Characteristics of medical practices in three developed managed care markets.

PubMed

Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard; McNeil, Barbara J

2005-06-01

To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences. Surveys of medical practices in three managed care markets conducted in 2000-2001. We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices. A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey. We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1-125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas. We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped.

The making of a nurse manager: the role of experiential learning in leadership development.

PubMed

Cathcart, Eloise Balasco; Greenspan, Miriam; Quin, Matthew

2010-05-01

To articulate the experientially acquired knowledge, skill and ethics embedded in nurse manager practice and describe the ways in which they were developed. The role of the nurse manager is usually described in lists of competencies, talents and traits which fail to capture the experience-based judgment and practical knowledge in this pivotal organizational role. Using Benner's methodology of practice articulation, 32 nurse managers wrote and interpreted first person narratives of their practice. The experience level of the group ranged from new nurse managers to those with more than 10 years' role tenure. The seminars were facilitated by a seasoned nurse executive and nurse manager with expertise in narrative interpretation. Interpretation of the paradigm case of one nurse manager suggests that complex leadership challenges can be a source of significant experiential learning for the individual and for the group. CONCLUSIONS; Articulating and reflecting on experiential learning elucidates the skilled knowledge and judgment embedded in nurse manager practice which cannot be accessed in any other way. Articulating the practical knowledge which is necessary for effective nurse manager practice can hasten the development of role incumbents.

WMOST 1.0 Download Page

EPA Pesticide Factsheets

The Watershed Management Optimization Support Tool (WMOST) allows water-resource managers and planners to screen a wide range of practices for cost-effectiveness in achieving watershed or water utilities management goals.

Human resource management in general practice: survey of current practice.

PubMed Central

Newton, J; Hunt, J; Stirling, J

1996-01-01

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received some type of formal training in staff management. CONCLUSION: This study shows that practice size is a major factor associated with differences in the organization and management of staffing. Any initiatives which increase the scale of primary care functions and services would have to address the issues of communication and coordination that might be associated with such a change. PMID:8855013

Assessment of range planting as a conservation practice

Treesearch

Stuart P. Hardegree; Thomas A. Jones; Bruce A. Roundy; Nancy L. Shaw; Thomas A. Monaco

2016-01-01

Natural Resource Conservation Service Range Planting - Conservation Practice Standards provide guidelines for making decisions about seedbed preparation, planting methods, plant materials selection, seeding rate, seeding depth, timing of seeding, postplanting management, and weed control. Adoption of these standards is expected to contribute to successful...

Best practices in nursing homes. Clinical supervision, management, and human resource practices.

PubMed

Dellefield, Mary Ellen

2008-07-01

Human resource practices including supervision and management are associated with organizational performance. Evidence supportive of such an association in nursing homes is found in the results of numerous research studies conducted during the past 17 years. In this article, best practices related to this topic have been culled from descriptive, explanatory, and intervention studies in a range of interdisciplinary research journals published between 1990 and 2007. Identified best practices include implementation of training programs on supervision and management for licensed nurses, certified nursing assistant job enrichment programs, implementation of consistent nursing assignments, and the use of electronic documentation. Organizational barriers and facilitators of these best practices are described. Copyright 2009, SLACK Incorporated.

The Standley allotment: a history of range recovery.

Treesearch

Gerald S. Strickler; Wade B. Hall

1980-01-01

One of the first range research programs on National Forest lands was conducted by Dr. Arthur W. Sampson in the Wallowa Mountains, Oregon, between 1907 and 1911. This paper reviews the historical perspective of and the basic range management principles and practices developed from Sampson's studies as well as the land and grazing management of the study area to...

Vegetation management practices: Past and present

Treesearch

Peter F. Ffolliott; Gerald J. Gottfried; William H. Kruse

2003-01-01

Improving management practices have been at the core of most research conducted in the semidesert grass-shrub vegetation on the Santa Rita Experimental Range. Much of this research has been directed to sustaining forage resources through proper livestock grazing and controlling the invasion of competing woody plants, primarily mesquite. Both research orientations...

Recommended practices for DSRC licensing and spectrum management : a guide for management, regulation, deployment, and administration for a connected vehicle environment.

DOT National Transportation Integrated Search

2015-12-01

The goal of this document is to make licensing requirements transparent and best practices accessible to any organization, public or private, seeking to deploy Connected Vehicle Dedicated Short Range Communications (DSRC) Roadside Units (RSU) a...

Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa.

PubMed

Daire, Judith; Gilson, Lucy

2014-09-01

In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager's job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Identifying Cost-Effective Water Resources Management Strategies: Watershed Management Optimization Support Tool (WMOST)

EPA Science Inventory

The Watershed Management Optimization Support Tool (WMOST) is a public-domain software application designed to aid decision makers with integrated water resources management. The tool allows water resource managers and planners to screen a wide-range of management practices for c...

Participatory approaches to understanding practices of flood management across borders

NASA Astrophysics Data System (ADS)

Bracken, L. J.; Forrester, J.; Oughton, E. A.; Cinderby, S.; Donaldson, A.; Anness, L.; Passmore, D.

2012-04-01

The aim of this paper is to outline and present initial results from a study designed to identify principles of and practices for adaptive co-management strategies for resilience to flooding in borderlands using participatory methods. Borderlands are the complex and sometimes undefined spaces existing at the interface of different territories and draws attention towards messy connections and disconnections (Strathern 2004; Sassen 2006). For this project the borderlands concerned are those between professional and lay knowledge, between responsible agencies, and between one nation and another. Research was focused on the River Tweed catchment, located on the Scottish-English border. This catchment is subject to complex environmental designations and rural development regimes that make integrated management of the whole catchment difficult. A multi-method approach was developed using semi-structured interviews, Q methodology and participatory GIS in order to capture wide ranging practices for managing flooding, the judgements behind these practices and to 'scale up' participation in the study. Professionals and local experts were involved in the research. The methodology generated a useful set of options for flood management, with research outputs easily understood by key management organisations and the wider public alike. There was a wide endorsement of alternative flood management solutions from both managers and local experts. The role of location was particularly important for ensuring communication and data sharing between flood managers from different organisations and more wide ranging stakeholders. There were complex issues around scale; both the mismatch between communities and evidence of flooding and the mismatch between governance and scale of intervention for natural flood management. The multi-method approach was essential in capturing practice and the complexities around governance of flooding. The involvement of key flood management organisations was integral to making the research of relevance to professionals.

Inequitable provision of optimal services for patients with chronic heart failure: a national geo-mapping study.

PubMed

Clark, Robyn A; Driscoll, Andrea; Nottage, Justin; McLennan, Skye; Coombe, David M; Bamford, Errol J; Wilkinson, David; Stewart, Simon

2007-02-19

To compare the location and accessibility of current Australian chronic heart failure (CHF) management programs and general practice services with the probable distribution of the population with CHF. Data on the prevalence and distribution of the CHF population throughout Australia, and the locations of CHF management programs and general practice services from 1 January 2004 to 31 December 2005 were analysed using geographic information systems (GIS) technology. Distance of populations with CHF to CHF management programs and general practice services. The highest prevalence of CHF (20.3-79.8 per 1000 population) occurred in areas with high concentrations of people over 65 years of age and in areas with higher proportions of Indigenous people. Five thousand CHF patients (8%) discharged from hospital in 2004-2005 were managed in one of the 62 identified CHF management programs. There were no CHF management programs in the Northern Territory or Tasmania. Only four CHF management programs were located outside major cities, with a total case load of 80 patients (0.7%). The mean distance from any Australian population centre to the nearest CHF management program was 332 km (median, 163 km; range, 0.15-3246 km). In rural areas, where the burden of CHF management falls upon general practitioners, the mean distance to general practice services was 37 km (median, 20 km; range, 0-656 km). There is an inequity in the provision of CHF management programs to rural Australians.

Workplace road safety risk management: An investigation into Australian practices.

PubMed

Warmerdam, Amanda; Newnam, Sharon; Sheppard, Dianne; Griffin, Mark; Stevenson, Mark

2017-01-01

In Australia, more than 30% of the traffic volume can be attributed to work-related vehicles. Although work-related driver safety has been given increasing attention in the scientific literature, it is uncertain how well this knowledge has been translated into practice in industry. It is also unclear how current practice in industry can inform scientific knowledge. The aim of the research was to use a benchmarking tool developed by the National Road Safety Partnership Program to assess industry maturity in relation to risk management practices. A total of 83 managers from a range of small, medium and large organisations were recruited through the Victorian Work Authority. Semi-structured interviews aimed at eliciting information on current organisational practices, as well as policy and procedures around work-related driving were conducted and the data mapped onto the benchmarking tool. Overall, the results demonstrated varying levels of maturity of risk management practices across organisations, highlighting the need to build accountability within organisations, improve communication practices, improve journey management, reduce vehicle-related risk, improve driver competency through an effective workplace road safety management program and review organisational incident and infringement management. The findings of the study have important implications for industry and highlight the need to review current risk management practices. Copyright © 2016 Elsevier Ltd. All rights reserved.

Management practices used by white-tailed deer farms in Pennsylvania and herd health problems.

PubMed

Brooks, Jason W; Jayarao, Bhushan M

2008-01-01

To determine current management practices used by white-tailed deer farms in Pennsylvania and identify animal health problems that exist in these herds. Cross-sectional study. Owners and managers of 233 farms in Pennsylvania that raised white-tailed deer. A self-administered questionnaire was mailed to participants. Herds ranged in size from 1 to 350 deer. Land holdings ranged from 0.07 to 607 hectares (0.17 to 1,500 acres). Stocking density ranged from 0.1 to 118.6 deer/hectare (0.04 to 48 deer/acre). Most (84%) respondents raised deer for breeding or hunting stock; 13% raised deer exclusively as pets or for hobby purposes, and purpose varied by herd size. Multiple associations were identified between management or disease factors and herd size. The use of vaccines, use of veterinary and diagnostic services, use of pasture, and use of artificial insemination increased as herd size increased. The most common conditions in herds of all sizes were respiratory tract disease, diarrhea, parasitism, and sudden death. The prevalence of respiratory tract disease increased as herd size increased. Results suggested that many aspects of herd management for white-tailed deer farms in Pennsylvania were associated with herd size, but that regardless of herd size, many preventive medicine practices were improperly used or underused in many herds.

Factors that influence effective perioperative temperature management by anesthesiologists: a qualitative study using the Theoretical Domains Framework.

PubMed

Boet, Sylvain; Patey, Andrea M; Baron, Justine S; Mohamed, Karim; Pigford, Ashlee-Ann E; Bryson, Gregory L; Brehaut, Jamie C; Grimshaw, Jeremy M

2017-06-01

Inadvertent perioperative hypothermia (IPH) is associated with a range of adverse outcomes. Safe and effective warming techniques exist to prevent IPH; however, IPH remains common. This study aimed to identify factors that anesthesiologists perceive may influence temperature management during the perioperative period. After Research Ethics Board approval, semi-structured interviews were conducted with staff anesthesiologists at a Canadian academic hospital. An interview guide based on the Theoretical Domains Framework (TDF) was used to capture 14 theoretical domains that may influence temperature management. The interview transcripts were coded using direct content analysis to generate specific beliefs and to identify relevant TDF domains perceived to influence temperature management behaviour. Data saturation was achieved after 15 interviews. The following nine theoretical domains were identified as relevant to designing an intervention for practices in perioperative temperature management: knowledge, beliefs about capabilities, beliefs about consequences, reinforcement, memory/attention/decision-making, environmental context and resources, social/professional role/identity, social influences, and behavioural regulation. Potential target areas to improve temperature management practices include interventions that address information needs about individual temperature management behaviour as well as patient outcome (feedback), increasing awareness of possible temperature management strategies and guidelines, and a range of equipment and surgical team dynamics that influence temperature management. This study identified several potential target areas for future interventions from nine of the TDF behavioural domains that anesthesiologists perceive to drive their temperature management practices. Future interventions that aim to close the evidence-practice gap in perioperative temperature management may include these targets.

Measuring clinical management by physicians and nurses in European hospitals: development and validation of two scales.

PubMed

Plochg, Thomas; Arah, Onyebuchi A; Botje, Daan; Thompson, Caroline A; Klazinga, Niek S; Wagner, Cordula; Mannion, Russell; Lombarts, Kiki

2014-04-01

Clinical management is hypothesized to be critical for hospital management and hospital performance. The aims of this study were to develop and validate professional involvement scales for measuring the level of clinical management by physicians and nurses in European hospitals. Testing of validity and reliability of scales derived from a questionnaire of 21 items was developed on the basis of a previous study and expert opinion and administered in a cross-sectional seven-country research project 'Deepening our Understanding of Quality improvement in Europe' (DUQuE). A sample of 3386 leading physicians and nurses working in 188 hospitals located in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Validity and reliability of professional involvement scales and subscales. Psychometric analysis yielded four subscales for leading physicians: (i) Administration and budgeting, (ii) Managing medical practice, (iii) Strategic management and (iv) Managing nursing practice. Only the first three factors applied well to the nurses. Cronbach's alpha for internal consistency ranged from 0.74 to 0.86 for the physicians, and from 0.61 to 0.81 for the nurses. Except for the 0.74 correlation between 'Administration and budgeting' and 'Managing medical practice' among physicians, all inter-scale correlations were <0.70 (range 0.43-0.61). Under testing for construct validity, the subscales were positively correlated with 'formal management roles' of physicians and nurses. The professional involvement scales appear to yield reliable and valid data in European hospital settings, but the scale 'Managing medical practice' for nurses needs further exploration. The measurement instrument can be used for international research on clinical management.

Department of Defense Best Management Practices for Munitions Constituents on Operational Ranges

DTIC Science & Technology

2014-04-01

website for updates on currently funded plant-based mitigation projects. Key Resources: Best EPH, Smith JC, Ringelberg DB. 2009. Phytoremediation of...Bruce N. 2012. Sustainable Range Management of RDX and TNT by Phytoremediation with Engineered Plants. SERDP Project ER-1498 Fact Sheet. Schnoor...J. 2011. Phytoremediation for the Containment and Treatment of Energetic and Propellant Material Releases on Testing and Training Ranges. SERDP

Toolkit of Available EPA Green Infrastructure Modeling Software: Watershed Management Optimization Support Tool (WMOST)

EPA Science Inventory

Watershed Management Optimization Support Tool (WMOST) is a software application designed tofacilitate integrated water resources management across wet and dry climate regions. It allows waterresources managers and planners to screen a wide range of practices across their watersh...

Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators' survey.

PubMed

Niven, Daniel J; Laupland, Kevin B; Tabah, Alexis; Vesin, Aurélien; Rello, Jordi; Koulenti, Despoina; Dimopoulos, George; de Waele, Jan; Timsit, Jean-Francois

2013-12-10

Although fever and hypothermia are common abnormal physical signs observed in patients admitted to intensive care units (ICU), little data exist on their optimal management. The objective of this study was to describe contemporary practices and determinants of management of temperature abnormalities among patients admitted to ICUs. Site leaders of the multi-national EUROBACT study were surveyed regarding diagnosis and management of temperature abnormalities among patients admitted to their ICUs. Of the 162 ICUs originally included in EUROBACT, responses were received from 139 (86%) centers in 23 countries in Europe (117), South America (8), Asia (5), North America (4), Australia (3) and Africa (2). A total of 117 (84%) respondents reported use of a specific temperature threshold in their ICU to define fever. A total of 14 different discrete levels were reported with a median of 38.2°C (inter-quartile range, IQR, 38.0°C to 38.5°C). The use of thermometers was protocolized in 91 (65%) ICUs and a wide range of methods were reportedly used, with axillary, tympanic and urinary bladder sites as the most common as primary modalities. Only 31 (22%) of respondents indicated that there was a formal written protocol for temperature control among febrile patients in their ICUs. In most or all cases practice was to control temperature, to use acetaminophen, and to perform a full septic workup in febrile patients and that this was usually directed by physician order. While reported practice was to treat nearly all patients with neurological impairment and most patients with acute coronary syndromes and infections, severe sepsis and septic shock, this was not the case for most patients with liver failure and fever. A wide range of definitions and management practices were reported regarding temperature abnormalities in the critically ill. Documenting temperature abnormality management practices, including variability in clinical care, is important to inform planning of future studies designed to optimize infection and temperature management strategies in the critically ill.

Non-face-to-face consultations and communications in primary care: the role and perspective of general practice managers in Scotland.

PubMed

Hanna, Lisa; May, Carl; Fairhurst, Karen

2011-01-01

Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers' attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients. To investigate practice managers' attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies. We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews. Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand. Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics. Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/communication technologies.

Silvicultural guide for northern hardwood types in the Northeast (revised)

Treesearch

William B. Leak; Dale S. Solomon; Paul S. DeBald

1987-01-01

A practical guide to the management of northern hardwoods for timber production in New England and New York. Both even-aged management are considered, and specific treatments are prescribed for a range of stand conditions and management objectives.

Managing Intermountain rangelands - improvement of range and wildlife habitats: proceedings; 1981 September 15-17; Twin Falls, ID; 1982 June 22-24; Elko, NV

Treesearch

Stephen B. Monsen; Nancy Shaw

1983-01-01

The proceedings summarizes recent research and existing literature pertaining to the restoration and management of game and livestock ranges in the Intermountain Region. Improved plant materials and planting practices are emphasized. The series of 28 papers was presented at the Restoration of Range and Wildlife Habitat Training Sessions held in Twin Falls, Idaho,...

Australian and New Zealand Perfusion Survey: Management and Procedure

PubMed Central

Tuble, Sigrid C.; Willcox, Timothy W.; Baker, Robert A.

2009-01-01

Abstract: In this report, we will discuss management and procedural aspects of perfusion practice. This report allows us to compare and contrast recent trends and changes in perfusion with historic practices. A survey comprised of 233 single-answer and 12 open-ended questions was sent by e-mail to senior perfusionists or individuals in charge of perfusion in 40 hospital groups. The survey encompasses a review of the perfusion practices for the calendar year of 2003, and respondents were required to answer the survey based on the predominant practice in their institutions. Standard management of routine adult cardiopulmonary bypass (CPB) in 2003 consisted of perfusion strategies that achieved a target temperature of 32.0°C (range, 28.0–35.0°C), a flow index of 2.4 L/min/m2 (range, 1.6–3.0 L/min/m2) during normothermia and 1.8 L/min/m2 (range, 1.2–3.0 L/min/m2) during hypothermia, and a pressure during CPB between 50 (range, 30–65 mmHg) and 70 mmHg (range, 60–95 mmHg). Myocardial protection with blood cardioplegia was used in 77% of the 20,688 CPB cases, whereas in 53% cases, cardiotomy blood was never processed. Pre-operatively, 76% of perfusion groups assessed their patients (21% directly with the patient), and 85% responded that perfusionists performed or participated in a formal pre-bypass checklist. The majority of the perfusion groups used a handwritten perfusion record (62%), 12% used an electronic perfusion record, and 26% used both, whereas more than one half of the groups were involved in quality assurance (79%), incident reporting (74%), audits (62%), research (53%), participating in interdisciplinary meetings (53%), and morbidity and mortality meetings (65%). Only 26% conducted formal perfusion team meetings. This report outlines the status of clinical management and procedural performance for perfusion practices in Australia and New Zealand in 2003. Awareness of these trends will allow perfusionists to assess both individual practices and unit performance. PMID:19681302

Animal damage management handbook.

Treesearch

Hugh C. Black

1994-01-01

This handbook treats animal damage management (ADM) in the West in relation to forest, range, and recreation resources; predator management is not addressed. It provides a comprehensive reference of safe, effective, and practical methods for managing animal damage on National Forest System lands. Supporting information is included in references after each chapter and...

Operationalizing Dynamic Ocean Management (DOM): Understanding the Incentive Structure, Policy and Regulatory Context for DOM in Practice

NASA Astrophysics Data System (ADS)

Lewison, R. L.; Saumweber, W. J.; Erickson, A.; Martone, R. G.

2016-12-01

Dynamic ocean management, or management that uses near real-time data to guide the spatial distribution of commercial activities, is an emerging approach to balance ocean resource use and conservation. Employing a wide range of data types, dynamic ocean management in a fisheries context can be used to meet multiple objectives - managing target quota, bycatch reduction, and reducing interactions with species of conservation concern. There is a growing list of DOM applications currently in practice in fisheries around the world, yet the approach is new enough that both fishers and fisheries managers are unclear how DOM can be applied to their fishery. Here, we use the experience from dynamic ocean management applications that are currently in practice to address the commonly asked question "How can dynamic management approaches be implemented in a traditionally managed fishery?". Combining knowledge from the DOM participants with a review of regulatory frameworks and incentive structures, stakeholder participation, and technological requirements of DOM in practice, we identify ingredients that have supported successful implementation of this new management approach.

The exit interview as a proxy measure of malaria case management practice: sensitivity and specificity relative to direct observation.

PubMed

Pulford, Justin; Siba, Peter M; Mueller, Ivo; Hetzel, Manuel W

2014-12-03

This paper aims to assess the sensitivity and specificity of exit interviews as a measure of malaria case management practice as compared to direct observation. The malaria case management of 1654 febrile patients attending 110 health facilities from across Papua New Guinea was directly observed by a trained research officer as part of a repeat cross sectional survey. Patient recall of 5 forms of clinical advice and 5 forms of clinical action were then assessed at service exit and statistical analyses on matched observation/exit interview data conducted. The sensitivity of exit interviews with respect to clinical advice ranged from 36.2% to 96.4% and specificity from 53.5% to 98.6%. With respect to clinical actions, sensitivity of the exit interviews ranged from 83.9% to 98.3% and specificity from 70.6% to 98.1%. The exit interview appears to be a valid measure of objective malaria case management practices such as the completion of a diagnostic test or the provision of antimalarial medication, but may be a less valid measure of low frequency, subjective practices such as the provision of malaria prevention advice.

Effects of nursing position on transformational leadership practices.

PubMed

Herman, Susan; Gish, Mary; Rosenblum, Ruth

2015-02-01

This study sought to identify significant differences in nursing leadership strengths by position title. Recent reports show aspects of transformational leadership (TL) related to position, age, and educational level. This study focuses on differentiating the strength of leadership practices across the range of nursing management positions. The Leadership Practices Inventory-Self-assessment survey, and a variety of demographic questions, were used to anonymously poll voluntary members of the Association of California Nurse Leaders. Nursing positions of director level and above were strongest in leadership practices. Those at manager and below were identified as needing additional leadership development. LPI-S subscales Enable Others to Act and Model the Way were strongest. Those at the manager level and below will benefit most from additional education and training. Even upper levels of management would gain from enhancing the LPI practices of Challenge the Process and Inspire a Shared Vision.

A social-ecological systems approach for environmental management.

