteen diaries were received, representing a 68% response rate. The majority of respondents (14/15) were female, each with between 5 and 15 years of nursing experience. Most participants made their diary entries at home. Diaries proved to be cathartic for individual nursing managers. Although inter-related and not mutually exclusive, the main themes that emerged from the diary analysis were health system deficiencies; human resource challenges; unsupportive management environment; leadership and governance; and the emotional impact of clinic management. Conclusions Diaries are an innovative method of capturing the work experiences of managers at the PHC level, as they allow for confidentiality and anonymity, often not possible with other qualitative research methods. The expressed concerns of nursing managers must be addressed to ensure the success of South Africa's health sector reforms, particularly at the PHC level. PMID:25537937
Public Schools Go Private.

ERIC Educational Resources Information Center

Harrington-Lueker, Donna

1993-01-01

The growing field of profit-making public-school management represents a way to begin school reform and save money. Educational Alternatives, Inc. has an agreement to manage eight elementary schools and one middle school in Baltimore, Maryland; and Whittle Communications, Inc. plans to seek contracts to manage existing public school programs. (MLF)
Adolescents and Conceptions of Social Relations in the Workplace.

ERIC Educational Resources Information Center

Haaken, Janice; Korschgen, Joyce

1988-01-01

Examined social class and adolescent social relations in the workplace. Indicated that middle-class adolescent females, part-time McDonald's employees, sought positive, affective ties with managers and viewed managers as allies, whereas working-class respondents tended to be critical of or to maintain emotional distance from managers. No…
Initial Validation of the Children's Worry Management Scale

ERIC Educational Resources Information Center

Zeman, Janice Lillian; Cassano, Michael; Suveg, Cynthia; Shipman, Kimberly

2010-01-01

We investigated the psychometric properties of a new instrument, the Children's Worry Management Scale (CWMS). The CWMS has three subscales that specify methods of regulating worry: inhibition (the suppression of worry), dysregulation (exaggerated displays of worry), and coping (constructive ways of managing worry). Using a Caucasian, middle-class…
Business and Management Education in Transitioning and Developing Countries: A Handbook

ERIC Educational Resources Information Center

McIntyre, John R., Ed.; Alon, Ilan, Ed.

2005-01-01

Business education is a critical ingredient in establishing a viable middle class of managers in transitioning and developing economies. Compiled in association with the Center for International Business Education and Research, this comprehensive examination of business and management education, pedagogical models, and curricula innovations in…
Water resource conflicts in the Middle East.

PubMed

Drake, C

1997-01-01

This article discusses the causes and sources of water resource conflict in the 3 major international river basins of the Middle East: the Tigris-Euphrates, the Nile, and the Jordan-Yarmuk. The physical geography of the Middle East is arid due to descending air, northeast trade winds, the southerly location, and high evaporation rates. Only Turkey, Iran, and Lebanon have adequate rainfall for population needs. Their mountainous geography and more northerly locations intercept rain and snow bearing westerly winds in winter. Parts of every other country are vulnerable to water shortages. Rainfall is irregular. Water resource conflicts are due to growing populations, economic development, rising standards of living, technological developments, political fragmentation, and poor water management. Immigration to the Jordan-Yarmuk watershed has added to population growth in this location. Over 50% of the population in the Middle East lives in urban areas where populations consume 10-12 times more water than those in rural areas. Water is wasted in irrigation schemes and huge dams with reservoirs where increased evaporation occurs. Technology results in greater water extraction of shallow groundwater and pollution of rivers and aquifers. British colonial government control led to reduced friction in most of the Nile basin. Now all ethnic groups have become more competitive and nationalistic. The Cold War restrained some of the conflict. Israel obtains 40% of its water from aquifers beneath the West Bank and Gaza. Geopolitical factors determine the mutual goodwill in managing international water. The 3 major water basins in the Middle East pose the greatest risk of water disputes. Possible solutions include conservation, better management, prioritizing uses, technological solutions, increased cooperation among co-riparians, developing better and enforceable international water laws, and reducing population growth rates.
Organization of primary health care for diabetes and hypertension in high, low and middle income countries.

PubMed

Lall, Dorothy; Prabhakaran, Dorairaj

2014-08-01

Chronic non-communicable diseases, predominantly diabetes and cardiovascular disease are a major public health problem globally. The chronicity of these diseases necessitates a restructuring of healthcare to address the multidisciplinary, sustained care including psychosocial support and development of self-management skills. Primary healthcare with elements of the chronic-care model provides the best opportunity for engagement with the health system. In this review, the authors discuss aspects of primary healthcare for management of diabetes and hypertension and innovations such as mobile-phone messaging, web-based registries, computer-based decision support systems and multifaceted health professionals in the care team among others that are being tested to improve the quality of care for these diseases in high, middle and low-income countries. The goal of quality care for diabetes and hypertension demands innovation within the realities of health systems both in high as well as low and middle-income countries.

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