PubMed

Virapongse, Arika; Brooks, Samantha; Metcalf, Elizabeth Covelli; Zedalis, Morgan; Gosz, Jim; Kliskey, Andrew; Alessa, Lilian

2016-08-01

Urgent environmental issues are testing the limits of current management approaches and pushing demand for innovative approaches that integrate across traditional disciplinary boundaries. Practitioners, scholars, and policy-makers alike call for increased integration of natural and social sciences to develop new approaches that address the range of ecological and societal impacts of modern environmental issues. From a theoretical perspective, social-ecological systems (SES) science offers a compelling approach for improved environmental management through the application of transdisciplinary and resilience concepts. A framework for translating SES theory into practice, however, is lacking. In this paper, we define the key components of an SES-based environmental management approach. We offer recommendations for integrating an SES approach into existing environmental management practices. Results presented are useful for management professionals that seek to employ an SES environmental management approach and scholars aiming to advance the theoretical foundations of SES science for practical application. Published by Elsevier Ltd.

Understanding Predictors of Nutrient Management Practice Diversity in Midwestern Agriculture

ERIC Educational Resources Information Center

Bates, Hanna; Arbuckle, J. Gordon, Jr.

2017-01-01

Agriculture's negative effect on water quality has become increasingly well documented. Farmers have a range of conservation practices available, yet rate of adoption is not optimal. Extension and other agricultural stakeholders play a key role in promotion of conservation practice adoption. We used survey data to examine relationships between…

Solving Discipline and Classroom Management Problems: Methods and Models for Today's Teachers. 6th Edition

ERIC Educational Resources Information Center

Wolfgang, Charles H.

2004-01-01

Offering a wide range of methods and practical advice, this sixth edition equips teachers with tools they need to deal effectively with a range of discipline/management problems in the classroom--from minor misbehavior to serious assaults. The following features are included in this edition: (1) A new chapter discusses how to deal with and support…

Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study.

PubMed

Eccles, Martin P; Hrisos, Susan; Francis, Jill J; Stamp, Elaine; Johnston, Marie; Hawthorne, Gillian; Steen, Nick; Grimshaw, Jeremy M; Elovainio, Marko; Presseau, Justin; Hunter, Margaret

2011-06-09

Type 2 diabetes is an increasingly prevalent chronic illness and an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of primary care teams. This study aimed to: investigate theoretically-based organisational, team, and individual factors determining the multiple behaviours needed to manage diabetes; and identify multilevel determinants of different diabetes management behaviours and potential interventions to improve them. This paper describes the instrument development, study recruitment, characteristics of the study participating practices and their constituent healthcare professionals and administrative staff and reports descriptive analyses of the data collected. The study was a predictive study over a 12-month period. Practices (N = 99) were recruited from within the UK Medical Research Council General Practice Research Framework. We identified six behaviours chosen to cover a range of clinical activities (prescribing, non-prescribing), reflect decisions that were not necessarily straightforward (controlling blood pressure that was above target despite other drug treatment), and reflect recommended best practice as described by national guidelines. Practice attributes and a wide range of individually reported measures were assessed at baseline; measures of clinical outcome were collected over the ensuing 12 months, and a number of proxy measures of behaviour were collected at baseline and at 12 months. Data were collected by telephone interview, postal questionnaire (organisational and clinical) to practice staff, postal questionnaire to patients, and by computer data extraction query. All 99 practices completed a telephone interview and responded to baseline questionnaires. The organisational questionnaire was completed by 931/1236 (75.3%) administrative staff, 423/529 (80.0%) primary care doctors, and 255/314 (81.2%) nurses. Clinical questionnaires were completed by 326/361 (90.3%) primary care doctors and 163/186 (87.6%) nurses. At a practice level, we achieved response rates of 100% from clinicians in 40 practices and > 80% from clinicians in 67 practices. All measures had satisfactory internal consistency (alpha coefficient range from 0.61 to 0.97; Pearson correlation coefficient (two item measures) 0.32 to 0.81); scores were generally consistent with good practice. Measures of behaviour showed relatively high rates of performance of the six behaviours, but with considerable variability within and across the behaviours and measures. We have assembled an unparalleled data set from clinicians reporting on their cognitions in relation to the performance of six clinical behaviours involved in the management of people with one chronic disease (diabetes mellitus), using a range of organisational and individual level measures as well as information on the structure of the practice teams and across a large number of UK primary care practices. We would welcome approaches from other researchers to collaborate on the analysis of this data.

''As-Needed'' Range Orders for Opioid Analgesics in the Management of Pain: A Consensus Statement of the American Society for Pain Management Nursing and the American Pain Society.

PubMed

Drew, Debra J; Gordon, Debra B; Morgan, Bonnie; Manworren, Renee C B

2018-06-01

Effective pain management requires careful titration of analgesics and evaluation of individual patient's responses to treatment using valid and reliable pain and pain relief assessment tools, and evidence-based patient monitoring for adverse treatment effects. A registered nurse, competent in pain assessment and analgesic administration, can safely interpret and implement properly written ''as-needed'' or ''PRN'' range orders for analgesic medications. The American Society for Pain Management Nursing (ASPMN) and the American Pain Society (APS) support safe medication practices and the appropriate use of PRN range orders for opioid analgesics in the management of pain. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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

LANDSCAPE MANAGEMENT PRACTICES

EPA Science Inventory

USDA Conservation Practices are applied at various scales ranging from a portion of a field or a specific farm operation to the watershed or landscape scale. The Conservation Effects Assessment Project is a joint effort of USDA Conservation and Research agencies to determine the...

Managing visitor impacts in parks: A multi-method study of the effectiveness of alternative management practices

USGS Publications Warehouse

Park, L.O.; Marion, J.L.; Manning, R.E.; Lawson, S.R.; Jacobi, C.

2008-01-01

How can recreation use be managed to control associated environmental impacts? What management practices are most effective and why? This study explored these and related questions through a series of experimental ?treatments? and associated ?controls? at the summit of Cadillac Mountain in Acadia National Park, a heavily used and environmentally fragile area. The treatments included five management practices designed to keep visitors on maintained trails, and these practices ranged from ?indirect? (information/education) to ?direct? (a fence bordering the trail). Research methods included unobtrusive observation of visitors to determine the percentage of visitors who walked off-trail and a follow-up visitor survey to explore why management practices did or didn?t work. All of the management practices reduced the percentage of visitors who walked off-trail. More aggressive applications of indirect practices were more effective than less aggressive applications, and the direct management practice of fencing was the most effective of all. None of the indirect management practices reduced walking off-trail to a degree that is likely to control damage to soil and vegetation at the study site. Study findings suggest that an integrated suite of direct and indirect management practices be implemented on Cadillac Mountain (and other, similar sites) that includes a) a regulation requiring visitors to stay on the maintained trail, b) enforcement of this regulation as needed, c) unobtrusive fencing along the margins of the trail, d) redesign of the trail to extend it, widen it in key places, and provide short spur trails to key ?photo points?, and e) an aggressive information/education program to inform visitors of the regulation to stay on the trail and the reasons for it. These recommendations are a manifestation of what may be an emerging principle of park and outdoor recreation management: intensive use requires intensive management.

Effects of management practices on grassland birds: Prairie Falcon

USGS Publications Warehouse

DeLong, John P.; Steenhof, Karen

2004-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 4,000 published and unpublished papers. A range map is provided to indicate the breeding, year-round, and nonbreeding ranges in the United States and southern Canada. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region.

Prescribing for pain--how do nurses contribute? A national questionnaire survey.

PubMed

Stenner, Karen; Carey, Nicola; Courtenay, Molly

2012-12-01

To provide information on the profile and practice of nurses in the UK who prescribe medication for pain. Pain is widely under-reported and under-treated and can have negative consequences for health and psychosocial well-being. Indications are that nurses can improve treatment and access to pain medications when they prescribe. Whilst nurses working in many practice areas treat patients with pain, little is known about the profile, prescribing practice or training needs of these nurses. A descriptive questionnaire survey. An online questionnaire was used to survey 214 nurses who prescribed for pain in the UK between May and July 2010. Data were analysed using descriptive statistics and non-parametric tests. Half the participants (50%) worked in primary care, 32% in secondary care and 14% worked across care settings. A range of services were provided, including general practice, palliative care, pain management, emergency care, walk-in-centres and out-of-hours. The majority (86%) independently prescribed 1-20 items per week. Non-opioid and weak opioids analgesics were prescribed by most (95%) nurses, whereas fewer (35%) prescribed strong opioids. Training in pain had been undertaken by 97% and 82% felt adequately trained, although 28% had problems accessing training. Those with specialist training prescribed a wider range of pain medications, were more likely to prescribe strong opioids and were more often in pain management roles. Nurses prescribe for pain in a range of settings with an emphasis on the treatment of minor ailments and acute pain. A range of medications are prescribed, and most nurses have access to training. The nursing contribution to pain treatment must be acknowledged within initiatives to improve pain management. Access to ongoing training is required to support nurse development in this area of practice to maximise benefits. © 2012 Blackwell Publishing Ltd.

Opportunities for improving management of advanced chronic kidney disease.

PubMed

Patwardhan, Meenal B; Matchar, David B; Samsa, Gregory P; Haley, William E

2008-01-01

Evidence suggests that management of advanced chronic kidney disease affects patient outcomes. To identify clinical areas that demand attention from a quality improvement perspective, we sought to examine the extent of conformance to an advanced chronic kidney disease guideline in a range of practices. A total of 237 patient medical records were abstracted from 4 primary care providers and 4 nephrology private practices across the country. In the practices studied, management of advanced chronic kidney disease patients was suboptimal for patients managed by primary care providers as well as those managed by nephrologists (overall conformance 27% and 42%, respectively), specifically for anemia, bone disease, and timing for renal replacement therapy. The current exercise (in conjunction with a literature search and focused and individual interviews with providers and patients) offered valuable information that was used to develop a toolkit for optimizing management of advanced chronic kidney disease.

Soil pollution at outdoor shooting ranges: Health effects, bioavailability and best management practices.

PubMed

Fayiga, A O; Saha, U K

2016-09-01

The total lead (Pb) concentrations of the surface soil, sub surface soil, vegetation and surface waters of outdoor shooting ranges are extremely high and above regulatory limits. Lead is dangerous at high concentrations and can cause a variety of serious health problems. Shooters and range workers are exposed to lead dust and can even take Pb dust home to their families while some animals around the shooting range can ingest the Pb bullets. The toxicity of Pb depends on its bioavailability which has been determined to be influenced greatly by the geochemical properties of each site. The bioavailability of Pb in shooting ranges has been found to be higher than other metal contaminated soils probably because of its very low residual Pb (<1%). Despite being an immobile element in the soil, migration of Pb within shooting ranges and offsite has been reported in literature. Best management practices to reduce mobility of Pb in shooting ranges involve an integrated Pb management program which has been described in the paper. The adoption of the non-toxic "green bullet" which has been developed to replace Pb bullets may reduce or prevent environmental pollution at shooting ranges. However, the contaminated soil resulting from decades of operation of several shooting ranges still needs to be restored to its natural state. Copyright © 2016 Elsevier Ltd. All rights reserved.

Management Options for Control of a Stunt and Needle Nematode in Southern Forest Nurseries

Treesearch

Michelle M. Cram; Stephen W. Fraedrich

2005-01-01

Crop rotation and fallow are management options that can be used to control plant parasitic nematodes in forest tree nurseries. Before these options can be put into practice, it is important to determine the host range and survivability under fallow of the parasitic nematode to be controlled. The results of host range tests on a needle nematode (Longidorus...

Integrated weed management systems with herbicide-tolerant crops in the European Union: lessons learnt from home and abroad.

PubMed

Lamichhane, Jay Ram; Devos, Yann; Beckie, Hugh J; Owen, Micheal D K; Tillie, Pascal; Messéan, Antoine; Kudsk, Per

2017-06-01

Conventionally bred (CHT) and genetically modified herbicide-tolerant (GMHT) crops have changed weed management practices and made an important contribution to the global production of some commodity crops. However, a concern is that farm management practices associated with the cultivation of herbicide-tolerant (HT) crops further deplete farmland biodiversity and accelerate the evolution of herbicide-resistant (HR) weeds. Diversification in crop systems and weed management practices can enhance farmland biodiversity, and reduce the risk of weeds evolving herbicide resistance. Therefore, HT crops are most effective and sustainable as a component of an integrated weed management (IWM) system. IWM advocates the use of multiple effective strategies or tactics to manage weed populations in a manner that is economically and environmentally sound. In practice, however, the potential benefits of IWM with HT crops are seldom realized because a wide range of technical and socio-economic factors hamper the transition to IWM. Here, we discuss the major factors that limit the integration of HT crops and their associated farm management practices in IWM systems. Based on the experience gained in countries where CHT or GMHT crops are widely grown and the increased familiarity with their management, we propose five actions to facilitate the integration of HT crops in IWM systems within the European Union.

Nine steps towards a better water meter management.

PubMed

Arregui, F J; Soriano, J; Cabrera, E; Cobacho, R

2012-01-01

The paper provides a comprehensive perspective of the critical aspects to be taken into account when planning the long-term management of water meters in a utility. In order to facilitate their quick understanding and practical implementation, they have been structured into nine steps. Ranging from an initial audit up to the final periodic meter replacement planning, these steps cover three aspects of the problem - field work, laboratory work and management tasks; and each one is developed in detail paying attention to the particular data needed and noting the practical outcome it will yield.

Occupational health and safety management practices and musculoskeletal disorders in aged care.

PubMed

Oakman, Jodi; Bartram, Timothy

2017-05-15

Purpose The purpose of this paper is to examine whether occupational health and safety (OHS) management used to manage musculoskeletal disorders (MSDs) in the aged care sector reflects contemporary research evidence of best practice to reduce the incidence of these disorders. Design/methodology/approach In total, 58 interviews were conducted with managers and supervisors in the aged care sector across four organisations in Australia. Policies and procedures relating to MSDs were reviewed for each organisation. Findings Policies and procedures for managing MSDs do not reflect contemporary evidence, which supports a complex aetiology, related to a range of physical and psychosocial workplace factors. Despite strong evidence that psychosocial factors contribute to MSD development, these were not included in the policies and procedures reviewed. Findings from the interviews management practices including leadership and various components of HRM were functioning well but fragmentation was evident due to the challenging nature of the aged care sector. Practical implications To address the significant burden of MSDs in the aged care sector, policies and procedures need to include coverage of psychosocial and physical workplace factors. The development of systematic and integrated OHS management at the workplace level may play an important role in the effective management of MSDs. Originality/value This study offers insights into the previously unexplored area of MSD risk management and the role of management practices such as HRM in the aged care sector.

Training and certification of work schedule managers may improve shift scheduling practices

DOT National Transportation Integrated Search

2011-02-01

The Federal Railroad Administration (FRA) Human Factors Research and Development (R&D) Program : sponsored the implementation of a strategic job analysis to investigate the job of work schedule managers : (WSMs) across a diverse range of industries t...

Can forest watershed management mitigate climate change effects on water resources

Treesearch

James M. Vose; Chelcy R. Ford; Stephanie Laseter; Salli Dymond; Ge Sun; Mary Beth Adams; Stephen Sebestyen; John Campbell; Charlie Luce; Devendra Amatya; Kelly Elder; Tamara Heartsill Scalley

2012-01-01

Long-term hydrology and climate data from United States Forest Service Experimental Forests and Ranges (EFR) provide critical information on the interactions among climate, streamflow, and forest management practices. We examined the relationships among streamflow responses to climate variation and forest management using long-term data. Analysis of climate data from a...

Can forest watershed management mitigate climate change impacts on water resources?

Treesearch

James M. Vose; Chelcy R. Ford; Stephanie Laseter; Salli Dymond; GE Sun; Mary Beth Adams; Stephen Sebestyen; John Campbell; Charles Luce; Devendra Amatya; Kelly Elder; Tamara. Heartsill-Scalley

2012-01-01

Long-term hydrology and climate data from United States Forest Service Experimental Forests and Ranges (EFR) provide critical information on the interactions among climate, streamflow, and forest management practices. We examined the relationships among streamflow responses to climate variation and forest management using long-term data. Analysis of climate data from a...

Training vs practice: A tale of opposition in acute cholecystitis.

PubMed

Patel, Purvi P; Daly, Shaun C; Velasco, Jose M

2015-10-18

Acute cholecystitis is one of the most common surgical diagnoses encountered by general surgeons. Despite its high incidence there remains a range of treatment of approaches. Current practices in biliary surgery vary as to timing, intraoperative utilization of biliary imaging, and management of bile duct stones despite growing evidence in the literature defining best practice. Management of patients with acute cholecystitis with early laparoscopic cholecystectomy (LC) results in better patient outcomes when compared with delayed surgical management techniques including antibiotic therapy or percutaneous cholecystostomy. Regardless of this data, many surgeons still prefer to utilize antibiotic therapy and complete an interval LC to manage acute cholecystitis. The use of intraoperative biliary imaging by cholangiogram or laparoscopic ultrasound has been demonstrated to facilitate the safe completion of cholecystectomy, minimizing the risk for inadvertent injury to surrounding structures, and lowering conversion rates, however it is rarely utilized. Choledocholithiasis used to be a diagnosis managed exclusively by surgeons but current practice favors referral to gastroenterologists for performance of preoperative endoscopic removal. Yet, there is evidence that intraoperative laparoscopic stone extraction is safe, feasible and may have added advantages. This review aims to highlight the differences between existing management of acute cholecystitis and evidence supported in the literature regarding best practice with the goal to change surgical practice to adopt these current recommendations.

Training vs practice: A tale of opposition in acute cholecystitis

PubMed Central

Patel, Purvi P; Daly, Shaun C; Velasco, Jose M

2015-01-01

Acute cholecystitis is one of the most common surgical diagnoses encountered by general surgeons. Despite its high incidence there remains a range of treatment of approaches. Current practices in biliary surgery vary as to timing, intraoperative utilization of biliary imaging, and management of bile duct stones despite growing evidence in the literature defining best practice. Management of patients with acute cholecystitis with early laparoscopic cholecystectomy (LC) results in better patient outcomes when compared with delayed surgical management techniques including antibiotic therapy or percutaneous cholecystostomy. Regardless of this data, many surgeons still prefer to utilize antibiotic therapy and complete an interval LC to manage acute cholecystitis. The use of intraoperative biliary imaging by cholangiogram or laparoscopic ultrasound has been demonstrated to facilitate the safe completion of cholecystectomy, minimizing the risk for inadvertent injury to surrounding structures, and lowering conversion rates, however it is rarely utilized. Choledocholithiasis used to be a diagnosis managed exclusively by surgeons but current practice favors referral to gastroenterologists for performance of preoperative endoscopic removal. Yet, there is evidence that intraoperative laparoscopic stone extraction is safe, feasible and may have added advantages. This review aims to highlight the differences between existing management of acute cholecystitis and evidence supported in the literature regarding best practice with the goal to change surgical practice to adopt these current recommendations. PMID:26483868

75 FR 65995 - Biomass Crop Assistance Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-27

... practices approved through conservation planning would be periodically monitored by USDA to determine the... negative impacts, through reduced purchases of inputs for traditional farming, within a region ranging from... changes in land management associated with the adoption of dedicated biomass energy cropping practices and...

Time management strategies in nursing practice.

PubMed

Waterworth, Susan

2003-09-01

With the increasing emphasis on efficiency and effectiveness in health care, how a nurse manages her time is an important consideration. Whilst time management is recognized as an important component of work performance and professional nursing practice, the reality of this process in nursing practice has been subject to scant empirical investigation. To explore how nurses organize and manage their time. A qualitative study was carried out, incorporating narratives (22 nurses), focus groups (24 nurses) and semi-structured interviews (22 nurses). In my role as practitioner researcher I undertook observation and had informal conversations, which provided further data. Study sites were five health care organizations in the United Kingdom during 1995-1999. Time management is complex, with nurses using a range of time management strategies and a repertoire of actions. Two of these strategies, namely routinization and prioritizing, are discussed, including their implications for understanding time management by nurses in clinical practice. Ignoring the influence of 'others', the team and the organization perpetuates a rather individualistic and self-critical perspective of time management. This may lead to a failure to address problems in the organizing of work, and the co-ordinating of care involving other health care workers.

Integration of professional judgement and decision-making in high-level adventure sports coaching practice.

PubMed

Collins, Loel; Collins, Dave

2015-01-01

This study examined the integration of professional judgement and decision-making processes in adventure sports coaching. The study utilised a thematic analysis approach to investigate the decision-making practices of a sample of high-level adventure sports coaches over a series of sessions. Results revealed that, in order to make judgements and decisions in practice, expert coaches employ a range of practical and pedagogic management strategies to create and opportunistically use time for decision-making. These approaches include span of control and time management strategies to facilitate the decision-making process regarding risk management, venue selection, aims, objectives, session content, and differentiation of the coaching process. The implication for coaches, coach education, and accreditation is the recognition and training of the approaches that "create time" for the judgements in practice, namely "creating space to think". The paper concludes by offering a template for a more expertise-focused progression in adventure sports coaching.

Perceptions of good medical practice in the NHS: a survey of senior health professionals.

PubMed

Hutchinson, A; Williams, M; Meadows, K; Barbour, R S; Jones, R

1999-12-01

To categorize senior health professionals' experience with poor medical practice in hospitals and in general practice, to describe perceptions which senior NHS staff have of good medical practice, and to describe how problems of poor medical practice are currently managed. A postal questionnaire survey. The questionnaire sought perceptions of good medical practice, asked participants to characterise deviations from good practice, and to describe experience with managing poor performance at the time of the introduction of the General Medical Council (GMC) performance procedures. A range of NHS settings in the UK: hospital trusts, health authorities/boards, local medical committees, community health councils. Senior health professionals involved in the management of medical professional performance. Perceptions of what constitutes good medical practice. Most respondents considered that persistent problems related to clinical practice (diagnosis, management, and outcome and prescribing) would require local management and, possibly, referral to the GMC performance procedures. Informal mechanisms, including informal discussion, education, training, and work shifting, were the most usual means of handling a doctor whose performance was poor. Many took a less serious view of deficiencies in performance on manner and attitude and communication, although consultation skills rather than technical skills comprised the greatest number of complaints about doctors. Senior NHS professionals seem reluctant to consider persistently poor consultation skills in the same critical light as they do persistently poor technical practice. These attitudes may need to change with the implementation of clinical governance and updated guidance from the GMC on what constitutes good medical practice.

Perceptions of work stress causes and effective interventions in employees working in public, private and non-governmental organisations: a qualitative study

PubMed Central

Bhui, Kamaldeep; Dinos, Sokratis; Galant-Miecznikowska, Magdalena; de Jongh, Bertine; Stansfeld, Stephen

2016-01-01

Aims and method To identify causes of stress at work as well as individual, organisational and personal interventions used by employees to manage stress in public, private and non-governmental organizations (NGOs). Qualitative interviews were conducted with 51 employees from a range of organisations. Results Participants reported adverse working conditions and management practices as common causes of work stress. Stress-inducing management practices included unrealistic demands, lack of support, unfair treatment, low decision latitude, lack of appreciation, effort–reward imbalance, conflicting roles, lack of transparency and poor communication. Organisational interventions were perceived as effective if they improved management styles, and included physical exercise, taking breaks and ensuring adequate time for planning work tasks. Personal interventions used outside of work were important to prevent and remedy stress. Clinical implications Interventions should improve management practices as well as promoting personal interventions outside of the work setting. PMID:28377811

Implementation of a protocol for the prevention and management of extravasation injuries in the neonatal intensive care patient.

PubMed

Warren, Diane

2011-06-01

This project sought to determine nurses' understanding and management of infants with intravenous (IV) therapy. There were three specific aims: • To improve identification and management of extravasation injuries in neonates • To ensure management of extravasation injuries in neonates is classified according to IV extravasation staging guidelines • To develop a protocol that outlined actions required to manage extravasation injuries. This project utilised a pre- and post-implementation audit strategy using the Joanna Briggs Institute (JBI) Getting Research into Practice (GRIP) program. This method has been used to improve clinical practice by utilising an audit, feedback and re-audit sequence. The project was implemented in four stages over a 7-month period from 21 October 2009 to 30 May 2010. Initially, there was poor compliance with all four criteria, ranging from zero to 63%. The GRIP phase of the project identified five barriers which were addressed throughout this project. These related to education of staff and the development of a protocol for the prevention and management of extravasation injuries in the neonatal population. Following implementation of best practice, the second audit showed a marked improvement in all four criteria, ranging from 70 to 100% compliance. Overall, this project has led to improvements in clinical practice in line with current evidence. This has resulted in enhanced awareness of the risks associated with IV therapy and of measures to prevent an injury occurring within this clinical setting. © 2011 The Author. International Journal of Evidence-Based Healthcare © 2011 The Joanna Briggs Institute.

Description and process evaluation of pharmacists' interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial).

PubMed

Howard, Rachel; Rodgers, Sarah; Avery, Anthony J; Sheikh, Aziz

2014-02-01

To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. PINCER pharmacists manually recorded patients' demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded, double-entered into SPSS version 15 and then summarised using percentages for categorical data (with 95% confidence interval (CI)) and, as appropriate, means (± standard deviation) or medians (interquartile range) for continuous data. Pharmacists spent a median of 20 min (interquartile range 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95% CI 70, 74; 1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95% CI 73, 76; 1516/2038) of cases and 1685 actions were taken in 61% (95% CI 59, 63; 1246/2038) of cases; 66% (95% CI 64, 68; 1383/2105) of interventions recommended by pharmacists were completed and 5% (95% CI 4, 6; 104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists' placement; the remaining recommendations were rejected or considered not relevant by GPs. The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training. © 2013 The Authors. International Journal of Pharmacy Practice published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.

The rationale for simple approaches for sustainability assessment and management in contaminated land practice.

PubMed

Bardos, R Paul; Bone, Brian D; Boyle, Richard; Evans, Frank; Harries, Nicola D; Howard, Trevor; Smith, Jonathan W N

2016-09-01

The scale of land-contamination problems, and of the responses to them, makes achieving sustainability in contaminated land remediation an important objective. The Sustainable Remediation Forum in the UK (SuRF-UK) was established in 2007 to support more sustainable remediation practice in the UK. The current international interest in 'sustainable remediation' has achieved a fairly rapid consensus on concepts, descriptions and definitions for sustainable remediation, which are now being incorporated into an ISO standard. However the sustainability assessment methods being used remain diverse with a range of (mainly) semi-quantitative and quantitative approaches and tools developed, or in development. Sustainability assessment is site specific and subjective. It depends on the inclusion of a wide range of considerations across different stakeholder perspectives. Taking a tiered approach to sustainability assessment offers important advantages, starting from a qualitative assessment and moving through to semi-quantitative and quantitative assessments on an 'as required' basis only. It is also clear that there are a number of 'easy wins' that could improve performance against sustainability criteria right across the site management process. SuRF-UK has provided a checklist of 'sustainable management practices' that describes some of these. This paper provides the rationale for, and an outline of, and recently published SuRF-UK guidance on preparing for and framing sustainability assessments; carrying out qualitative sustainability assessment; and simple good management practices to improve sustainability across contaminated land management activities. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Effects of management practices on grassland birds: Greater Prairie-Chicken

USGS Publications Warehouse

Svedarsky, W. Daniel; Toepfer, J.E.; Westemeier, R.L.; Robel, R.J.

2003-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the breeding distribution of Greater Prairie-Chicken in the United States and southern Canada. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species’ breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management is posted at the Web site mentioned below.

RESEARCH IN URBAN STORMWATER BMPS

EPA Science Inventory

The use of best management practices (BMPs) in an urban watershed can provide adequate degress of treatment at a relatively low cost. BMPs can range from being management operations (such as street sweeping or reducing the amount of pesticides used on urban lawns) to structural t...

THE COMPLICATIONS OF MONITORING TREATMENT BMPS.

EPA Science Inventory

The use of best management practices (BMPs) in an urban watershed can provide pollutant load reductions at a relatively low cost. BMPs can range from being management operations (such as street sweeping or reducing the amount of pesticides used on urban lawns) to structural trea...

THE COMPLICATIONS OF MONITORING TREATMENT BMPS

EPA Science Inventory

The use of best management practices (BMPs) in an urban watershed can provide pollutant load reductions at a relatively low cost. BMPs can range from being management operations (such as street sweeping or reducing the amount of pesticides used on urban lawns) to structural trea...

A Middle-Range Explanatory Theory of Self-Management Behavior for Collaborative Research and Practice.

PubMed

Blok, Amanda C

2017-04-01

To report an analysis of the concept of self-management behaviors. Self-management behaviors are typically associated with disease management, with frequent use by nurse researchers related to chronic illness management and by international health organizations for development of disease management interventions. A concept analysis was conducted within the context of Orem's self-care framework. Walker and Avant's eight-step concept analysis approach guided the analysis. Academic databases were searched for relevant literature including CIHAHL, Cochrane Databases of Systematic Reviews and Register of Controlled Trials, MEDLINE, PsycARTICLES and PsycINFO, and SocINDEX. Literature using the term "self-management behavior" and published between April 2001 and March 2015 was analyzed for attributes, antecedents, and consequences. A total of 189 journal articles were reviewed. Self-management behaviors are defined as proactive actions related to lifestyle, a problem, planning, collaborating, and mental support, as well as reactive actions related to a circumstantial change, to achieve a goal influenced by the antecedents of physical, psychological, socioeconomic, and cultural characteristics, as well as collaborative and received support. The theoretical definition and middle-range explanatory theory of self-management behaviors will guide future collaborative research and clinical practice for disease management. © 2016 Wiley Periodicals, Inc.

Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study

PubMed Central

2011-01-01

Background Type 2 diabetes is an increasingly prevalent chronic illness and an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of primary care teams. This study aimed to: investigate theoretically-based organisational, team, and individual factors determining the multiple behaviours needed to manage diabetes; and identify multilevel determinants of different diabetes management behaviours and potential interventions to improve them. This paper describes the instrument development, study recruitment, characteristics of the study participating practices and their constituent healthcare professionals and administrative staff and reports descriptive analyses of the data collected. Methods The study was a predictive study over a 12-month period. Practices (N = 99) were recruited from within the UK Medical Research Council General Practice Research Framework. We identified six behaviours chosen to cover a range of clinical activities (prescribing, non-prescribing), reflect decisions that were not necessarily straightforward (controlling blood pressure that was above target despite other drug treatment), and reflect recommended best practice as described by national guidelines. Practice attributes and a wide range of individually reported measures were assessed at baseline; measures of clinical outcome were collected over the ensuing 12 months, and a number of proxy measures of behaviour were collected at baseline and at 12 months. Data were collected by telephone interview, postal questionnaire (organisational and clinical) to practice staff, postal questionnaire to patients, and by computer data extraction query. Results All 99 practices completed a telephone interview and responded to baseline questionnaires. The organisational questionnaire was completed by 931/1236 (75.3%) administrative staff, 423/529 (80.0%) primary care doctors, and 255/314 (81.2%) nurses. Clinical questionnaires were completed by 326/361 (90.3%) primary care doctors and 163/186 (87.6%) nurses. At a practice level, we achieved response rates of 100% from clinicians in 40 practices and > 80% from clinicians in 67 practices. All measures had satisfactory internal consistency (alpha coefficient range from 0.61 to 0.97; Pearson correlation coefficient (two item measures) 0.32 to 0.81); scores were generally consistent with good practice. Measures of behaviour showed relatively high rates of performance of the six behaviours, but with considerable variability within and across the behaviours and measures. Discussion We have assembled an unparalleled data set from clinicians reporting on their cognitions in relation to the performance of six clinical behaviours involved in the management of people with one chronic disease (diabetes mellitus), using a range of organisational and individual level measures as well as information on the structure of the practice teams and across a large number of UK primary care practices. We would welcome approaches from other researchers to collaborate on the analysis of this data. PMID:21658211

Building chronic disease management capacity in General Practice: The South Australian GP Plus Practice Nurse Initiative.

PubMed

Fuller, Jeffrey; Koehne, Kristy; Verrall, Claire C; Szabo, Natalie; Bollen, Chris; Parker, Sharon

2015-01-01

This paper draws on the implementation experience of the South Australian GP Plus Practice Nurse Initiative in order to establish what is needed to support the development of the chronic disease management role of practice nurses. The Initiative was delivered between 2007 and 2010 to recruit, train and place 157 nurses across 147 General Practices in Adelaide. The purpose was to improve chronic disease management in General Practice, by equipping nurses to work as practice nurses who would coordinate care and establish chronic disease management systems. Secondary analysis of qualitative data contained in the Initiative evaluation report, specifically drawing on quarterly project records and four focus groups conducted with practice nurses, practice nurse coordinators and practice nurse mentors. As evidenced by the need to increase the amount of support provided during the implementation of the Initiative, nurses new to General Practice faced challenges in their new role. Nurses described a big learning curve as they dealt with role transition to a new work environment and learning a range of new skills while developing chronic disease management systems. Informants valued the skills development and support offered by the Initiative, however the ongoing difficulties in implementing the role suggested that change is also needed at the level of the Practice. While just over a half of the placement positions were retained, practice nurses expressed concern with having to negotiate the conditions of their employment. In order to advance the role of practice nurses as managers of chronic disease support is needed at two levels. At one level support is needed to assist practice nurses to build their own skills. At the level of the Practice, and in the wider health workforce system, support is also needed to ensure that Practices are organisationally ready to include the practice nurse within the practice team.

Incentives to improve farm management: EMS, supply-chains and civil society.

PubMed

Gunningham, Neil

2007-02-01

This paper focuses on impediments to environmentally sound management practices and how these might be overcome, with an emphasis on the role of environmental management systems, supply chains and civil society. It argues that: Farmers are under increased pressure to cut costs and improve production but with little opportunity to increase prices. Commonly short-term economic interest has damaging environmental implications. Current government policy, in Australia and in many other jurisdictions, relies heavily on voluntary arrangements, education and information, as the main policy instruments through which to persuade farmers to adopt better environmental farm management - e.g. the recent push to encourage the use of voluntary environmental management systems. However, there is good evidence to suggest that these can only make a valuable contribution when combined with a range of other policy instruments, including positive and negative incentives, intervention by third parties and in some cases, an underpinning of regulation. Arguably, what is needed is a strategy that builds on the strengths of voluntary environmental management arrangements while compensating for their weaknesses by combining them with other, complementary policy instruments. If so, we must engage with a range of questions that have not so far figured substantially in the policy debate. Although the principal focus has been on the role of government in bringing about on-farm change in management practices, supply chain pressure (at least in respect of agricultural chemicals and practices which threaten food safety) and civil society action are also potentially powerful mechanisms for bringing about change. Government can and should play a role in harnessing such forces in the interests of improved environmental on-farm practices.

Practice nurse and health visitor management of acute minor illness in a general practice.

PubMed

Pritchard, A; Kendrick, D

2001-11-01

To evaluate practice nurse (PN) and health visitor (HV) management of patients with acute minor illnesses, monitor the effect on general practitioner (GP) workload, and describe the range of conditions seen by nurses. Patients requesting 'urgent' appointments (within 24 hours) were offered consultations with a PN or HV trained in the management of acute minor illness. Comparative data were collected before and after the establishment of the acute minor illness service. A general practice in Nottingham, England. Patient satisfaction, consultation rate, prescriptions, investigations, referrals and urgent re-consultations for the same condition within 2 weeks. About 2056 urgent consultations were recorded in the study period, of which 332 (16.1%) were seen by PNs and 46 (2.2%) by a HV. High levels of patient satisfaction were reported for all health professionals. Patients seeing the HV reported higher levels of satisfaction than those consulting GPs (P=0.033) and PNs (P=0.010). There was no difference by health professional for prescription rates (P=0.76), re-consultations (P=0.14), or referrals to secondary care (P=0.07). General practitioners were more likely to initiate further investigations than the PNs or HV (P < 0.001). With suitable training, PNs and HVs can successfully manage patients with a range of conditions. General practitioner workload can be reduced while maintaining high patient satisfaction levels.

Factors that influence producer decisions to implement management strategies.

PubMed

Field, Thomas G

2014-12-01

Cow-calf enterprises in the USA are widely divergent in size, locale, resource availability, management skill, and market focus. Furthermore, variation exists in dependence on the cow-calf enterprise as a primary source of income, perception about the utility of a particular management practice or technology, and assessment of cost: benefit resulting from implementation impact decisions. Enterprises with larger cow inventories, greater dependence on income from the cattle enterprise, and that retain ownership further into the supply chain beyond the cow-calf operation are more likely to institute management protocols such as vaccination programs, defined calving seasons, and reproductive technologies. Successful cow-calf managers place the highest priority on herd nutrition, pasture and range management, herd health, financial management marketing, production management, and genetics. Management practices are more likely to be adopted when they align with a manager's perception of the utility, labor availability, favorable cost: benefit outcomes and profit motivation.

Implementation of behavioral health interventions in real world scenarios: Managing complex change.

PubMed

Clark, Khaya D; Miller, Benjamin F; Green, Larry A; de Gruy, Frank V; Davis, Melinda; Cohen, Deborah J

2017-03-01

A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care. Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach. The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration. This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Intermountain west range improvement practices: lessons learned

USDA-ARS?s Scientific Manuscript database

The Nevada Section, Society for Range Management held its annual summer field tour July 29-30, 2016 in Eureka, Nevada, where numerous private land owners, conservation districts, consultants, state and federal agencies participated in a learningful and exciting tour. The tour included the cooperatio...

Clinical reasoning and population health: decision making for an emerging paradigm of health care.

PubMed

Edwards, Ian; Richardson, Barbara

2008-01-01

Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners' understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community.

Effects of management practices on grassland birds: Greater Sage-Grouse

USGS Publications Warehouse

Rowland, Mary M.

2004-01-01

Information on the habitat requirements and effects of habitat management on Greater Sage-Grouse was summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the current range of Greater Sage-Grouse (adapted from Schroeder et al. 2004). Although birds may be observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species’ nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species’ breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of shrub-steppe birds and their responses to habitat management is posted at the Web site mentioned below.

Effects of management practices on grassland birds: Merlin

USGS Publications Warehouse

Konrad, Paul M.

2004-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the breeding, year-round, and nonbreeding ranges in the United States and southern Canada. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species’ nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species’ breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management is posted at the Web site mentioned below.

Effects of management practices on grassland birds: Golden eagle

USGS Publications Warehouse

DeLong, John P.

2004-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 4,000 published and unpublished papers. A range map is provided to the breeding, year-round, and nonbreeding ranges in the United States and southern Canada. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species’ nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species’ breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management is posted at the Web site mentioned below.

Critical leadership and management skills for pathology practice.

PubMed

Brimhall, Bradley B; Wright, Louis D; McGregor, Kelli L; Hernandez, James S

2007-10-01

Managed care has changed the nature of medical practice. The practice of pathology has also changed and is likely to undergo further modification. Additional skills in leadership and management are needed to perform optimally in the current medical marketplace. To determine whether pathologists view business and informatics skills as being important and valuable in their practices. A survey was sent electronically (via e-mail) to 2566 pathologists and pathology administrators. Two hundred sixteen survey recipients (8.4%) responded to the survey. The response rate to individual questions ranged from 86% to 99% (186 to 214 of 216 total respondents). Most who took the survey ranked communication (203/209; 97%), leadership skills (165/209; 79%), and systems thinking skills (155/209; 74%) as either "very important" or "essential." Fewer respondents were willing to offer salary premiums for marketing (108/196; 55%), business or finance (92/196; 47%), or staff leadership (95/196; 48%) skills unless the candidate had a track record of measurable achievement using these skills. Those practicing in academia as well as those making hiring decisions by themselves were more likely to value leadership and management skills. Fewer than 1% of respondents in any category considered current pathology residency training in leadership and management to be adequate. Prospective employers value leadership and management skills. Pathology residency programs must include meaningful training in pathology practice management and informatics to satisfy the demand for these skills in the modern pathology marketplace.

Results of a survey to determine demographic and business management factors associated with size and growth rate of rural mixed-animal veterinary practices.

PubMed

Brusk, Amy M; White, Brad J; Goehl, Dan R; Dhuyvetter, Kevin C

2010-12-15

To determine potential associations between demographic and business management factors and practice size and growth rate in rural mixed-animal veterinary practices. Cross-sectional survey. 54 mixed-animal practitioners. A cross-sectional survey (96 questions) was electronically disseminated. Responses were collected, and outcomes (number of veterinarians [NV], growth in number of veterinarians [NVG], gross practice income [GPI], growth in gross practice income [GPIG], gross practice income per veterinarian [GPIV], and growth in gross practice income per veterinarian [GPIVG]) were calculated. Bivariate analyses were performed and multivariable models created to determine associations between survey responses and outcomes of interest. Survey respondents were from mixed-animal practices, and most (46/54 [85.2%]) practiced in small communities (< 25,000 people). Study practices had a median ± SD NV of 2.3 ± 1.9 veterinarians, median GPI of $704,547 ± 754,839, and median GPIV of $282,065 ± 182,344. Multivariable regression analysis revealed several factors related to practice size, including the number of associate veterinarians and veterinary technicians in the practice, service fee structure, and employment of a business manager. Typically, practices had positive mean growth in NVG (4.4%), GPIG (8.5%), and GPIVG (8.1%), but growth rate was highly variable among practices. Factors associated with growth rate included main species interest, frequency for adjusting prices, use of a marketing plan, service fee structure, and sending a client newsletter. Mixed-animal practices had a large range in size and growth rate. Economic indices were impacted by common business management practices.

Harvest-created canopy gaps increase species and functional trait diversity of the forest ground-layer community

Treesearch

Christel C. Kern; Rebecca A. Montgomery; Peter B. Reich; Terry F. Strong

2014-01-01

Biodiversity conservation within managed forests depends, in part, on management practices that restore or maintain plant community diversity and function. Because many plant communities are adapted to natural disturbances, gap-based management has potential to meet this need by using the historical range of variation in canopy disturbances to guide elements of harvest...

Management of infection control in dental practice.

PubMed

Smith, A; Creanor, S; Hurrell, D; Bagg, J; McCowan, M

2009-04-01

This was an observational study in which the management policies and procedures associated with infection control and instrument decontamination were examined in 179 dental surgeries by a team of trained surveyors. Information relating to the management of a wide range of infection control procedures, in particular the decontamination of dental instruments, was collected by interview and by examination of practice documentation. This study found that although the majority of surgeries (70%) claimed to have a management policy on infection control, only 50% of these were documented. For infection control policies, 79% of surgeries had access to the British Dental Association Advice Sheet A12. Infection control policies were claimed to be present in 89% of surgeries, of which 62% were documented. Seventy-seven per cent of staff claimed to have received specific infection control training, but for instrument decontamination this was provided mainly by demonstration (97%) or observed practice (88%). Many dental nurses (74%) and dental practitioners (57%) did not recognise the symbol used to designate a single-use device. Audit of infection control or decontamination activities was undertaken in 11% of surgeries. The majority of surgeries have policies and procedures for the management of infection control in dental practice, but in many instances these are not documented. The training of staff in infection control and its documentation is poorly managed and consideration should be given to development of quality management systems for use in dental practice.

Practice transitions--past, present, and future.

PubMed

Prokes, Ronald I

2014-01-01

Until the 1960s, the value of a practice upon the retirement of the dentist was considered to be nil. In the next several decades, the value of a practice as a going business concern was recognized and formulas based on productivity were used to establish the sales price of "walkaway" practice transitions. Increasingly creative means, such as pre-sale, deferred pre-sale, shareholder process, incremental practice sale, and practice mergers have been created to make practice transitions more flexible, thereby maximizing the financial value of transitions. Dentists at the beginning of their careers will have an increasing range of opportunities in the future, with various combinations of financial security, freedom from manage- ment concerns, control over the practice, and accumulation of equity. Those in the 45- to 55-year age range should be planning in detail for their transition. Those older than 55 should begin exercising their plans since the future will involve much longer transitions.

Review of Ecologically-Based Pest Management in California Vineyards

PubMed Central

Wilson, Houston

2017-01-01

Grape growers in California utilize a variety of biological, cultural, and chemical approaches for the management of insect and mite pests in vineyards. This combination of strategies falls within the integrated pest management (IPM) framework, which is considered to be the dominant pest management paradigm in vineyards. While the adoption of IPM has led to notable and significant reductions in the environmental impacts of grape production, some growers are becoming interested in the use of an explicitly non-pesticide approach to pest management that is broadly referred to as ecologically-based pest management (EBPM). Essentially a subset of IPM strategies, EBPM places strong emphasis on practices such as habitat management, natural enemy augmentation and conservation, and animal integration. Here, we summarize the range and known efficacy of EBPM practices utilized in California vineyards, followed by a discussion of research needs and future policy directions. EBPM should in no way be seen in opposition, or as an alternative to the IPM framework. Rather, the further development of more reliable EBPM practices could contribute to the robustness of IPM strategies available to grape growers. PMID:29019946

Review of Ecologically-Based Pest Management in California Vineyards.

PubMed

Wilson, Houston; Daane, Kent M

2017-10-11

Grape growers in California utilize a variety of biological, cultural, and chemical approaches for the management of insect and mite pests in vineyards. This combination of strategies falls within the integrated pest management (IPM) framework, which is considered to be the dominant pest management paradigm in vineyards. While the adoption of IPM has led to notable and significant reductions in the environmental impacts of grape production, some growers are becoming interested in the use of an explicitly non-pesticide approach to pest management that is broadly referred to as ecologically-based pest management (EBPM). Essentially a subset of IPM strategies, EBPM places strong emphasis on practices such as habitat management, natural enemy augmentation and conservation, and animal integration. Here, we summarize the range and known efficacy of EBPM practices utilized in California vineyards, followed by a discussion of research needs and future policy directions. EBPM should in no way be seen in opposition, or as an alternative to the IPM framework. Rather, the further development of more reliable EBPM practices could contribute to the robustness of IPM strategies available to grape growers.

Winter habitat selection patterns of Merriam's turkeys in the southern Black Hills, South Dakota

Treesearch

Chad P. Lehman; Mark A. Rumble; Lester D. Flake

2007-01-01

In northern areas of their expanded range, information on Merriam's turkeys (Meleagris gallopavo merriami) is lacking, specifically pertaining to wintering behavior and factors associated with winter habitat selection. Forest managers need detailed quantification of the effects of logging and other management practices on wintering habitats...

An ecosystem service approach to support integrated pond management: a case study using Bayesian belief networks--highlighting opportunities and risks.

PubMed

Landuyt, Dries; Lemmens, Pieter; D'hondt, Rob; Broekx, Steven; Liekens, Inge; De Bie, Tom; Declerck, Steven A J; De Meester, Luc; Goethals, Peter L M

2014-12-01

Freshwater ponds deliver a broad range of ecosystem services (ESS). Taking into account this broad range of services to attain cost-effective ESS delivery is an important challenge facing integrated pond management. To assess the strengths and weaknesses of an ESS approach to support decisions in integrated pond management, we applied it on a small case study in Flanders, Belgium. A Bayesian belief network model was developed to assess ESS delivery under three alternative pond management scenarios: intensive fish farming (IFF), extensive fish farming (EFF) and nature conservation management (NCM). A probabilistic cost-benefit analysis was performed that includes both costs associated with pond management practices and benefits associated with ESS delivery. Whether or not a particular ESS is included in the analysis affects the identification of the most preferable management scenario by the model. Assessing the delivery of a more complete set of ecosystem services tends to shift the results away from intensive management to more biodiversity-oriented management scenarios. The proposed methodology illustrates the potential of Bayesian belief networks. BBNs facilitate knowledge integration and their modular nature encourages future model expansion to more encompassing sets of services. Yet, we also illustrate the key weaknesses of such exercises, being that the choice whether or not to include a particular ecosystem service may determine the suggested optimal management practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Laser therapy in general dental practice

NASA Astrophysics Data System (ADS)

Darbar, Arun A.

2006-02-01

This is a clinical presentation on the use of laser therapy in a private dental practice using a 810nm diode. A wide range of conditions involving pain management, treatment and as an adjunct to procedures to enhance patient comfort and experience. This will include cases treated for TMD (Temporo mandibular dysfunction), apthous ulcers, angular chelitis, cold sores, gingival retraction, periodontal treatment and management of failing dental implants. The case presentation will include the protocols used and some long term reviews. The results have been very positive and will be shared to enable this form of treatment to be used more frequently and with confidence within dental practice.

Moneymed: a game to develop management skills in general practice

PubMed Central

Essex, B.; Jackson, R. N.

1981-01-01

A game has been developed to train people in the financial and administrative skills needed for effective general practice management. These skills cover a wide range of legal, economic, administrative and personnel problems encountered in general practice. Thirty-four trainees and six trainers showed a highly significant improvement in knowledge and problem-solving skills after playing the game. The format and design of the game allow the problem type, complexity and solution to vary and to be readily updated. So far, this seems to be one of the most effective instruments yet developed for learning these skills. Imagesp736-a PMID:7338867

Electronic health records and support for primary care teamwork.

PubMed

O'Malley, Ann S; Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A; Scholle, Sarah Hudson

2015-03-01

Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Important, misunderstood, and challenging: a qualitative study of nurses' and allied health professionals' perceptions of implementing self-management for patients with COPD.

PubMed

Young, Hannah M L; Apps, Lindsay D; Harrison, Samantha L; Johnson-Warrington, Vicki L; Hudson, Nicky; Singh, Sally J

2015-01-01

In light of the growing burden of COPD, there is increasing focus on the role of self-management for this population. Currently, self-management varies widely. Little is known either about nurses' and allied health professionals' (AHPs') understanding and provision of self-management in clinical practice. This study explores nurses' and AHPs' understanding and implementation of supported COPD self-management within routine clinical practice. Nurses and AHPs participated in face-to-face semistructured interviews to explore their understanding and provision of COPD self-management, as well as their perceptions of the challenges to providing such care. Purposive sampling was used to select participants from a range of professions working within primary, community, and secondary care settings. Three researchers independently analyzed each transcript using a thematic approach. A total of 14 participants were interviewed. Nurses and AHPs viewed self-management as an important aspect of COPD care, but often misunderstood what it involved, leading to variation in practice. A number of challenges to supporting self-management were identified, which related to lack of time, lack of insight regarding training needs, and assumptions regarding patients' perceived self-management abilities. Nurses and AHPs delivering self-management require clear guidance, training in the use of effective self-management skills, and education that challenges their preconceptions regarding patients. The design of health care services also needs to consider the practical barriers to COPD self-management support for the implementation of such interventions to be successful.

To Be or Not to Be (Stressed): The Critical Role of a Psychologically Healthy Workplace in Effective Stress Management.

PubMed

Grawitch, Matthew J; Ballard, David W; Erb, Kaitlyn R

2015-10-01

This article explains how key practices pertaining to the psychologically healthy workplace can be used to develop a comprehensive approach to stress management in contemporary organizations. Specifically, we demonstrate the ways in which employee involvement, recognition, work-life balance, health and safety, and growth and development practices can be used to assist in the reduction of work stress and the proactive management of strain. Although many organizations strive to establish a positive environment conducive to work and well-being, identifying where to begin can often seem like a daunting task. Currently, many stress management efforts emphasize individual-level interventions that are simply implemented alongside existing organizational practices. We propose that a broader perspective allows for a better understanding of the stress process, resulting in the ability to consider a wider range of changes to organizational processes. Combining knowledge regarding psychologically healthy workplace practices, stress management intervention levels and the personal resource allocation framework, we present a comprehensive framework for approaching workplace stress management, which can be tailored to the unique needs of various organizations, departments and employees. By adopting this broader perspective, we believe organizations can more strategically address employee stress, resulting in more effective stress management and a profound impact on stress-related outcomes. Copyright © 2014 John Wiley & Sons, Ltd.

NASA Earth Resources Survey Symposium. Volume 1-A: Agriculture, environment

NASA Technical Reports Server (NTRS)

1975-01-01

A number of papers dealing with the practical application of imagery obtained from remote sensors on LANDSAT satellites, the Skylab Earth resources experiment package, and aircraft to problems in agriculture and the environment were presented. Some of the more important topics that were covered included: range management and resources, environmental monitoring and management, crop growth and inventory, land management, multispectral band scanners, forest management, mapping, marshlands, strip mining, water quality and pollution, ecology.

Comparison of environmental and egg microbiology associated with conventional and free range laying hen management

USDA-ARS?s Scientific Manuscript database

Eggs from alternative production practices are a growing niche in the market. Meeting consumer requests for greater diversity in retail egg options has resulted in some unique challenges such as understanding the food safety implications of eggs from alternative production practices. A study was c...

Getting the most out of your practice--the Practice Health Atlas and business modelling opportunities.

PubMed

Del Fante, Peter; Allan, Don; Babidge, Elizabeth

2006-01-01

The Practice Health Atlas (PHA) is a decision support tool for general practice, designed by the Adelaide Western Division of General Practice (AWDGP). This article describes the features of the PHA and its potential role in enhancing health care. In developing the PHA, the AWDGP utilises a range of software tools and consults with a practice to understand its clinical data management approach. The PHA comprises three sections: epidemiology, business and clinical modelling systems, access to services. The objectives include developing a professional culture around quality health data and synthesis of aggregated de-identified general practice data at both practice and divisional level (and beyond) to assist with local health needs assessment, planning, and funding. Evaluation occurs through group feedback sessions and from the general practitioners and staff. It has demonstrated its potential to fulfill the objectives in outcome areas such as data quality and management, team based care, pro-active practice population health care, and business systems development, thereby contributing to improved patient health outcomes.

Localized Flood Management

EPA Pesticide Factsheets

practitioners will cover a range of practices that can help communities build flood resilience, from small scale interventions such as rain gardens and permeable pavement to coordinated open space and floodplain preservation

A Summary of Best Management Practices for Nonpoint Source Pollution

DTIC Science & Technology

1992-08-01

200-1, Environmental Protection and Enhancement, requies that NPS pollution be minimized and that Army installations and major commands comply with...Federal and state regula- tions. However, environmental managers and engineers have no concise summary of alterna- tives available for NPS pollution... environmental managers and engineers have no concise summary of alternatives available for NPS pollution control. This report presents a range of

Conservation Agriculture Improves Soil Quality, Crop Yield, and Incomes of Smallholder Farmers in North Western Ghana

PubMed Central

Naab, Jesse B.; Mahama, George Y.; Yahaya, Iddrisu; Prasad, P. V. V.

2017-01-01

Conservation agriculture (CA) practices are being widely promoted in many areas in sub-Saharan Africa to recuperate degraded soils and improve ecosystem services. This study examined the effects of three tillage practices [conventional moldboard plowing (CT), hand hoeing (MT) and no-tillage (NT)], and three cropping systems (continuous maize, soybean–maize annual rotation, and soybean/maize intercropping) on soil quality, crop productivity, and profitability in researcher and farmer managed on-farm trials from 2010 to 2013 in northwestern Ghana. In the researcher managed mother trial, the CA practices of NT, residue retention and crop rotation/intercropping maintained higher soil organic carbon, and total soil N compared to conventional tillage practices after 4 years. Soil bulk density was higher under NT than under CT soils in the researcher managed mother trails or farmers managed baby trials after 4 years. In the researcher managed mother trial, there was no significant difference between tillage systems or cropping systems in maize or soybean yields in the first three seasons. In the fourth season, crop rotation had the greatest impact on maize yields with CT maize following soybean increasing yields by 41 and 49% compared to MT and NT maize, respectively. In the farmers’ managed trials, maize yield ranged from 520 to 2700 kg ha-1 and 300 to 2000 kg ha-1 for CT and NT, respectively, reflecting differences in experience of farmers with NT. Averaged across farmers, CT cropping systems increased maize and soybean yield ranging from 23 to 39% compared with NT cropping systems. Partial budget analysis showed that the cost of producing maize or soybean is 20–29% cheaper with NT systems and gives higher returns to labor compared to CT practice. Benefit-to-cost ratios also show that NT cropping systems are more profitable than CT systems. We conclude that with time, implementation of CA practices involving NT, crop rotation, intercropping of maize and soybean along with crop residue retention presents a win–win scenario due to improved crop yield, increased economic return, and trends of increasing soil fertility. The biggest challenge, however, remains with producing enough biomass and retaining same on the field. PMID:28680427

Effectiveness of a quality management program in dental care practices.

PubMed

Goetz, Katja; Campbell, Stephen M; Broge, Björn; Brodowski, Marc; Wensing, Michel; Szecsenyi, Joachim

2014-04-28

Structured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany. This was an exploratory study with a before-after-design. 45 dental care practices that had completed the European Practice Assessment (EPA) accreditation scheme twice (intervention group) were selected for the study. The mean interval between the before and after assessment was 36 months. The comparison group comprised of 56 dental practices that had undergone their first assessment simultaneously with follow-up assessment in the intervention group. Aggregated scores for five EPA domains: 'infrastructure', 'information', 'finance', 'quality and safety' and 'people' were calculated. In the intervention group, small non-significant improvements were found in the EPA domains. At follow-up, the intervention group had higher scores on EPA domains as compared with the comparison group (range of differences was 4.2 to 10.8 across domains). These differences were all significant in regression analyses, which controlled for relevant dental practice characteristics. Dental care practices that implemented a quality management program had better organizational quality in contrast to a comparison group. This may reflect both improvements in the intervention group and a selection effect of dental practices volunteering for the first round of EPA practice assessment.

Pencil and paper: the simple solution to getting the numbers you need to effectively manage your practice.

PubMed

Manji, I

1996-01-01

Once you have mastered the basics by going through the monitoring exercise once or twice, you will find it takes little time and effort to start finding out just where your practice stands. You only solve a problem after you have found out that there is one and you might find that this simple monitoring exercise shows you areas of your practice where a little attention from you will pay big dividends. Monitoring is like a fine wine: it improves with age. As you begin to compile more and more months of data, you will be able to start comparing this month's performance with last month's, or this quarter with last quarter, this year with last year. One of the most useful things monitoring will do for you is to allow you to compare your practice's performance with that of other practices. Averages, norms, and performance survey results are to be found in a range of practice management publications. Using your monitoring information in this comparative way helps you to identify those areas in your practice management that are holding you back from achieving your true potential. This lets you focus your management time and effort on the truly important issues, which, when solved, will help you turn your practice into a less stressful, more enjoyable, and more profitable place to work.

Adolescent testicular microlithiasis: A case-based, multinational survey of clinical management practices.

PubMed

Brodie, Katie E; Saltzman, Amanda F; Cost, Nicholas G

2018-04-01

Testicular microlithiasis (TM) is a condition characterized by calcium deposits within the testis, usually detected incidentally during ultrasonography of the scrotum. TM has been associated with the presence of, and possibly the development of, testicular malignancy. Our aim was to document international clinical management practices for TM and to analyze what factors and perception of risk influence conservative versus active management and follow-up. European Society for Paediatric Urology (ESPU) and Society for Pediatric Urology (SPU) members were invited to complete an online case-based survey of clinical management practices of TM. Eight cases had a single variable changed each time (classic versus limited TM, unilateral versus bilateral, prior cryptorchidism versus no cryptorchidism) to ascertain the provider's perception of risk. The respondents completed multiple choice questions on initial management, follow-up plan, length and interval of follow-up. Multivariate logistic regression was performed to determine factors associated with decisions on management and follow-up. There were 265 respondents to the survey from 35 countries (Table). Median time in practice was 13 years. Factors that were significantly associated with more aggressive initial management (more than counseling on self-examination) included: not yet in independent practice, low volume TM cases per year, those practicing pediatric and adult urology, classic appearance of TM and cryptorchidism. Factors that were significantly associated with urologist follow-up and active investigation included: European practitioners, low TM case volume per year, those practicing both pediatric urology and pediatric surgery, classic TM appearance and a case history of cryptorchidism. Interval and length of follow-up was wide-ranging, with most respondents favoring annual follow-up. Management of TM varies and a mix of surgeon and case factors significantly influences management strategies. This baseline understanding of the lack of systematic management suggests the need for the development of consensus guidelines and prospective study. Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices.

PubMed

Staveski, Sandra L; Pickler, Rita H; Lin, Li; Shaw, Richard J; Meinzen-Derr, Jareen; Redington, Andrew; Curley, Martha A Q

2018-06-01

The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. Descriptive self-report survey. A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. Pediatric cardiac intensive care clinicians (physicians and nurses). None. One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia. Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

Ecosystem-based fisheries management: Perception on definitions, implementations, and aspirations.

PubMed

Trochta, John T; Pons, Maite; Rudd, Merrill B; Krigbaum, Melissa; Tanz, Alexander; Hilborn, Ray

2018-01-01

Ecosystem-based fisheries management (EBFM) was developed to move beyond single species management by incorporating ecosystem considerations for the sustainable utilization of marine resources. Due to the wide range of fishery characteristics, including different goals of fisheries management across regions and species, theoretical best practices for EBFM vary greatly. Here we highlight the lack of consensus in the interpretation of EBFM amongst professionals in marine science and its implementation. Fisheries policy-makers and managers, stock assessment scientists, conservationists, and ecologists had very different opinions on the degree to which certain management strategies would be considered EBFM. We then assess the variability of the implementation of EBFM, where we created a checklist of characteristics typifying EBFM and scored fisheries across different regions, species, ecosystems, and fishery size and capacity. Our assessments show fisheries are unlikely to meet all the criteria on the EBFM checklist. Consequentially, it is unnecessary for management to practice all the traits of EBFM, as some may be disparate from the ecosystem attributes or fishery goals. Instead, incorporating some ecosystem-based considerations to fisheries management that are context-specific is a more realistic and useful way for EBFM to occur in practice.

Ecosystem-based fisheries management: Perception on definitions, implementations, and aspirations

PubMed Central

Hilborn, Ray

2018-01-01

Ecosystem-based fisheries management (EBFM) was developed to move beyond single species management by incorporating ecosystem considerations for the sustainable utilization of marine resources. Due to the wide range of fishery characteristics, including different goals of fisheries management across regions and species, theoretical best practices for EBFM vary greatly. Here we highlight the lack of consensus in the interpretation of EBFM amongst professionals in marine science and its implementation. Fisheries policy-makers and managers, stock assessment scientists, conservationists, and ecologists had very different opinions on the degree to which certain management strategies would be considered EBFM. We then assess the variability of the implementation of EBFM, where we created a checklist of characteristics typifying EBFM and scored fisheries across different regions, species, ecosystems, and fishery size and capacity. Our assessments show fisheries are unlikely to meet all the criteria on the EBFM checklist. Consequentially, it is unnecessary for management to practice all the traits of EBFM, as some may be disparate from the ecosystem attributes or fishery goals. Instead, incorporating some ecosystem-based considerations to fisheries management that are context-specific is a more realistic and useful way for EBFM to occur in practice. PMID:29381700

Proceedings of the 17th biennial southern silvicultural research conference

Treesearch

A. Gordon Holley; Kristina F. Connor; James D. Haywood

2015-01-01

A range of issues affecting southern forests are addressed in 108 papers or extended abstracts. Papers are grouped in 13 sections that cover the topics of hardwood regeneration, best management practices for stream crossings, pine regeneration and genetics, fire effects, eco-physiology, forest nutrition, vegetation management, forest threats, biomass, biometrics,...

Instructional Design as Knowledge Management: A Knowledge-in-Practice Approach to Choosing Instructional Methods

ERIC Educational Resources Information Center

McIver, Derrick; Fitzsimmons, Stacey; Flanagan, David

2016-01-01

Decisions about instructional methods are becoming more complex, with options ranging from problem sets to experiential service-learning projects. However, instructors not trained in instructional design may make these important decisions based on convenience, comfort, or trends. Instead, this article draws on the knowledge management literature…

Human resource management and performance in healthcare organisations.

PubMed

Harris, Claire; Cortvriend, Penny; Hyde, Paula

2007-01-01

The purpose of this paper is to compare the evidence from a range of reviews concerned with the links between human resource management (HRM) and performance. The aim of the paper is to review this diverse literature, and to derive human resource (HR) implications for healthcare researchers, policy makers and managers. Recent reviews of the human resource management and performance literature are examined, in addition to the inclusion of a previously unpublished review. Their methods, HRM focus, findings and recommendations are contrasted in order to produce this review. The paper finds that relationships have been found between a range of HRM practices, policies systems and performance. Despite being an important concern for HR professionals, there is little research exploring the link between HRM and performance in the health sector. The paper sees that recent studies have found HRM practices to be associated with patient outcomes such as mortality, yet they yield little information regarding the processes through which HRM affects individual performance and its consequent impact on patient care. The use of approaches that seek to gain an understanding of workers' interpretations of their experience, i.e. the psychological process through which HRM can affect individual performance, may shed some light on how these processes work in practice. The paper shows that increasing autonomy for healthcare organisations in the UK, i.e. Foundation Trusts, may offer increased opportunity for locally tailored HR systems and practices. The paper presents findings drawn from a review of previous research on a subject of increasing relevance to HR researchers and practitioners in healthcare organisations. The paper indicates alternative approaches to research and practice in light of extant research.

Brownfields to green fields: Realising wider benefits from practical contaminant phytomanagement strategies.

PubMed

Cundy, A B; Bardos, R P; Puschenreiter, M; Mench, M; Bert, V; Friesl-Hanl, W; Müller, I; Li, X N; Weyens, N; Witters, N; Vangronsveld, J

2016-12-15

Gentle remediation options (GROs) are risk management strategies or technologies involving plant (phyto-), fungi (myco-), and/or bacteria-based methods that result in a net gain (or at least no gross reduction) in soil function as well as effective risk management. GRO strategies can be customised along contaminant linkages, and can generate a range of wider economic, environmental and societal benefits in contaminated land management (and in brownfields management more widely). The application of GROs as practical on-site remedial solutions is still limited however, particularly in Europe and at trace element (typically metal and metalloid) contaminated sites. This paper discusses challenges to the practical adoption of GROs in contaminated land management, and outlines the decision support tools and best practice guidance developed in the European Commission FP7-funded GREENLAND project aimed at overcoming these challenges. The GREENLAND guidance promotes a refocus from phytoremediation to wider GROs- or phyto-management based approaches which place realisation of wider benefits at the core of site design, and where gentle remediation technologies can be applied as part of integrated, mixed, site risk management solutions or as part of "holding strategies" for vacant sites. The combination of GROs with renewables, both in terms of biomass generation but also with green technologies such as wind and solar power, can provide a range of economic and other benefits and can potentially support the return of low-level contaminated sites to productive usage, while combining GROs with urban design and landscape architecture, and integrating GRO strategies with sustainable urban drainage systems and community gardens/parkland (particularly for health and leisure benefits), has large potential for triggering GRO application and in realising wider benefits in urban and suburban systems. Quantifying these wider benefits and value (above standard economic returns) will be important in leveraging funding for GRO application and soft site end-use more widely at vacant or underutilized sites. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of management practices on grassland birds: Lesser Prairie-Chicken

USGS Publications Warehouse

Jamison, Brent E.; Dechant, Jill A.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Euliss, Betty R.

2002-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 4,000 published and unpublished papers. A range map is provided to indicate the breeding distribution of Lesser Prairie-Chicken in the United States and southern Canada. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species’ nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species’ breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management is posted at the Web site mentioned below.

Effects of management practices on grassland birds: Brewer's sparrow

USGS Publications Warehouse

Walker, Brett L.

2004-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species’ nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species’ breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management is posted at the Web site mentioned below.

The Perception, Level of Safety Satisfaction and Safety Feedback on Occupational Safety and Health Management among Hospital Staff Nurses in Sabah State Health Department.

PubMed

Cheah, Whye Lian; Giloi, Nelbon; Chang, Ching Thon; Lim, Jac Fang

2012-07-01

This study aimed to determine the perception and level of safety satisfaction of staff nurses with regards to Occupational Safety and Health (OSH) management practice in the Sabah Health Department, and to associate the OSH management dimensions, to Safety Satisfaction and Safety Feedback. A cross-sectional study using a validated self-administered questionnaire was conducted among randomly respondents. 135 nurses responded the survey. Mean (SD) score for each dimension ranged from 1.70 ± 0.68-4.04 ± 0.65, with Training and Competence dimension (mean [SD], 4.04 ± 0.65) had the highest while Safety Incidence was the least score (mean [SD], 1.70 ± 0.68). Both mean (SD) scores for Safety Satisfaction and Safety Feedback was high, 3.28 ± 0.51 and 3.57 ± 0.73, respectively. Pearson's correlation analysis indicated that all OSH dimensions had significant correlation with Safety Satisfaction and Safety Feedback (r coefficient ranged from 0.176-0.512) except for Safety Incidence. The overall perception of OSH management was rather low. Significant correlation between Safety Satisfaction and Safety Feedback and several dimensions, suggest that each organization to put in place the leaders who have appropriate leadership and supervisory skills and committed in providing staff training to improve staff's competency in OSH practice. In addition, clear goals, rules, and reporting system will help the organization to implement proper OSH management practice.

Doing Qualitative Research Using Your Computer: A Practical Guide

ERIC Educational Resources Information Center

Hahn, Chris

2008-01-01

This book is a practical, hands-on guide to using commonly available everyday technology, including Microsoft software, to manage and streamline research projects. It uses straight-forward, everyday language to walk readers through this process, drawing on a wide range of examples to demonstrate how easy it is to use such software. This guide is…

Nature and Quality of Antipsychotic Prescribing Practice in UK Psychiatry of Intellectual Disability Services

ERIC Educational Resources Information Center

Paton, C.; Flynn, A.; Shingleton-Smith, A.; McIntyre, S.; Bhaumik, S.; Rasmussen, J.; Hardy, S.; Barnes, T.

2011-01-01

Background: Antipsychotics are perceived to be over-used in the management of behavioural problems in people with an intellectual disability (ID). Published guidelines have set good practice standards for the use of these drugs for behavioural indications. We sought to identify the range of indications for which antipsychotic drugs are prescribed…

Development and quality of reproduction in two-age central Appalachian hardwoods - 10-year results

Treesearch

Gary W. Miller; Thomas M. Schuler

1995-01-01

Silvicultural practices that promote two-age stand structures have the potential to meet a wide range of forest resource goals. Such practices can overcome perceived disadvantages associated with clearcutting and still provide sustainable yields of desirable timber products and other woodland benefits. Forest managers need information on stand development following two...

A Review of HR Practices in Knowledge-Intensive Firms and MNEs: 2000-2006

ERIC Educational Resources Information Center

Majeed, Zahid

2009-01-01

Purpose: The aim of this paper is to show the association which exists among the wide range of knowledge management, knowledge sharing and HRM practices in the knowledge-intensive firms. Design/methodology/approach: The proposed literature review includes the systematic process of research in the following manner; after identifying the main area…

Clinical examination and management of the dizzy patient.

PubMed

Sandhu, Jaswinder S; Rea, Peter A

2016-12-02

Dizziness is the commonest reason for a GP appointment over the age of 75 years and many dizzy patients will end up in hospital. This article introduces the range of vestibular disorders commonly seen in hospital practice with a symptom-based approach and discusses the range of treatments that might be considered.

The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice.

PubMed

Grant, Suzanne; Checkland, Katherine; Bowie, Paul; Guthrie, Bruce

2017-04-27

The handling of laboratory, imaging and other test results in UK general practice is a high-volume organisational routine that is both complex and high risk. Previous research in this area has focused on errors and harm, but a complementary approach is to better understand how safety is achieved in everyday practice. This paper ethnographically examines the role of informal dimensions of test results handling routines in the achievement of safety in UK general practice and how these findings can best be developed for wider application by policymakers and practitioners. Non-participant observation was conducted of high-volume organisational routines across eight UK general practices with diverse organisational characteristics. Sixty-two semi-structured interviews were also conducted with the key practice staff alongside the analysis of relevant documents. While formal results handling routines were described similarly across the eight study practices, the everyday structure of how the routine should be enacted in practice was informally understood. Results handling safety took a range of local forms depending on how different aspects of safety were prioritised, with practices varying in terms of how they balanced thoroughness (i.e. ensuring the high-quality management of results by the most appropriate clinician) and efficiency (i.e. timely management of results) depending on a range of factors (e.g. practice history, team composition). Each approach adopted created its own potential risks, with demands for thoroughness reducing productivity and demands for efficiency reducing handling quality. Irrespective of the practice-level approach adopted, staff also regularly varied what they did for individual patients depending on the specific context (e.g. type of result, patient circumstances). General practices variably prioritised a legitimate range of results handling safety processes and outcomes, each with differing strengths and trade-offs. Future safety improvement interventions should focus on how to maximise practice-level knowledge and understanding of the range of context-specific approaches available and the safeties and risks inherent in each within the context of wider complex system conditions and interactions. This in turn has the potential to inform new kinds of proactive, contextually appropriate approaches to intervention development and implementation focusing on the enhanced deliberation of the safety of existing high-volume routines.

Conflicts of interest in divisions of general practice

PubMed Central

Palmer, N; Braunack‐Mayer, A; Rogers, W; Provis, C; Cullity, G

2006-01-01

Community‐based healthcare organisations manage competing, and often conflicting, priorities. These conflicts can arise from the multiple roles these organisations take up, and from the diverse range of stakeholders to whom they must be responsive. Often such conflicts may be titled conflicts of interest; however, what precisely constitutes such conflicts and what should be done about them is not always clear. Clarity about the duties owed by organisations and the roles they assume can help identify and manage some of these conflicts. Taking divisions of general practice in Australia as an example, this paper sets out to distinguish two main types of conflicts of interest, so that they may be more clearly identified and more effectively managed. PMID:17145912

Effects of management practices on wetland birds: Yellow Rail

USGS Publications Warehouse

Goldade, Christopher M.; Dechant, Jill A.; Johnson, Douglas H.; Zimmerman, Amy L.; Jamison, Brent E.; Church, James O.; Euliss, Betty R.

2002-01-01

Information on the habitat requirements and effects of habitat management on wetland birds were summarized from information in more than 500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although the BBS may not capture the presence of elusive waterbird species, the BBS is a standardized survey and the range maps, in many cases, represent the most consistent information available on species’ distributions. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The section on brood parasitism summarizes information on intra- and interspecific parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species’ nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes recommendations for habitat management provided in the literature. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of wetland birds and their responses to habitat management is posted at the Web site mentioned below.

Effects of management practices on wetland birds: Virginia rail

USGS Publications Warehouse

Zimmerman, Amy L.; Dechant, Jill A.; Jamison, Brent E.; Johnson, Douglas H.; Goldade, Christopher M.; Church, James O.; Euliss, Betty R.

2002-01-01

Information on the habitat requirements and effects of habitat management on wetland birds were summarized from information in more than 500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although the BBS may not capture the presence of elusive waterbird species, the BBS is a standardized survey and the range maps, in many cases, represent the most consistent information available on species’ distributions. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The section on brood parasitism summarizes information on intra- and interspecific parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species’ nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes recommendations for habitat management provided in the literature. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of wetland birds and their responses to habitat management is posted at the Web site mentioned below.

Effects of management practices on wetland birds: Black tern

USGS Publications Warehouse

Zimmerman, Amy L.; Dechant, Jill A.; Johnson, Douglas A.; Goldade, Christopher M.; Jamison, Brent E.; Euliss, Betty R.

2002-01-01

Information on the habitat requirements and effects of habitat management on wetland birds were summarized from information in more than 500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although the BBS may not capture the presence of elusive waterbird species, the BBS is a standardized survey and the range maps, in many cases, represent the most consistent information available on species’ distributions. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The section on brood parasitism summarizes information on intra- and interspecific parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species’ nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes recommendations for habitat management provided in the literature. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management is posted at the Web site mentioned below.

Effects of management practices on wetland birds: American Avocet

USGS Publications Warehouse

Dechant, Jill A.; Zimmerman, Amy L.; Johnson, Douglas H.; Goldade, Christopher M.; Jamison, Brent E.; Euliss, Betty R.

2002-01-01

Information on the habitat requirements and effects of habitat management on wetland birds were summarized from information in more than 500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although the BBS may not capture the presence of elusive waterbird species, the BBS is a standardized survey and the range maps, in many cases, represent the most consistent information available on species’ distributions. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The section on brood parasitism summarizes information on intra- and interspecific parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species’ nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species’ response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes recommendations for habitat management provided in the literature. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of wetland birds and their responses to habitat management is posted at the Web site mentioned below.

Mindfulness-Based Stress Reduction in Advanced Nursing Practice: A Nonpharmacologic Approach to Health Promotion, Chronic Disease Management, and Symptom Control.

PubMed

Williams, Hants; Simmons, Leigh Ann; Tanabe, Paula

2015-09-01

The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary. © The Author(s) 2015.

General practitioners in partnership with management: an organisational model for debate.

PubMed Central

Starey, N; Bosanquet, N; Griffiths, J

1993-01-01

The role of general practitioners is changing and expanding. Doctors have more control over the treatment received by their patients but remain largely unaccountable to the public and management. This article proposes an organisational model for integrating primary and secondary care which retains the advantages of fund-holding while giving management control over overall strategy. It proposes that general practitioners control funds for all primary and secondary care. Secondary care will be contracted through a joint team of managers and an elected general practice executive committee. A new health care purchasing authority will contract for primary services with individual practices or primary care provider units. General practitioners will have local contracts reflecting their desire to provide an expanded range of services and the needs of the community. PMID:8461651

A silvicultural Guide for Spruce-Fir in the Northeast

Treesearch

Robert M. Frank; John C. Bjorkbom

1973-01-01

A practical guide to the silvicultural treatment of spruce-fir stands for timber production in New England and New York. Both evenaged and uneven-aged management are considered, covering both the establishment of new stands and the culture of existing stands. Includes a set of prescriptions describing specific treatments for a range of stand conditions and management...

Whole-system phosphorus balances as a practical tool for lake management

Treesearch

Johanna Schussler; Lawrence A. Baker; Hugh Chester-Jones

2007-01-01

Controlling phosphorus (P) inputs to lakes remains a priority of lake management. This study develops watershed P balances for 11 recreational lakes in Minnesota. Areal P input rates to the watersheds ranged from 0.32 to 6.0 kg Pha-1 year-1 and was linearly related to the percentage of watershed in agriculture. Watershed P...

Initial riparian down wood dynamics in relation to thinning and buffer width

Treesearch

Paul D. Anderson; Deanna H. Olson; Adrian Ares

2013-01-01

Down wood plays many functional roles in aquatic and riparian ecosystems. Simplifi cation of forest structure and low abundance of down wood in stream channels and riparian areas is a common legacy of historical management in headwater forests west of the Cascade Range in the US northwest. Contemporary management practices emphasize the implementation of vegetation...

A Guide to the Management of Curriculum Materials Centers for the 21st Century: The Promise and the Challenge.

ERIC Educational Resources Information Center

Carr, Jo Ann, Ed.

Curriculum Materials Centers (CMCs), resource centers that support teacher education programs, are facing many challenges, including maintaining funding, meeting increased expectations, and coping with changes in technology. This volume covers a wide range of management issues from the perspective of 18 librarians, including practical advice on…

Photo series for quantifying forest residues in managed lands of the Medicine Bow National Forest

Treesearch

John B. Popp; John E. Lundquist

2006-01-01

This photo series presents a visual representation of a range of fuel loading conditions specifically found on the Medicine Bow National Forest. The photos are grouped by forest type and past management practices. This field guide describes the distribution of different types of woody fuels and includes some vegetation data.

Conversion of natural forest to managed forest plantations decreases tree resistance to prolonged droughts

Treesearch

Jean-Christophe Domec; John S. King; Eric Ward; A. Christopher Oishi; Sari Palmroth; Andrew Radecki; Dave M. Bell; Guofang Miao; Michael Gavazzi; Daniel M. Johnson; Steve G. McNulty; Ge Sun; Asko Noormets

2015-01-01

Throughout the southern US, past forest management practices have replaced large areas of native forests with loblolly pine plantations and have resulted in changes in forest response to extreme weather conditions. However, uncertainty remains about the response of planted versus natural species to drought across the geographical range of these forests. Taking...

Compassionate listening - managing psychological trauma in refugees.

PubMed

Gardiner, Joanne; Walker, Kate

2010-04-01

The physical and psychosocial effects of trauma in refugees are wide ranging and long lasting. They can affect symptom presentation, the patient-doctor relationship and management of refugee victims of trauma. This article discusses how refugees survivors of trauma may present to the general practitioner and gives an approach to psychological assessment and management. A strong therapeutic relationship built by patient led, sensitive assessment over time is the foundation to care. A management framework based on trauma recovery stages and adapted for general practice, is presented.

Beyond evidence-based nursing: tools for practice.

PubMed

Jutel, Annemarie

2008-05-01

This commentary shares my views of evidence-based nursing as a framework for practice, pointing out its limitations and identifying a wider base of appraisal tools required for making good clinical decisions. As the principles of evidence-based nursing take an increasingly greater hold on nursing education, policy and management, it is important to consider the range of other decision-making tools which are subordinated by this approach. This article summarizes nursing's simultaneous reliance on and critique of evidence-based practice (EBP) in a context of inadequate critical reasoning. It then provides an exemplar of the limitations of evidence-based practice and offers an alternative view of important precepts of decision-making. I identify means by which nurses can develop skills to engage in informed and robust critique of practices and their underpinning rationale. Nurses need to be able to locate and assess useful and reliable information for decision-making. This skill is based on a range of tools which include, but also go beyond EBP including: information literacy, humanities, social sciences, public health, statistics, marketing, ethics and much more. This essay prompts nursing managers to reflect upon whether a flurried enthusiasm to adopt EBP neglects other important decision-making skills which provide an even stronger foundation for robust nursing decisions.

A new framing approach in guideline development to manage different sources of knowledge.

PubMed

Lukersmith, Sue; Hopman, Katherine; Vine, Kristina; Krahe, Lee; McColl, Alexander

2017-02-01

Contemporary guideline methodology struggles to consider context and information from different sources of knowledge besides quantitative research. Return to work programmes involve multiple components and stakeholders. If the guideline is to be relevant and practical for a complex intervention such as return to work, it is essential to use broad sources of knowledge. This paper reports on a new method in guideline development to manage different sources of knowledge. The method used framing for the return-to-work guidance within the Clinical Practice Guidelines for the Management of Rotator Cuff Syndrome in the Workplace. The development involved was a multi-disciplinary working party of experts including consumers. The researchers considered a broad range of research, expert (practice and experience) knowledge, the individual's and workplace contexts, and used framing with the International Classification of Functioning, Disability and Health. Following a systematic database search on four clinical questions, there were seven stages of knowledge management to extract, unpack, map and pack information to the ICF domains framework. Companion graded recommendations were developed. The results include practical examples, user and consumer guides, flow charts and six graded or consensus recommendations on best practice for return to work intervention. Our findings suggest using framing in guideline methodology with internationally accepted frames such as the ICF is a reliable and transparent framework to manage different sources of knowledge. Future research might examine other examples and methods for managing complexity and using different sources of knowledge in guideline development. © 2016 John Wiley & Sons, Ltd.

Treating youths with selective mutism with an alternating design of exposure-based practice and contingency management.

PubMed

Vecchio, Jennifer; Kearney, Christopher A

2009-12-01

Selective mutism is a severe childhood disorder involving failure to speak in public situations in which speaking is expected. The present study examined 9 youths with selective mutism treated with child-focused, exposure-based practices and parent-focused contingency management via an alternating treatments design. Broadband measures of functioning were employed, but particular focus was made on behavioral assessment of words spoken audibly and daily in public situations. Treatment ranged from 8 to 32 sessions and resulted in positive end-state functioning for 8 of 9 participants. Broader analyses indicated greater effectiveness for exposure-based practice than contingency management. The results support recent case reports of behavioral treatment for this population but in more rigorous fashion. Clinical and research challenges are discussed, including caveats about length and intensity of treatment for this population and need to develop standardized daily measures.

Team composition and chronic disease management within primary healthcare practices in eastern Ontario: an application of the Measuring Organizational Attributes of Primary Health Care Survey.

PubMed

Lukewich, Julia; Edge, Dana S; VanDenKerkhof, Elizabeth; Williamson, Tyler; Tranmer, Joan

2018-04-15

Various organizational-level attributes are being implemented in primary healthcare to improve healthcare delivery. There is a need to describe the distribution and nature of these attributes and explore differences across practices.AimThe aim of this study was to better understand organizational attributes of primary care teams, focusing specifically on team composition, nursing roles, and strategies that support chronic disease management. We employed a cross-sectional survey design. Team composition, nursing roles, availability of health services, and chronic disease management activities were described using the 'Measuring Organizational Attributes of Primary Health Care Survey.'FindingsA total of 76% (n=26 out of 34) of practice locations completed the survey, including family health teams (FHT; n=21) and community health centers (CHC; n=4). Nurse practitioners (NPs) and registered nurses (RNs) were the most common non-physician providers, and CHCs had a greater proportion of non-physician providers than FHTs. There was overlap in roles performed by NPs and RNs, and registered practical nurses engaged in fewer roles compared with NPs and RNs. A greater proportion of FHTs had systematic chronic disease management services for hypertension, depression and Alzheimer's disease compared with CHC practices. The 'Measuring Organizational Attributes of Primary Health Care Survey' was a useful tool to highlight variability in organizational attributes across PHC practices. Nurses are prominent within PHC practices, engaging in a wide range of roles related to chronic disease management, suggesting a need to better understand their contributions to patient care to optimize their roles.

Early pregnancy failure management among family physicians.

PubMed

Wallace, Robin; Dehlendorf, Christine; Vittinghoff, Eric; Gold, Katherine J; Dalton, Vanessa K

2013-03-01

Family physicians, as primary care providers for reproductive-aged women, frequently initiate or refer patients for management of early pregnancy failure (EPF). Safe and effective options for EPF treatment include expectant management, medical management with misoprostol, and aspiration in the office or operating room. Current practice does not appear to reflect patient preferences or to utilize the most cost-effective treatments. We compared characteristics and practice patterns among family physicians who do and do not provide multiple options for EPF care. We performed a secondary analysis of a national survey of women's health providers to describe demographic and practice characteristics among family physicians who care for women with EPF. We used multivariate logistic regression to identify correlates of providing more than one option for EPF management. The majority of family physicians provide only one option for EPF; expectant management was most frequently used among our survey respondents. Misoprostol and office-based aspiration were rarely used. Providing more than one option for EPF management was associated with more years in practice, smaller county population, larger proportions of Medicaid patients, intrauterine contraception provision, and prior training in office-based aspiration. Family physicians are capable of providing a comprehensive range of options for EPF management in the outpatient setting but few providers currently do so. To create a more patient-centered and cost-effective model of care for EPF, additional resources should be directed at education, skills training, and system change initiatives to prepare family physicians to offer misoprostol and office-based aspiration to women with EPF.

Technical Change and Manpower Planning: Co-Ordination at Enterprise Level. Industrial Relations Aspects of Manpower Policy 4.

ERIC Educational Resources Information Center

Barkin, Solomon, Ed.

The 29 case studies in this report seek to define the policies and practices followed by firms in programing technological change and manpower adjustments. The purpose of the report is to make these policies and practices more broadly known and to extend the range of effective adjustments provided by individual managements. The inquiries were…

Introducing "The Matrix Classroom" University Course Design That Facilitates Active and Situated Learning though Creating Two Temporary Communities of Practice

ERIC Educational Resources Information Center

Roberts, Emma; Sayer, Karen

2017-01-01

This paper illustrates a radical course design structured to create active and situated learning in which students participate in communities of practice within the classroom, replicating real-life work situations. This paper illustrates the approach through a People Management module, but the approach is also used across a range of disciplines…

Ethical challenges within Veterans Administration healthcare facilities: perspectives of managers, clinicians, patients, and ethics committee chairpersons.

PubMed

Foglia, Mary Beth; Pearlman, Robert A; Bottrell, Melissa; Altemose, Jane K; Fox, Ellen

2009-04-01

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions.

Self-management and transitions in women with advanced breast cancer.

PubMed

Schulman-Green, Dena; Bradley, Elizabeth H; Knobf, M Tish; Prigerson, Holly; DiGiovanna, Michael P; McCorkle, Ruth

2011-10-01

Self-management involves behaviors that individuals perform to handle health conditions. Self-management may be particularly challenging during transitions-shifts from one life phase or status to another, for example, from cure- to noncure-oriented care-because they can be disruptive and stressful. Little is known about individuals' experiences with self-management, especially during transitions. Our purpose was to describe experiences of self-management in the context of transitions among women with advanced breast cancer. We interviewed a purposive sample of 15 women with metastatic breast cancer about their self-management preferences, practices, and experiences, including how they managed transitions. Interviews were recorded and transcribed. The qualitative method of interpretive description was used to code and analyze the data. Participants' mean age was 52 years (range 37-91 years); most were White (80%), married (80%), and college educated (60%). Self-management practices related to womens' health and to communication with loved ones and providers. Participants expressed a range of preferences for participation in self-management. Self-management included developing skills, becoming empowered, and creating supportive networks. Barriers to self-management included symptom distress, difficulty obtaining information, and lack of knowledge about the cancer trajectory. Women identified transitions as shifts in physical, emotional, and social well-being, as when their cancer progressed and there was a need to change therapy. Transitions often prompted changes in how actively women self-managed and were experienced as positive, negative, and neutral. Self-management preferences can vary. Providers should explore and revisit patients' preferences and ability to self-manage over time, particularly during transitions. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

New Zealand rural primary health care workforce in 2005: more than just a doctor shortage.

PubMed

Goodyear-Smith, Felicity; Janes, Ron

2008-02-01

To obtain a 2005 snapshot of New Zealand (NZ) rural primary health care workforce, specifically GPs, general practice nurses and community pharmacists. Postal questionnaires, November 2005. NZ-wide rural general practices and community pharmacies. Rural general practice managers, GPs, nurses, community pharmacy managers and pharmacists. Self-reported data: demographics, country of training, years in practice, business ownership, hours worked including on-call, intention to leave rural practice. General practices: response rate 95% (206/217); 70% GP-owned, practice size ranged from one GP/one nurse to 12 GPs/nine nurses. PHARMACIES: Response rate 90% (147/163). Majority had one (33%) or two (32%) pharmacists; <10% had more than three pharmacists. GPs: response rate 64% (358/559), 71% male, 73% aged >40, 61% full-time, 79% provide on-call, 57% overseas-trained, 78% male and 57% female GPs aged >40; more full-time male GPs (76%) than female (37%) . Nurses: response rate 65% (445/685), 97% female, 72% aged >40, 31% full-time, 28% provide on-call, 84% NZ-trained, 45% consulted independently in 'nurse-clinics' within practice setting. Pharmacists: response rate 96% (248/258), 52% male, 66% aged >40, 71% full-time, 33% provide on-call, 92% NZ-trained, 55% sole/partner pharmacy owners. Many intend to leave NZ rural practice within 5 years: GPs (34%), nurses (25%) and pharmacists (47%). This is the first NZ-wide rural workforce survey to include a range of rural primary health care providers (GPs, nurses and pharmacists). Ageing rural primary health care workforce and intentions to leave herald worsening workforce shortages.

76 FR 49408 - Endangered and Threatened Wildlife and Plants; Proposed Listing of the Miami Blue Butterfly as...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-10

... plants, nectar sources, dependence on ants), range, distribution, population size, and metapopulation... practices, displacement of native host plants by invasive exotic species, detrimental land management...

Can disease management target patients most likely to generate high costs? The impact of comorbidity.

PubMed

Charlson, Mary; Charlson, Robert E; Briggs, William; Hollenberg, James

2007-04-01

Disease management programs are increasingly used to manage costs of patients with chronic disease. We sought to examine the clinical characteristics and measure the health care expenditures of patients most likely to be targeted by disease management programs. Retrospective analysis of prospectively obtained data. A general medicine practice with both faculty and residents at an urban academic medical center. Five thousand eight hundred sixty-one patients enrolled in the practice for at least 1 year. Annual cost of diseases targeted by disease management. Patients' clinical and demographic information were collected from a computer system used to manage patients. Data included diagnostic information, medications, and resource usage over 1 year. We looked at 10 common diseases targeted by disease management programs. Unadjusted annual median costs for chronic diseases ranged between $1,100 and $1,500. Congestive heart failure ($1,500), stroke ($1,500), diabetes ($1,500), and cancer ($1,400) were the most expensive. As comorbidity increased, annual adjusted costs increased exponentially. Those with comorbidity scores of 2 or more accounted for 26% of the population but 50% of the overall costs. Costs for individual chronic conditions vary within a relatively narrow range. However, the costs for patients with multiple coexisting medical conditions increase rapidly. Reducing health care costs will require focusing on patients with multiple comorbid diseases, not just single diseases. The overwhelming impact of comorbidity on costs raises significant concerns about the potential ability of disease management programs to limit the costs of care.

Manage indirect practice expense the way you practice medicine: with information.

PubMed

Zeller, T L; Senagore, A J; Siegel, G

1999-05-01

Surgeons are increasingly faced with the pressures of maintaining the highest quality of patient care, while at the same time maintaining financial viability. The purpose of this project was to provide a framework for analyzing practice costs for colorectal surgeons using an activity-based cost accounting model. A survey of 11 practices that were diverse in terms of geography, managed care penetration, academic vs. private practice style, and case distribution was performed. In activity-based costing the assignment of typical costs such as staff salaries are assigned to the appropriate business process. The business processes employed in this study were service patients in the office, perform in-office procedures, schedule cases in facilities, service patients in the hospital, insurance authorization, maintain medical records, billing, collections, resolve billing disputes, interaction with third parties, maintain professional education, sustain and manage the practice, maintain the facility, teaching and research, and performing drug studies. The final step is to assign the cost associated with all appropriate business processes to the appropriate cost object. The cost objects in this study were defined as a charge office visit, no-charge office visit, charge hospital visit, in-office procedures, in-facility procedures, and performing drug studies. The data were then analyzed to allow a comparison of four similar practices within the study group. The data demonstrated that the cost of seeing a charge office visit ranged from $55 to $105. Similarly, the cost of seeing a no-charge office visit during the global period ranged from $43 to $100. The study analyzed possible explanations for the wide variability in these costs. It is essential that physicians clearly understand the sources of expenses generated by the operation of their practices. A clear comprehension of costs will lead colorectal surgeons to make appropriate decisions regarding such important issues as office staffing ratios, office square footage, and instrumentation acquisitions.

A first look at chorioamnionitis management practice variation among US obstetricians.

PubMed

Greenberg, Mara B; Anderson, Britta L; Schulkin, Jay; Norton, Mary E; Aziz, Natali

2012-01-01

Objective. To examine practice patterns for diagnosis and treatment of chorioamnionitis among US obstetricians. Study Design. We distributed a mail-based survey to members of the American College of Obstetricians and Gynecologists, querying demographics, practice setting, and chorioamnionitis management strategies. We performed univariable and multivariable analyses. Results. Of 500 surveys distributed, 53.8% were returned, and 212 met study criteria and were analyzed. Most respondents work in group practice (66.0%), perform >100 deliveries per year (60.0%), have been in practice >10 years (77.3%), and work in a nonuniversity setting (85.1%). Temperature plus one additional criterion (61.3%) was the most common diagnostic strategy. Over 25 different primary antibiotic regimens were reported, including use of a single agent by 30.0% of respondents. A wide range of postpartum antibiotic duration was reported from no postpartum treatment (34.5% after vaginal delivery, 11.3% after cesarean delivery) to 48 hours of postpartum treatment (24.7% after vaginal delivery, 32.1% after cesarean delivery). No practitioner characteristic was independently associated with diagnostic or therapeutic strategies in multivariable analysis. Conclusion. There is a wide variation in contemporary clinical practices for the management of chorioamnionitis. This may represent a dearth of level I evidence. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.

Using Assessments of Dental Students' Entrepreneurial Self-Efficacy to Aid Practice Management Education.

PubMed

Mollica, Anthony G; Cain, Kevin; Callan, Richard S

2017-06-01

In the past, the typical practice management curriculum in U.S. dental schools was found to place a heavy emphasis on customer service, whereas areas typically stressed in business entrepreneurship and management courses (e.g., long-range planning, competing strategies, and supplier relationship) received less attention. However, future dentists will likely have many points in their careers at which they must decide whether to begin a new business or to associate with a practice, and entrepreneurial and management training can help them make and implement those decisions. The aim of this exploratory study was to investigate the impact of one dental school's practice management education on students' entrepreneurial self-efficacy (ESE), a construct examined for the first time in dental education. ESE is an individual's belief that he or she is personally capable of planning for, operating, and managing a successful business. In December 2014, all students in all four classes were asked to complete a survey measuring their ESE. The response rates for each class were D1 94%, D2 91%, D3 87%, and D4 79%. The results showed that the mean scores of the fourth-year class were higher on all five examined dimensions than those of the other three classes. The same was true for the mean for each class with the exception of the competency regarding an individual's perception of his or her abilities to deploy and manage human resources, in which the first-year class had a higher score than the fourth-year class (149.07>146.06). The fourth-year class had statistically significant higher scores than the third-year class, consistent with the implementation of practice management courses in the curriculum.

Effect of seedbed preparation on natural reproduction of spruce and hemlock under dense shade

Treesearch

Grant Davis; Arthur C. Hart

1961-01-01

The cutting practices commonly recommended for spruce-fir stands in the Northeast involve uneven-aged management. The success of this type of management is predicated upon stand structures that have a range of size classes from seedlings to mature trees in intimate mixture. This kind of stand structure requires a continuous supply of reproduction of desirable species....

Comparisons of management practices and farm design on Australian commercial layer and meat chicken farms: Cage, barn and free range.

PubMed

Scott, Angela Bullanday; Singh, Mini; Toribio, Jenny-Ann; Hernandez-Jover, Marta; Barnes, Belinda; Glass, Kathryn; Moloney, Barbara; Lee, Amanda; Groves, Peter

2017-01-01

There are few published studies describing the unique management practices, farm design and housing characteristics of commercial meat chicken and layer farms in Australia. In particular, there has been a large expansion of free range poultry production in Australia in recent years, but limited information about this enterprise exists. This study aimed to describe features of Australian commercial chicken farms, with particular interest in free range farms, by conducting on-farm interviews of 25 free range layer farms, nine cage layer farms, nine barn layer farms, six free range meat chicken farms and 15 barn meat chicken farms in the Sydney basin bioregion and South East Queensland. Comparisons between the different enterprises (cage, barn and free range) were explored, including stocking densities, depopulation procedures, environmental control methods and sources of information for farmers. Additional information collected for free range farms include range size, range characteristics and range access. The median number of chickens per shed was greatest in free range meat chicken farms (31,058), followed by barn meat chicken (20,817), free range layer (10,713), barn layer (9,300) and cage layer farms (9,000). Sheds had cooling pads and tunnel ventilation in just over half of both barn and free range meat chicken farms (53%, n = 8) and was least common in free range layer farms (16%, n = 4). Range access in free range meat chicken farms was from sunrise to dark in the majority (93%, n = 14) of free range meat chicken farms. Over half of free range layer farms (56%, n = 14) granted range access at a set time each morning; most commonly between 9:00 to 10.00am (86%, n = 12), and chickens were placed back inside sheds when it was dusk.

Comparisons of management practices and farm design on Australian commercial layer and meat chicken farms: Cage, barn and free range

PubMed Central

Singh, Mini; Toribio, Jenny-Ann; Hernandez-Jover, Marta; Barnes, Belinda; Glass, Kathryn; Moloney, Barbara; Lee, Amanda; Groves, Peter

2017-01-01

There are few published studies describing the unique management practices, farm design and housing characteristics of commercial meat chicken and layer farms in Australia. In particular, there has been a large expansion of free range poultry production in Australia in recent years, but limited information about this enterprise exists. This study aimed to describe features of Australian commercial chicken farms, with particular interest in free range farms, by conducting on-farm interviews of 25 free range layer farms, nine cage layer farms, nine barn layer farms, six free range meat chicken farms and 15 barn meat chicken farms in the Sydney basin bioregion and South East Queensland. Comparisons between the different enterprises (cage, barn and free range) were explored, including stocking densities, depopulation procedures, environmental control methods and sources of information for farmers. Additional information collected for free range farms include range size, range characteristics and range access. The median number of chickens per shed was greatest in free range meat chicken farms (31,058), followed by barn meat chicken (20,817), free range layer (10,713), barn layer (9,300) and cage layer farms (9,000). Sheds had cooling pads and tunnel ventilation in just over half of both barn and free range meat chicken farms (53%, n = 8) and was least common in free range layer farms (16%, n = 4). Range access in free range meat chicken farms was from sunrise to dark in the majority (93%, n = 14) of free range meat chicken farms. Over half of free range layer farms (56%, n = 14) granted range access at a set time each morning; most commonly between 9:00 to 10.00am (86%, n = 12), and chickens were placed back inside sheds when it was dusk. PMID:29166389

TH-E-209-00: Radiation Dose Monitoring and Protocol Management

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

NONE

Radiation dose monitoring solutions have opened up new opportunities for medical physicists to be more involved in modern clinical radiology practices. In particular, with the help of comprehensive radiation dose data, data-driven protocol management and informed case follow up are now feasible. Significant challenges remain however and the problems faced by medical physicists are highly heterogeneous. Imaging systems from multiple vendors and a wide range of vintages co-exist in the same department and employ data communication protocols that are not fully standardized or implemented making harmonization complex. Many different solutions for radiation dose monitoring have been implemented by imaging facilitiesmore » over the past few years. Such systems are based on commercial software, home-grown IT solutions, manual PACS data dumping, etc., and diverse pathways can be used to bring the data to impact clinical practice. The speakers will share their experiences with creating or tailoring radiation dose monitoring/management systems and procedures over the past few years, which vary significantly in design and scope. Topics to cover: (1) fluoroscopic dose monitoring and high radiation event handling from a large academic hospital; (2) dose monitoring and protocol optimization in pediatric radiology; and (3) development of a home-grown IT solution and dose data analysis framework. Learning Objectives: Describe the scope and range of radiation dose monitoring and protocol management in a modern radiology practice Review examples of data available from a variety of systems and how it managed and conveyed. Reflect on the role of the physicist in radiation dose awareness.« less

The Perception, Level of Safety Satisfaction and Safety Feedback on Occupational Safety and Health Management among Hospital Staff Nurses in Sabah State Health Department

PubMed Central

Cheah, Whye Lian; Giloi, Nelbon; Chang, Ching Thon; Lim, Jac Fang

2012-01-01

Background: This study aimed to determine the perception and level of safety satisfaction of staff nurses with regards to Occupational Safety and Health (OSH) management practice in the Sabah Health Department, and to associate the OSH management dimensions, to Safety Satisfaction and Safety Feedback. Methods: A cross-sectional study using a validated self-administered questionnaire was conducted among randomly respondents. Results: 135 nurses responded the survey. Mean (SD) score for each dimension ranged from 1.70 ± 0.68–4.04 ± 0.65, with Training and Competence dimension (mean [SD], 4.04 ± 0.65) had the highest while Safety Incidence was the least score (mean [SD], 1.70 ± 0.68). Both mean (SD) scores for Safety Satisfaction and Safety Feedback was high, 3.28 ± 0.51 and 3.57 ± 0.73, respectively. Pearson’s correlation analysis indicated that all OSH dimensions had significant correlation with Safety Satisfaction and Safety Feedback (r coefficient ranged from 0.176–0.512) except for Safety Incidence. Conclusion: The overall perception of OSH management was rather low. Significant correlation between Safety Satisfaction and Safety Feedback and several dimensions, suggest that each organization to put in place the leaders who have appropriate leadership and supervisory skills and committed in providing staff training to improve staff’s competency in OSH practice. In addition, clear goals, rules, and reporting system will help the organization to implement proper OSH management practice. PMID:23610550

Effects of management practices on grassland birds: Clay-colored Sparrow

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Nenneman, Melvin P.; Euliss, Betty R.

1998-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Western Meadowlark

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Zimmerman, Amy L.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Chestnut-collared Longspur

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Nenneman, Melvin P.; Euliss, Betty R.

1998-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Baird's Sparrow

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Nenneman, Melvin P.; Euliss, Betty R.

1998-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Nelson's Sharp-tailed Sparrow

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Rabie, Paul A.; Euliss, Betty R.

2002-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: McCown's Longspur

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Rabie, Paul A.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Burrowing Owl

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Rabie, Paul A.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Long-billed Curlew

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Rabie, Paul A.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Upland Sandpiper

USGS Publications Warehouse

Dechant, Jill A.; Dinkins, Meghan F.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Parkin, Barry D.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Lark Sparrow

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Parkin, Barry D.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Horned Lark

USGS Publications Warehouse

Dinkins, Meghan F.; Zimmerman, Amy L.; Dechant, Jill A.; Parkin, Barry D.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Euliss, Betty R.

2000-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Willet

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Parkin, Barry D.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Sedge Wren

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Parkin, Barry D.; Euliss, Betty R.

1998-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Field Sparrow

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Parkin, Barry D.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Bobolink

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Zimmerman, Amy L.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Lark Bunting

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Zimmerman, Amy L.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Vesper Sparrow

USGS Publications Warehouse

Dechant, Jill A.; Dinkins, Meghan F.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Euliss, Betty R.

2000-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Dickcissel

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Zimmerman, Amy L.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Ferruginous Hawk

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Zimmerman, Amy L.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: American Bittern

USGS Publications Warehouse

Dechant, Jill A.; Sondreal, Marriah L.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Zimmerman, Amy L.; Euliss, Betty R.

1999-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Effects of management practices on grassland birds: Swainson's Hawk

USGS Publications Warehouse

Dechant, Jill A.; Dinkins, Meghan F.; Johnson, Douglas H.; Igl, Lawrence D.; Goldade, Christopher M.; Euliss, Betty R.

2000-01-01

Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates of cowbird parasitism, host responses to parasitism, and factors that influence parasitism, such as nest concealment and host density. The impact of management depends, in part, upon a species' nesting phenology and biology. The section on breeding-season phenology and site fidelity includes details on spring arrival and fall departure for migratory populations in the Great Plains, peak breeding periods, the tendency to renest after nest failure or success, and the propensity to return to a previous breeding site. The duration and timing of breeding varies among regions and years. Species' response to management summarizes the current knowledge and major findings in the literature on the effects of different management practices on the species. The section on management recommendations complements the previous section and summarizes specific recommendations for habitat management provided in the literature. If management recommendations differ in different portions of the species' breeding range, recommendations are given separately by region. The literature cited contains references to published and unpublished literature on the management effects and habitat requirements of the species. This section is not meant to be a complete bibliography; for a searchable, annotated bibliography of published and unpublished papers dealing with habitat needs of grassland birds and their responses to habitat management, use the Grassland and Wetland Birds Bibliography on the home page of this resource.

Practice Patterns of Speech-Language Pathologists in Pediatric Vocal Health.

PubMed

Hartley, Naomi A; Braden, Maia; Thibeault, Susan L

2017-05-17

The purpose of this study was to investigate current practices of speech-language pathologists (SLPs) in the management of pediatric vocal health, with specific analysis of the influence of clinical specialty and workplace setting on management approaches. American Speech-Language-Hearing Association-certified clinicians providing services within the United States (1%-100% voice caseload) completed an anonymous online survey detailing clinician demographics; employment location and service delivery models; approaches to continuing professional development; and specifics of case management, including assessment, treatment, and discharge procedures. Current practice patterns were analyzed for 100 SLPs (0-42 years of experience; 77 self-identifying as voice specialists) providing services in 34 U.S. states across a range of metropolitan and nonmetropolitan workplace settings. In general, SLPs favored a multidisciplinary approach to management; included perceptual, instrumental, and quality of life measures during evaluation; and tailored intervention to the individual using a combination of therapy approaches. In contrast with current practice guidelines, only half reported requiring an otolaryngology evaluation prior to initiating treatment. Both clinical specialty and workplace setting were found to affect practice patterns. SLPs in school settings were significantly less likely to consider themselves voice specialists compared with all other work environments. Those SLPs who considered themselves voice specialists were significantly more likely to utilize voice-specific assessment and treatment approaches. SLP practice largely mirrors current professional practice guidelines; however, potential exists to further enhance client care. To ensure that SLPs are best able to support children in successful communication, further research, education, and advocacy are required.

Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting.

PubMed

Tropea, J; Slee, J; Holmes, A C N; Gorelik, A; Brand, C A

2009-02-01

Despite delirium being common in older hospitalized people, little is known about its management. The aims of this study are (1) to describe the pharmacological management of delirium in an acute care setting as a baseline measure prior to the implementation of newly developed Australian guidelines; and (2) to determine what areas of delirium pharmacological management need to be targeted for future practical guideline implementation and quality improvement activities. A medical record audit was conducted using a structured audit form. All patients aged 65 years and over who were admitted to a general medical or orthopaedic unit of the Royal Melbourne Hospital between 1 March 2006 and 28 February 2007 and coded with delirium were included. Data on the use of antipsychotic medications for the management of delirium in relation to best practice recommendations were assessed. Overall 174 episodes of care were included in the analysis. Antipsychotic medications were used for the management of most patients with severe behavioral and or emotional disturbance associated with delirium. There was variation in the prescribing patterns of antipsychotic agents and the documentation of medication management plans. Less than a quarter of patients prescribed antipsychotic medication were started on a low dose and very few were reviewed on a regular basis. A wide range of practice is seen in the use of antipsychotic agents to manage older patients with severe symptoms associated with delirium. The findings highlight the need to implement evidence-based guideline recommendations with a focus on improving the consistency in the pharmacological management and documentation processes.

Evaluation of computerized decision support for oral anticoagulation management based in primary care.

PubMed

Fitzmaurice, D A; Hobbs, F D; Murray, E T; Bradley, C P; Holder, R

1996-09-01

Increasing indications for oral anticoagulation has led to pressure on general practices to undertake therapeutic monitoring. Computerized decision support (DSS) has been shown to be effective in hospitals for improving clinical management. Its usefulness in primary care has previously not been investigated. To test the effectiveness of using DSS for oral anticoagulation monitoring in primary care by measuring the proportions of patients adequately controlled, defined as within the appropriate therapeutic range of International Normalised Ratio (INR). All patients receiving warfarin from two Birmingham inner city general practices were invited to attend a practice-based anticoagulation clinic. In practice A all patients were managed using DSS. In practice B patients were randomized to receive dosing advice either through DSS or through the local hospital laboratory. Clinical outcomes, adverse events and patient acceptability were recorded. Forty-nine patients were seen in total. There were significant improvements in INR control from 23% to 86% (P > 0.001) in the practice where all patients received dosing through DSS. In the practice where patients were randomized to either DSS or hospital dosing, logistic regression showed a significant trend for improvement in intervention patients which was not apparent in the hospital-dosed patients (P < 0.001). Mean recall times were significantly extended in patients who were dosed by the practice DSS through the full 12 months (24 days to 36 days) (P = 0.033). Adverse events were comparable between hospital and practice-dosed patients, although a number of esoteric events occurred. Patient satisfaction with the practice clinics was high. Computerized DSS enables the safe and effective transfer of anticoagulation management from hospital to primary care and may result in improved patient outcome in terms of the level of control, frequency of review and general acceptability.

Practice management education during surgical residency.

PubMed

Jones, Kory; Lebron, Ricardo A; Mangram, Alicia; Dunn, Ernest

2008-12-01

Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management. The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits. Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period. When residents finish their surgical training they need to be ready to enter the world of business. These needs will be present whether pursuing a career in academic medicine or the private sector. A program that focuses on the business aspect of surgery enables the residents to better navigate the future while helping to fulfill the systems-based practice competency.

Relationship Between Labor and Delivery Unit Management Practices and Maternal Outcomes.

PubMed

Plough, Avery C; Galvin, Grace; Li, Zhonghe; Lipsitz, Stuart R; Alidina, Shehnaz; Henrich, Natalie J; Hirschhorn, Lisa R; Berry, William R; Gawande, Atul A; Peter, Doris; McDonald, Rory; Caldwell, Donna L; Muri, Janet H; Bingham, Debra; Caughey, Aaron B; Declercq, Eugene R; Shah, Neel T

2017-08-01

To define, measure, and characterize key competencies of managing labor and delivery units in the United States and assess the associations between unit management and maternal outcomes. We developed and administered a management measurement instrument using structured telephone interviews with both the primary nurse and physician managers at 53 diverse hospitals across the United States. A trained interviewer scored the managers' interview responses based on management practices that ranged from most reactive (lowest scores) to most proactive (highest scores). We established instrument validity by conducting site visits among a subsample of 11 hospitals and established reliability using interrater comparison. Using a factor analysis, we identified three themes of management competencies: management of unit culture, patient flow, and nursing. We constructed patient-level regressions to assess the independent association between these management themes and maternal outcomes. Proactive management of unit culture and nursing was associated with a significantly higher risk of primary cesarean delivery in low-risk patients (relative risk [RR] 1.30, 95% CI 1.02-1.66 and RR 1.47, 95% CI 1.13-1.92, respectively). Proactive management of unit culture was also associated with a significantly higher risk of prolonged length of stay (RR 4.13, 95% CI 1.98-8.64), postpartum hemorrhage (RR 2.57, 95% CI 1.58-4.18), and blood transfusion (RR 1.87, 95% CI 1.12-3.13). Proactive management of patient flow and nursing was associated with a significantly lower risk of prolonged length of stay (RR 0.23, 95% CI 0.12-0.46 and RR 0.27, 95% CI 0.11-0.62, respectively). Labor and delivery unit management varies dramatically across and within hospitals in the United States. Some proactive management practices may be associated with increased risk of primary cesarean delivery and maternal morbidity. Other proactive management practices may be associated with decreased risk of prolonged length of stay, indicating a potential opportunity to safely improve labor and delivery unit efficiency.

Effects of RN Age and Experience on Transformational Leadership Practices.

PubMed

Herman, Susan; Gish, Mary; Rosenblum, Ruth; Herman, Michael

2017-06-01

This study reported the evolution of transformational leadership (TL) practices and behaviors across years of age, management experience, and professional nursing practice within a professional nursing leadership organization. Recent studies of CNO TL found valuations peak near age 60 years. This study reported on a wider range of management positions, correlating years of RN practice and management experience and age to TL metrics. This study used Kouzes and Posner's Leadership Practices Inventory-Self-Assessment (LPI-S) to survey a nursing leadership organization, the Association of California Nurse Leaders (ACNL). Anonymous responses were analyzed to identify leadership trends in age and years of professional service. On average, LPI-S metrics of leadership skills advance through years of management, RN experience, and age. The TL scores are statistically higher in most LPI-S categories for those with more than 30 years of RN or management experience. Decade-averaged LPI-S TL metrics in the ACNL survey evolve linearly throughout age before peaking in the decade from age 60 to 69 years. A similar evolution of TL metrics is seen in decades of either years of management experience or years of RN experience. Transformational leadership increased with nursing maturity particularly for LPI-S categories of "inspire a shared vision," "challenge the process," and "enable others to act." In the ACNL population studied, decade-averaged leadership metrics advanced. Leadership evolution with age in the broader RN population peaked in age bracket 60 to 69 years. The LPI-S averages declined when older than 70 years, coinciding with a shift from full-time work toward retirement and part-time employment.

Making framing of uncertainty in water management practice explicit by using a participant-structured approach.

PubMed

Isendahl, Nicola; Dewulf, Art; Pahl-Wostl, Claudia

2010-01-01

By now, the need for addressing uncertainty in the management of water resources is widely recognized, yet there is little expertise and experience how to effectively deal with uncertainty in practice. Uncertainties in water management practice so far are mostly dealt with intuitively or based on experience. That way decisions can be quickly taken but analytic processes of deliberate reasoning are bypassed. To meet the desire of practitioners for better guidance and tools how to deal with uncertainty more practice-oriented systematic approaches are needed. For that purpose we consider it important to understand how practitioners frame uncertainties. In this paper we present an approach where water managers developed criteria of relevance to understand and address uncertainties. The empirical research took place in the Doñana region of the Guadalquivir estuary in southern Spain making use of the method of card sorting. Through the card sorting exercise a broad range of criteria to make sense of and describe uncertainties was produced by different subgroups, which were then merged into a shared list of criteria. That way framing differences were made explicit and communication on uncertainty and on framing differences was enhanced. In that, the present approach constitutes a first step to enabling reframing and overcoming framing differences, which are important features on the way to robust decision-making. Moreover, the elaborated criteria build a basis for the development of more structured approaches to deal with uncertainties in water management practice. Copyright 2009 Elsevier Ltd. All rights reserved.

Guidelines for maintaining and managing the vaccine cold chain.

PubMed

2003-10-24

In February 2002, the Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) released their revised General Recommendations on Immunization, which included recommendations on the storage and handling of immunobiologics. Because of increased concern over the potential for errors with the vaccine cold chain (i.e., maintaining proper vaccine temperatures during storage and handling to preserve potency), this notice advises vaccine providers of the importance of proper cold chain management practices. This report describes proper storage units and storage temperatures, outlines appropriate temperature-monitoring practices, and recommends steps for evaluating a temperature-monitoring program. The success of efforts against vaccine-preventable diseases is attributable in part to proper storage and handling of vaccines. Exposure of vaccines to temperatures outside the recommended ranges can affect potency adversely, thereby reducing protection from vaccine-preventable diseases. Good practices to maintain proper vaccine storage and handling can ensure that the full benefit of immunization is realized.

Developing Baselines for Prescribed Burning Smoke Management Plans and Best Management Practices

DTIC Science & Technology

2015-09-01

skillful application of fire to natural fuels under conditions of weather, fuel moisture , soil moisture , etc., to allow confine- ment of the fire to...also the potential for excessive soil compaction and disturbance, stimulation of invasive nonnative plant species, removal of natural nutrient...that not only provide safe, accessible, maneuverable, and defensible range conditions necessary for mission training, but also support biodiversity

The 10 Dimensions of Employee Involvement.

ERIC Educational Resources Information Center

Magjuka, Richard J.

1993-01-01

A survey of 923 employee involvement programs (57%) yielded 10 themes: range of problem content, team staffing, team membership status, team resources, training practices, information access, financial rewards, performance management systems, goal-setting structures, and roles of job supervisors. (JOW)

Planning for Fiscal Risk Management Demands of Retirees.

ERIC Educational Resources Information Center

Wood, R. Craig

1981-01-01

Assesses the common practice of allowing retiring employees to continue receiving group insurance benefits and suggests that before agreeing to this arrangement, administrators should consider the situation carefully and plan for the potential long-range consequences. (Author/WD)

Physician pattern of patient notification of test results.

PubMed

Thiedke, Carolyn C; Hoeft, Katherine A; Pearson, William S

2005-01-01

To discover how community-based family physicians notify patients of test results and whether there are differences based on sex, length of time in practice, reimbursement status, employment status,or percentage of practice in managed care. We mailed a survey to 500 randomly selected members of the South Carolina chapter of the American Academy of Family Physicians. All analyses were preformed using SASTM version 8.2. Both descriptive and inferential statistics were used to analyze the collected data. A total of 367 physicians responded (73% response rate). The main outcome variable was the time each physician spent notifying patients of test results: a mean of 20.86 +/- 18.3 minutes per day(range 0-120 minutes/day). Women physicians and those with more than 75% managed care were significantly more likely to spend more than the median time notifying patients of test results. Physicians vary in the amount of time they spend notifying patients of their test results, with female physicians and those with more than 75% of their practice in managed care spending more time than do male physicians and physicians with less managed care.

Integrated Pest Management of Coffee Berry Borer: Strategies from Latin America that Could Be Useful for Coffee Farmers in Hawaii.

PubMed

Aristizábal, Luis F; Bustillo, Alex E; Arthurs, Steven P

2016-02-03

The coffee berry borer (CBB), Hypothenemus hampei Ferrari (Coleoptera: Curculionidae: Scolytinae) is the primary arthropod pest of coffee plantations worldwide. Since its detection in Hawaii (September 2010), coffee growers are facing financial losses due to reduced quality of coffee yields. Several control strategies that include cultural practices, biological control agents (parasitoids), chemical and microbial insecticides (entomopathogenic fungi), and a range of post-harvest sanitation practices have been conducted to manage CBB around the world. In addition, sampling methods including the use of alcohol based traps for monitoring CBB populations have been implemented in some coffee producing countries in Latin America. It is currently unclear which combination of CBB control strategies is optimal under economical, environmental, and sociocultural conditions of Hawaii. This review discusses components of an integrated pest management program for CBB. We focus on practical approaches to provide guidance to coffee farmers in Hawaii. Experiences of integrated pest management (IPM) of CBB learned from Latin America over the past 25 years may be relevant for establishing strategies of control that may fit under Hawaiian coffee farmers' conditions.

Making history critical.

PubMed

Learmonth, Mark

2017-08-21

Purpose The purpose of this paper is to explore a possible discursive history of National Health Service (NHS) "management" (with management, for reasons that will become evident, very much in scare quotes). Such a history is offered as a complement, as well as a counterpoint, to the more traditional approaches that have already been taken to the history of the issue. Design/methodology/approach Document analysis and interviews with UK NHS trust chief executives. Findings After explicating the assumptions of the method it suggests, through a range of empirical sources that the NHS has undergone an era of administration, an era of management and an era of leadership. Research limitations/implications The paper enables a recasting of the history of the NHS; in particular, the potential for such a discursive history to highlight the interests supported and denied by different representational practices. Practical implications Today's so-called leaders are leaders because of conventional representational practices - not because of some essence about what they really are. Social implications New ideas about the nature of management. Originality/value The value of thinking in terms of what language does - rather than what it might represent.

Evidence for Public Health Risks of Wastewater and Excreta Management Practices in Southeast Asia: A Scoping Review

PubMed Central

Lam, Steven; Nguyen-Viet, Hung; Tuyet-Hanh, Tran Thi; Nguyen-Mai, Huong; Harper, Sherilee

2015-01-01

The use of wastewater and excreta in agriculture is a common practice in Southeast Asia; however, concerns remain about the potential public health risks of this practice. We undertook a scoping review to examine the extent, range, and nature of literature, as well as synthesize the evidence for associations between wastewater and excreta management practices and public health risks in Southeast Asia. Three electronic databases (PubMed, CAB Direct, and Web of Science) were searched and a total of 27 relevant studies were included and evaluated. The available evidence suggested that possible occupational health risks of wastewater and excreta management practices include diarrhea, skin infection, parasitic infection, bacterial infection, and epilepsy. Community members can be at risk for adverse health outcomes through consuming contaminated fish, vegetables, or fruits. Results suggested that practices including handling, treatment, and use of waste may be harmful to human health, particularly farmer’s health. Many studies in this review, however, had limitations including lack of gender analyses, exposure assessment, and longitudinal study designs. These findings suggest that more studies on identifying, quantitatively assessing, and mitigating health risks are needed if sustainable benefits are to be obtained from wastewater and excreta reuse in agriculture in Southeast Asia. PMID:26501297

The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists.

PubMed

Lindahl, Jared R; Fisher, Nathan E; Cooper, David J; Rosen, Rochelle K; Britton, Willoughby B

2017-01-01

Buddhist-derived meditation practices are currently being employed as a popular form of health promotion. While meditation programs draw inspiration from Buddhist textual sources for the benefits of meditation, these sources also acknowledge a wide range of other effects beyond health-related outcomes. The Varieties of Contemplative Experience study investigates meditation-related experiences that are typically underreported, particularly experiences that are described as challenging, difficult, distressing, functionally impairing, and/or requiring additional support. A mixed-methods approach featured qualitative interviews with Western Buddhist meditation practitioners and experts in Theravāda, Zen, and Tibetan traditions. Interview questions probed meditation experiences and influencing factors, including interpretations and management strategies. A follow-up survey provided quantitative assessments of causality, impairment and other demographic and practice-related variables. The content-driven thematic analysis of interviews yielded a taxonomy of 59 meditation-related experiences across 7 domains: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Even in cases where the phenomenology was similar across participants, interpretations of and responses to the experiences differed considerably. The associated valence ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring. In order to determine what factors may influence the valence, impact, and response to any given experience, the study also identified 26 categories of influencing factors across 4 domains: practitioner-level factors, practice-level factors, relationships, and health behaviors. By identifying a broader range of experiences associated with meditation, along with the factors that contribute to the presence and management of experiences reported as challenging, difficult, distressing or functionally impairing, this study aims to increase our understanding of the effects of contemplative practices and to provide resources for mediators, clinicians, meditation researchers, and meditation teachers.

Promoting a culture of disaster preparedness.

PubMed

Medina, Angeli

2016-01-01

Disasters from all hazards, ranging from natural disasters, human-induced disasters, effects of climate change to social conflicts can significantly affect the healthcare system and community. This requires a paradigm shift from a reactive approach to a disaster risk management 'all-hazards' approach. Disaster management is a joint effort of the city, state, regional, national, multi-agencies and international organisations that requires effective communication, collaboration and coordination. This paper offers lessons learned and best practices, which, when taken into consideration, can strengthen the phases of disaster risk management.

Otitis Media: Beyond the Examining Room.

PubMed

Welling, Deborah R; Ukstins, Carol A

2018-02-01

The management of hearing loss associated with otitis media is multifaceted. Clinical practice guidelines set the collaborative prescriptive standards for the medical management of otitis media in children. Treatment of this condition does not end with the medical practitioner. There are far-reaching effects of otitis media and its sequelae that permeate every aspect of patients' lives including physiological, educational, and psychosocial. Therefore, a comprehensive interprofessional treatment plan must be designed taking into consideration best practices from a range of professions to maximize clinical outcomes, including the treating physician, speech-language pathologist, clinical audiologist, educational audiologist, and professionals in the educational setting. Copyright © 2017 Elsevier Inc. All rights reserved.

Survey points to practices that reduce refinery maintenance spending

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

Ricketts, R.

During the past decade, Solomon Associates Inc., Dallas, has conducted several comparative analyses of maintenance costs in the refining industry. These investigations have brought to light maintenance practices and reliability improvement activities that are responsible for the wide range of maintenance costs recorded by refineries. Some of the practices are of an organizational nature and thus are of interest to managers reviewing their operations. The paper discusses maintenance costs; profitability; cost trends; equipment availability; funds application; two basic organizational approached to maintenance (repair-focused organization and reliability-focused organization); low-cost practices; and organizational style.

Determining Home Range and Preferred Habitat of Feral Horses on the Nevada National Security Site Using Geographic Information Systems

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

Burns, Ashley V.

2014-05-30

Feral horses (Equus caballus) are free-roaming descendants of domesticated horses and legally protected by the Wild and Free-Roaming Horses and Burros Act of 1971, which mandates how feral horses and burros should be managed and protected on federal lands. Using a geographic information system to determine the home range and suitable habitat of feral horses on the federally managed Nevada National Security Site can enable wildlife biologists in making best management practice recommendations. Home range was estimated at 88.1 square kilometers. Site suitability was calculated for elevation, forage, slope, water presence and horse observations. These variables were combined in successivemore » iterations into one polygon. Suitability rankings established that 85 square kilometers are most suitable habitat, with 2,052 square kilometers of good habitat 1,252 square kilometers of fair habitat and 122 square kilometers of least suitable habitat.« less

A prospective survey of chiropractic student experiences with pediatric care and variability of case mix while on clinical placement in Rarotonga.

PubMed

Todd, Angela J; Carroll, Matthew T; Russell, David G; Mitchell, Eleanor K L

2017-03-01

To compare chiropractic students' perceptions of preparedness for practice before and after a clinical placement in Rarotonga and to report demographics from these experiences. The students completed deidentified pre- and postplacement surveys assessing pediatric practice preparedness. Students tallied the patient numbers, age, and chiropractic techniques used per visit for each day of clinic placement. On completion of the program, participating students (27/34, or 79% of the student cohort) did a postplacement survey on their perception of practice preparedness. Data were analyzed with the Spearman rho correlation, the Mann-Whitney U test, and regression analysis. There was an increase in perceived preparedness for pediatric practice, ranging from 24.1% of the student cohort at the start of the study to 82.1% following clinical placement in Rarotonga. The change in student preparedness to practice with children was positively correlated with the total number of children managed (r s = .05, p = .01) and the number of children managed who were under 10 years of age (r s = .60, p = .001). Multiple regression analysis demonstrated a medium positive effect for postprogram preparedness (F [4, 20] = 3.567, p = .024). Clinical outreach to Rarotonga provided a broad case mix of patients and a change in student perceptions of preparedness to practice with children, which was positively affected by the total number of children managed and the number of children managed who were under 10 years of age.

Can Disease Management Target Patients Most Likely to Generate High Costs? The Impact of Comorbidity

PubMed Central

Charlson, Robert E.; Briggs, William; Hollenberg, James

2007-01-01

Context Disease management programs are increasingly used to manage costs of patients with chronic disease. Objective We sought to examine the clinical characteristics and measure the health care expenditures of patients most likely to be targeted by disease management programs. Design Retrospective analysis of prospectively obtained data. Setting A general medicine practice with both faculty and residents at an urban academic medical center. Participants Five thousand eight hundred sixty-one patients enrolled in the practice for at least 1 year. Main Outcomes Annual cost of diseases targeted by disease management. Measurements Patients’ clinical and demographic information were collected from a computer system used to manage patients. Data included diagnostic information, medications, and resource usage over 1 year. We looked at 10 common diseases targeted by disease management programs. Results Unadjusted annual median costs for chronic diseases ranged between $1,100 and $1,500. Congestive heart failure ($1,500), stroke ($1,500), diabetes ($1,500), and cancer ($1,400) were the most expensive. As comorbidity increased, annual adjusted costs increased exponentially. Those with comorbidity scores of 2 or more accounted for 26% of the population but 50% of the overall costs. Conclusions Costs for individual chronic conditions vary within a relatively narrow range. However, the costs for patients with multiple coexisting medical conditions increase rapidly. Reducing health care costs will require focusing on patients with multiple comorbid diseases, not just single diseases. The overwhelming impact of comorbidity on costs raises significant concerns about the potential ability of disease management programs to limit the costs of care. PMID:17372794

Understanding performance management in primary care.

PubMed

Rogan, Lisa; Boaden, Ruth

2017-02-13

Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

Good practices in health care "management experimentation models": insights from an international public-private partnership on transplantation and advanced specialized therapies.

PubMed

Longo, Maria Cristina

2015-01-01

The research analyzes good practices in health care "management experimentation models," which fall within the broader range of the integrative public-private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the "management experimentation models" are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations. In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC - Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies. The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable. The recognition of ISMETT's good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

Compensation and exotic livestock disease management: the views of animal keepers and veterinarians in England.

PubMed

Hamilton-Webb, A; Naylor, R; Little, R; Maye, D

2016-11-19

Relatively little is known about the perceived influence of different compensation systems on animal keepers' management of exotic livestock disease. This paper aims to address this research gap by drawing on interviews with 61 animal keepers and 21 veterinarians, as well as a series of nine animal keeper focus groups across five different livestock sectors in England. The perceived influence of current compensation systems on disease control behaviour was explored and alternative compensation systems that respectively reward positive practices and penalise poor practices were presented in the form of scenarios, alongside a third system that considered the option of a cost-sharing levy system between industry and government. The results indicate that animal keepers consider themselves to be influenced by a range of non-financial factors, for example, feelings of responsibility, reputation and animal welfare concerns, in the context of their exotic disease management practices. The majority of animal keepers were unaware of the current compensation systems in place for exotic diseases, and were therefore not consciously influenced by financial recompense. Concerns were raised about linking compensation to disease management behaviour due to auditing difficulties. A cost-sharing levy system would likely raise awareness of exotic disease and compensation among animal keepers, but differentiation of payments based upon individual farm-level risk assessments was called for by participants as a strategy to promote positive disease management practices. British Veterinary Association.

TH-E-209-03: Development of An In-House CT Dose Monitoring and Management System Based On Open-Source Software Resources -- Pearls and Pitfalls

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

Zhang, D.

Radiation dose monitoring solutions have opened up new opportunities for medical physicists to be more involved in modern clinical radiology practices. In particular, with the help of comprehensive radiation dose data, data-driven protocol management and informed case follow up are now feasible. Significant challenges remain however and the problems faced by medical physicists are highly heterogeneous. Imaging systems from multiple vendors and a wide range of vintages co-exist in the same department and employ data communication protocols that are not fully standardized or implemented making harmonization complex. Many different solutions for radiation dose monitoring have been implemented by imaging facilitiesmore » over the past few years. Such systems are based on commercial software, home-grown IT solutions, manual PACS data dumping, etc., and diverse pathways can be used to bring the data to impact clinical practice. The speakers will share their experiences with creating or tailoring radiation dose monitoring/management systems and procedures over the past few years, which vary significantly in design and scope. Topics to cover: (1) fluoroscopic dose monitoring and high radiation event handling from a large academic hospital; (2) dose monitoring and protocol optimization in pediatric radiology; and (3) development of a home-grown IT solution and dose data analysis framework. Learning Objectives: Describe the scope and range of radiation dose monitoring and protocol management in a modern radiology practice Review examples of data available from a variety of systems and how it managed and conveyed. Reflect on the role of the physicist in radiation dose awareness.« less

Dynamics of wood in stream networks of the western Cascades Range, Oregon

Treesearch

Nicole M. Czarnomski; David M. Dreher; Kai U. Snyder; Julia A. Jones; Frederick J. Swanson

2008-01-01

We develop and test a conceptual model of wood dynamics in stream networks that considers legacies of forest management practices, floods, and debris flows. We combine an observational study of wood in 25 km of 2nd- through 5th-order streams in a steep, forested watershed of the western Cascade Range of Oregon with whole-network studies of forest cutting, roads, and...

Understanding effective care management implementation in primary care: a macrocognition perspective analysis.

PubMed

Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A

2015-08-21

Care management in primary care can be effective in helping patients with chronic disease improve their health status. Primary care practices, however, are often challenged with its implementation. Incorporating care management involves more than a simple physical process redesign to existing clinical care routines. It involves changes to who is working with patients, and consequently such things as who is making decisions, who is sharing patient information, and how. Studying the range of such changes in "knowledge work" during implementation requires a perspective and tools designed to do so. We used the macrocognition perspective, which is designed to understand how individuals think in dynamic, messy real-world environments such as care management implementation. To do so, we used cognitive task analysis to understand implementation in terms of such thinking as decision making, knowledge, and communication. Data collection involved semi-structured interviews and observations at baseline and at approximately 9 months into implementation at five practices in one physician-owned administratively connected group of practices in the state of Michigan, USA. Practices were intervention participants in a larger trial of chronic care model implementation. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with macrocognition as a guiding framework. Seventy-four interviews and five observations were completed. There were differences in implementation success across the practices, and these differences in implementation success were well explained by macrocognition. Practices that used more macrocognition functions and used them more often were also more successful in care management implementation. Although care management can introduce many new changes into the delivery of primary care clinical practice, implementing it successfully as a new complex intervention is possible. Macrocognition is a useful perspective for illuminating the elements that facilitate new complex interventions with a view to addressing them during implementation planning.

Learning, Teaching and Ambiguity in Virtual Worlds

NASA Astrophysics Data System (ADS)

Carr, Diane; Oliver, Martin; Burn, Andrew

What might online communities and informal learning practices teach us about virtual world pedagogy? In this chapter we describe a research project in which learning practices in online worlds such as World of Warcraft and Second LifeTM (SL) were investigated. Working within an action research framework, we employed a range of methods to investigate how members of online communities define the worlds they encounter, negotiate the terms of participation, and manage the incremental complexity of game worlds. The implications of such practices for online pedagogy were then explored through teaching in SL. SL eludes simple definitions. Users, or "residents", of SL partake of a range of pleasures and activities - socialising, building, creating and exhibiting art, playing games, exploring, shopping, or running a business, for instance. We argue that the variable nature of SL gives rise to degrees of ambiguity. This ambiguity impacts on inworld social practices, and has significant implications for online teaching and learning.

The Local Turn: an Introductory Essay Revisiting Leadership, Elite Capture and Good Governance in Indonesian Conservation and Development Programs.

PubMed

Warren, Carol; Visser, Leontine

The local turn in good governance theory and practice responded to critiques of the ineffectiveness of state management and the inequity of privatization alternatives in natural resource management. Confounding expectations of greater effectiveness from decentralised governance, including community-based natural resource management, however, critics argue that expanded opportunities for elite capture have become widely associated with program failures. This overview of theoretical controversies on leadership, patronage and elite capture is part of a themed section in this issue that challenges assumptions across a wide range of current policy literature. It introduces a set of Indonesian case studies that examine practices of local leaders and elites and seek to account in structural terms for appropriations both by ('elite capture') and of ('captured elites') these key figures. These studies explore the structural factors and co-governance practices most likely to promote effective participation of the full spectrum of local interests in pursuit of better local natural resource governance.

Conservation genomics of natural and managed populations: building a conceptual and practical framework.

PubMed

Benestan, Laura Marilyn; Ferchaud, Anne-Laure; Hohenlohe, Paul A; Garner, Brittany A; Naylor, Gavin J P; Baums, Iliana Brigitta; Schwartz, Michael K; Kelley, Joanna L; Luikart, Gordon

2016-07-01

The boom of massive parallel sequencing (MPS) technology and its applications in conservation of natural and managed populations brings new opportunities and challenges to meet the scientific questions that can be addressed. Genomic conservation offers a wide range of approaches and analytical techniques, with their respective strengths and weaknesses that rely on several implicit assumptions. However, finding the most suitable approaches and analysis regarding our scientific question are often difficult and time-consuming. To address this gap, a recent workshop entitled 'ConGen 2015' was held at Montana University in order to bring together the knowledge accumulated in this field and to provide training in conceptual and practical aspects of data analysis applied to the field of conservation and evolutionary genomics. Here, we summarize the expertise yield by each instructor that has led us to consider the importance of keeping in mind the scientific question from sampling to management practices along with the selection of appropriate genomics tools and bioinformatics challenges. © 2016 John Wiley & Sons Ltd.

A typology of intellectual property management for public health innovation and access: design considerations for policymakers.

PubMed

Taubman, Antony

2010-01-19

This paper seeks to set the practical discipline of public interest intellectual property (IP) management in public health into its broader policy context. The most immediate and direct impact of IP systems on public welfare results not from international standards nor from national legislation - though these norms are fundamentally important - but rather from the accumulated impact of numerous practical choices whether or not to seek IP protection; where and where not; and how any exclusive rights are deployed, by whom, and to what end. IP management is the essentially practical exercise of limited exclusive rights over protected subject matter, the judicious use of those rights to leverage outcomes that advance an institution's or a firm's objectives. Exclusive rights are used to construct and define knowledge-based relationships, to leverage access to technology and other necessary resources, and to enhance market-based incentives. IP management choices range across a broad spectrum, spanning public domain strategies, open or exclusive licensing, and strong exclusivity. The idea of 'exclusive rights', as a specific legal mechanism, can run counter to expectations of greater openness and accessibility, but actual outcomes will depend very much on how these mechanisms are used in practice. For public interest or public sector institutions concerned with health research and development, particularly the development of new medicines, IP management choices can be just as critical as they are for private firms, although a predominant institutional concentration on advancing direct public interest objectives may lead to significantly different approaches in weighing and exercising practical choices for IP management: even so, a private sector approach should not be conflated with exclusivity as an end in itself, nor need public interest IP management eschew all leverage over IP. This paper offers a tentative framework for a richer typology of those choices, to give a sense of practical options available and the factors that might guide their application, but without advocating any particular approach.

A Typology of Intellectual Property Management for Public Health Innovation and Access: Design Considerations for Policymakers§

PubMed Central

Taubman, Antony

2010-01-01

This paper seeks to set the practical discipline of public interest intellectual property (IP) management in public health into its broader policy context. The most immediate and direct impact of IP systems on public welfare results not from international standards nor from national legislation – though these norms are fundamentally important - but rather from the accumulated impact of numerous practical choices whether or not to seek IP protection; where and where not; and how any exclusive rights are deployed, by whom, and to what end. IP management is the essentially practical exercise of limited exclusive rights over protected subject matter, the judicious use of those rights to leverage outcomes that advance an institution's or a firm's objectives. Exclusive rights are used to construct and define knowledge-based relationships, to leverage access to technology and other necessary resources, and to enhance market-based incentives. IP management choices range across a broad spectrum, spanning public domain strategies, open or exclusive licensing, and strong exclusivity. The idea of ‘exclusive rights’, as a specific legal mechanism, can run counter to expectations of greater openness and accessibility, but actual outcomes will depend very much on how these mechanisms are used in practice. For public interest or public sector institutions concerned with health research and development, particularly the development of new medicines, IP management choices can be just as critical as they are for private firms, although a predominant institutional concentration on advancing direct public interest objectives may lead to significantly different approaches in weighing and exercising practical choices for IP management: even so, a private sector approach should not be conflated with exclusivity as an end in itself, nor need public interest IP management eschew all leverage over IP. This paper offers a tentative framework for a richer typology of those choices, to give a sense of practical options available and the factors that might guide their application, but without advocating any particular approach. PMID:20517487

Avian foods, foraging and habitat conservation in world rice fields

USGS Publications Warehouse

Stafford, J.D.; Kaminski, R.M.; Reinecke, K.J.

2010-01-01

Worldwide, rice (Oryza sativa) agriculture typically involves seasonal flooding and soil tillage, which provides a variety of microhabitats and potential food for birds. Water management in rice fields creates conditions ranging from saturated mud flats to shallow (<30 cm) water, thereby attracting different guilds of birds. Grain not collected during harvest (i.e. waste rice) is typically the most abundant potential food of birds in rice fields, with estimates of seed mass from North America ranging from 66672 kg/ha. Although initially abundant after harvest, waste rice availability can be temporally limited. Few abundance estimates for other foods, such as vertebrate prey or forage vegetation, exist for rice fields. Outside North America, Europe and Japan, little is known about abundance and importance of any avian food in rice fields. Currently, flooding rice fields after harvest is the best known management practice to attract and benefit birds. Studies from North America indicate specific agricultural practices (e.g. burning stubble) may increase use and improve access to food resources. Evaluating and implementing management practices that are ecologically sustainable, increase food for birds and are agronomically beneficial should be global priorities to integrate rice production and avian conservation. Finally, land area devoted to rice agriculture appears to be stable in the USA, declining in China, and largely unquantified in many regions. Monitoring trends in riceland area may provide information to guide avian conservation planning in rice-agriculture ecosystems.

The importance of family management, closeness with father and family structure in early adolescent alcohol use.

PubMed

Habib, Cherine; Santoro, Joseph; Kremer, Peter; Toumbourou, John; Leslie, Eva; Williams, Joanne

2010-10-01

To examine the importance of family management, family structure and father-adolescent relationships on early adolescent alcohol use. Cross-sectional data was collected across 30 randomly selected Australian communities stratified to represent a range of socio-economic and regional variation. Data were collected during school time from adolescents attending a broad range of schools. The sample consisted of a combined 8256 students (aged 10-14 years). Students completed a web-based survey as part of the Healthy Neighbourhoods project. Family management-which included practices such as parental monitoring and family rules about alcohol use-had the strongest and most consistent relationship with alcohol use in early adolescence. Adolescents reporting higher family management were less likely to have drunk alcohol in their life-time, less likely to drink alcohol in the preceding 30 days and less likely to have had an alcohol binge. Adolescents reporting emotionally close relationships with their fathers were less likely to have drunk alcohol in their life-time and less likely to have had an alcohol binge in the preceding fortnight. Findings indicate that family management practices may contribute to alcohol abstinence in adolescents. Furthermore, emotionally close father-adolescent relationships may also foster abstinence; however, fathers' drinking behaviours need to be considered. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

Patient profile, referral sources, and consultant utilization in a primary care sports medicine clinic.

PubMed

Butcher, J D; Zukowski, C W; Brannen, S J; Fieseler, C; O'Connor, F G; Farrish, S; Lillegard, W A

1996-12-01

Sports medicine has matured as a focused discipline within primary care with the number of primary care sports medicine physicians growing annually. The practices of these physicians range from "part-time" sports medicine as a part of a broader practice in their primary specialty, to functioning as a full-time team physician for a university or college. Managed care organizations are increasingly incorporating primary care sports medicine providers into their organizations. The optimal role of these providers in a managed care system has not been described. A descriptive analysis was made of patient contacts in a referral-based, free-standing primary care sports medicine clinic associated with a large managed care system. This study describes patient information including demographic data, referral source, primary diagnosis, specialized diagnostic testing, and subsequent specialty consultation. A total of 1857 patient contacts were analyzed. New patients were referred from a full range of physicians both primary care (family practice, internal medicine, pediatrics, and emergency physicians) and other specialists, with family practice clinic providers (physicians, physician assistants, and nurse practitioners) accounting for the largest percentage of new referrals. The majority of patient visits were for orthopedic injuries (95.4%); the most frequently involved injury sites were: knee (26.5%), shoulder (18.2%), back (14.3%), and ankle (10%). The most common types of injury were: tendinitis (21.3%), chronic anterior knee pain (10.6%), and ligament sprains (9.9%). Specialized testing was requested for 8% of all patients. The majority of patients were treated at the Ft Belvoir Sports Medicine Clinic by primary care sports medicine physicians without further specialty referral. Primary care sports medicine physicians offer an intermediate level of care for patients while maintaining a practice in their primary care specialty. This dual practice is ideal in the managed care setting. This study demonstrates the complementary nature of primary care sports medicine and orthopedics, with the primary care sports medicine physician reducing the demand on orthopedists for nonsurgical treatment. This study also demonstrates the need for revision in the orthopedic curriculum for primary care physicians.

Role of storms and forest practices in sedimentation of an Oregon Coast Range lake

NASA Astrophysics Data System (ADS)

Richardson, K.; Hatten, J. A.; Wheatcroft, R. A.; Guerrero, F. J.

2014-12-01

The design of better management practices in forested watersheds to face climate change and the associated increase in the frequency of extreme events requires a better understanding of watershed responses to extreme events in the past and also under management regimes. One of the most sensitive watershed processes affected is sediment yield. Lake sediments record events which occur in a watershed and provide an opportunity to examine the interaction of storms and forest management practices in the layers of the stratigraphy. We hypothesize that timber harvesting and road building since the 1900s has resulted in increases in sedimentation; however, the passage of the Oregon Forest Practices Act (OFPA) in 1972 has led to a decrease in sedimentation. Sediment cores were taken at Loon Lake in the Oregon Coast Range. The 32-m deep lake captures sediment from a catchment highly impacted by recent land use and episodic Pacific storms. We can use sedimentological tools to measure changes in sediment production as motivated by extreme floods before settlement, during a major timber harvesting period, and after installation of forestry Best Management Practices. Quantification of changes in particle size and elemental composition (C, N, C/N) throughout the cores can elucidate changes in watershed response to extreme events, as can changes in layer thickness. Age control in the cores is being established by Cesium-137 and radiocarbon dating. Given the instrumental meteorological data and decadal climate reconstructions, we will disentangle climate driven signals from changes in land use practices. The sediment shows distinct laminations and varying thickness of layers throughout the cores. Background deposition is composed of thin layers (<0.5 cm) of fine silts and clays, punctuated by thicker layers (3-25 cm) every 10 to 75 cm. These thick layers consist of distinctly textured units, generally fining upward. We interpret the thick layers in Loon Lake to be deposited by sediment-producing floods throughout much of the 1500-year lifespan of this lake. We will explore the relationship between sedimentation, land use, and climate forcing events to determine if the OFPA is having an effect on reducing sedimentation rates as a result of extreme magnitude storm events.

Profile of medical waste management in two healthcare facilities in Lagos, Nigeria: a case study.

PubMed

Idowu, Ibijoke; Alo, Babajide; Atherton, William; Al Khaddar, Rafid

2013-05-01

Proper management and safe disposal of medical waste (MW) is vital in the reduction of infection or illness through contact with discarded material and in the prevention of environmental contamination in hospital facilities. The management practices for MW in selected healthcare facilities in Lagos, Nigeria were assessed. The cross-sectional study involved the use of questionnaires, in-depth interviews, focused group discussions and participant observation strategies. It also involved the collection, segregation, identification and weighing of waste types from wards and units in the representative facilities in Lagos, Nigeria, for qualitative and quantitative analysis of the MW streams. The findings indicated that the selected Nigerian healthcare facilities were lacking in the adoption of sound MW management (MWM) practices. The average MW ranged from 0.01 kg/bed/day to 3.98 kg/bed/day. Moreover, about 30% of the domestic waste from the healthcare facilities consisted of MW due to inappropriate co-disposal practices. Multiple linear regression was applied to predict the volume of waste generated giving a correlation coefficient (R(2)) value of 0.99 confirming a good fit of the data. This study revealed that the current MWM practices and strategies in Lagos are weak, and suggests an urgent need for review to achieve vital reversals in the current trends.

A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue

PubMed Central

Howell, D.; Keller–Olaman, S.; Oliver, T.K.; Hack, T.F.; Broadfield, L.; Biggs, K.; Chung, J.; Gravelle, D.; Green, E.; Hamel, M.; Harth, T.; Johnston, P.; McLeod, D.; Swinton, N.; Syme, A.; Olson, K.

2013-01-01

Purpose The purpose of the present systematic review was to develop a practice guideline to inform health care providers about screening, assessment, and effective management of cancer-related fatigue (crf) in adults. Methods The internationally endorsed adapte methodology was used to develop a practice guideline for pan-Canadian use. A systematic search of the literature identified a broad range of evidence: clinical practice guidelines, systematic reviews, and other guidance documents on the screening, assessment, and management of crf. The search included medline, embase, cinahl, the Cochrane Library, and other guideline and data sources to December 2009. Results Two clinical practice guidelines were identified for adaptation. Seven guidance documents and four systematic reviews also provided supplementary evidence to inform guideline recommendations. Health professionals across Canada provided expert feedback on the adapted recommendations in the practice guideline and algorithm through a participatory external review process. Conclusions Practice guidelines can facilitate the adoption of evidence-based assessment and interventions for adult cancer patients experiencing fatigue. Development of an algorithm to guide decision-making in practice may also foster the uptake of a guideline into routine care. PMID:23737693

Adaptation for the Ages: Strategic Leaders, 1972-2012 and Beyond

DTIC Science & Technology

2013-03-01

1986), two of the scholarly giants in the field of America’s first battles, suggest that a “thorough knowledge of war…increases the competence—and...reinforce traditional practices. Embracing Uncertainty and Managing Change The challenge for the Army is in envisioning and describing accurately...schools, officers might attend one or more short courses in subjects ranging from foreign language to organizational management . The career officer

KSC-04pd1655

NASA Image and Video Library

2004-08-05

KENNEDY SPACE CENTER, FLA. - At the ribbon cutting for the Enhanced Firing Range on Schwartz Rd. at Kennedy Space Center, Dave Saleeba practices firing on the new range. Saleeba is assistant administrator with the Office of Security Management and Safeguards at NASA Headquarters and was a guest speaker at the ceremony. NASA’s Federal Law Enforcement Training Academy’s firing range has been upgraded to include a “rifle-grade” shoot house, a portable, tactical “shoot-back” trailer for cover and concealment drills, automated running targets and a new classroom facility. They are added to the existing three firearms ranges, “pistol-grade” shoot house, obstacle course and rappel tower. NASA’s Security Management and Safeguards Office funded the enhancements in order to improve ability to train the KSC security force and to support local, state and federal law enforcement agencies in Homeland Security.

Patients' experiences of shared decision making in primary care practices in the United kingdom.

PubMed

Fullwood, Catherine; Kennedy, Anne; Rogers, Anne; Eden, Martin; Gardner, Caroline; Protheroe, Joanne; Reeves, David

2013-01-01

Shared decision making (SDM) and patient self-management support are key components of US and UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial is implementing training in self-management support for primary care physicians in one UK region. This article describes preintervention levels of patient-reported SDM and explores how this varies with patient and practice characteristics. We analyzed baseline data from a cluster randomized controlled trial for 2965 patients with diabetes, chronic obstructive pulmonary disease, and irritable bowel syndrome (IBS) from 29 family practices. Patient-level measures included self-report of chronic conditions, SDM (Health Care Climate Questionnaire [HCCQ]), health status, and demographic characteristics. Area and practice characteristics included chronic disease workload and socioeconomic deprivation. The mean SDM score was 75 (out of 100), but the range was wide. The mean score was lower for IBS patients but did not vary with other disease conditions. Younger patients and those with poorer health status reported lower degrees of SDM. No associations were found with practice characteristics. The study was restricted to one socioeconomically deprived region, and hence results may not be nationally representative of the United Kingdom. Ceiling effects on SDM scores may limit the utility of the HCCQ. Lower ratings from some patient groups may reflect differences in expectations rather than differences in physician behavior. Overall levels of SDM were high, and no patient or practice characteristic represented a serious barrier to SDM. However, we cannot say to what extent SDM in this chronic population addressed self-management issues rather than clinical care. More nuanced measures of SDM are required that distinguish between different forms of care.

Hospital-Level Variation in Practice Patterns and Patient Outcomes for Pediatric Patients Hospitalized With Functional Constipation.

PubMed

Librizzi, Jamie; Flores, Samuel; Morse, Keith; Kelleher, Kelly; Carter, Jodi; Bode, Ryan

2017-06-01

Constipation is a common pediatric condition with a prevalence of 3% to 5% in children aged 4 to 17 years. Currently, there are no evidence-based guidelines for the management of pediatric patients hospitalized with constipation. The primary objective was to evaluate practice patterns and patient outcomes for the hospital management of functional constipation in US children's hospitals. We conducted a multicenter, retrospective cohort study of children aged 0 to 18 years hospitalized for functional constipation from 2012 to 2014 by using the Pediatric Health Information System. Patients were included by using constipation and other related diagnoses as classified by International Classification of Diseases, Ninth Revision . Patients with complex chronic conditions were excluded. Outcome measures included percentage of hospitalizations due to functional constipation, therapies used, length of stay, and 90-day readmission rates. Statistical analysis included means with 95% confidence intervals for individual hospital outcomes. A total of 14 243 hospitalizations were included, representing 12 804 unique patients. The overall percentage of hospitalizations due to functional constipation was 0.65% (range: 0.19%-1.41%, P < .0001). The percentage of patients receiving the following treatment during their hospitalization included: electrolyte laxatives: 40% to 96%; sodium phosphate enema: 0% to 64%; mineral oil enema: 0% to 61%; glycerin suppository: 0% to 37%; bisacodyl 0% to 47%; senna: 0% to 23%; and docusate 0% to 11%. Mean length of stay was 1.97 days (range: 1.31-2.73 days, P < .0001). Mean 90-day readmission rate was 3.78% (range: 0.95%-7.53%, P < .0001). There is significant variation in practice patterns and clinical outcomes for pediatric patients hospitalized with functional constipation across US children's hospitals. Collaborative initiatives to adopt evidence-based best practices guidelines could help standardize the hospital management of pediatric functional constipation. Copyright © 2017 by the American Academy of Pediatrics.

Independent extended and supplementary nurse prescribing practice in the UK: a national questionnaire survey.

PubMed

Courtenay, Molly; Carey, Nicola; Burke, Joanna

2007-09-01

Nurses are able to prescribe independently from a list of nearly 250 prescription only medicines for a range of over 100 medical conditions or, from the whole British National Formulary as a supplementary prescriber. There is some evidence available on the prescribing practices of district nurses and health visitors and early independent extended prescribers. Little or no attention has focussed on supplementary nurse prescribing. To provide an overview of the prescribing practices of independent extended/supplementary nurse prescribers and the factors that facilitate or inhibit prescribing. National questionnaire survey. United Kingdom. A convenience sample of 868 qualified independent extended/supplementary nurse prescribers self-completed a written questionnaire. A total of 756 (87%) used independent extended prescribing; 304 (35%) used supplementary prescribing to treat a range of chronic conditions (including asthma, diabetes and hypertension); 710 (82%) nurses worked in primary care. Nurses in general practice reported the largest number of reasons preventing prescribing. Reasons included the inability to computer generate prescriptions and to implement the Clinical Management Plan. Nurses in primary care reported more continuing professional development needs. These needs included update on prescribing policy and the treatment management of conditions. A total of 277 (32%) nurses were unable to access continuing professional development. Independent extended/supplementary nurse prescribers work predominantly in primary care and do prescribe medicines. These nurses are highly qualified and have many years clinical experience. Supplementary prescribing is used by a minority of nurses. Implementing the Clinical Management Plan is a barrier preventing the use of this mode of prescribing. The continuing professional development needs of independent extended/supplementary nurse prescribers are frequently unmet. It will become increasingly important that these needs are met once nurses are able to prescribe the full range of medicines included in the British National Formulary, limited only by their area of competence.

TH-E-209-01: Fluoroscopic Dose Monitoring and Patient Follow-Up Program at Massachusetts General Hospital

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

Liu, B.

2016-06-15

Radiation dose monitoring solutions have opened up new opportunities for medical physicists to be more involved in modern clinical radiology practices. In particular, with the help of comprehensive radiation dose data, data-driven protocol management and informed case follow up are now feasible. Significant challenges remain however and the problems faced by medical physicists are highly heterogeneous. Imaging systems from multiple vendors and a wide range of vintages co-exist in the same department and employ data communication protocols that are not fully standardized or implemented making harmonization complex. Many different solutions for radiation dose monitoring have been implemented by imaging facilitiesmore » over the past few years. Such systems are based on commercial software, home-grown IT solutions, manual PACS data dumping, etc., and diverse pathways can be used to bring the data to impact clinical practice. The speakers will share their experiences with creating or tailoring radiation dose monitoring/management systems and procedures over the past few years, which vary significantly in design and scope. Topics to cover: (1) fluoroscopic dose monitoring and high radiation event handling from a large academic hospital; (2) dose monitoring and protocol optimization in pediatric radiology; and (3) development of a home-grown IT solution and dose data analysis framework. Learning Objectives: Describe the scope and range of radiation dose monitoring and protocol management in a modern radiology practice Review examples of data available from a variety of systems and how it managed and conveyed. Reflect on the role of the physicist in radiation dose awareness.« less

TH-E-209-02: Dose Monitoring and Protocol Optimization: The Pediatric Perspective

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

MacDougall, R.

Radiation dose monitoring solutions have opened up new opportunities for medical physicists to be more involved in modern clinical radiology practices. In particular, with the help of comprehensive radiation dose data, data-driven protocol management and informed case follow up are now feasible. Significant challenges remain however and the problems faced by medical physicists are highly heterogeneous. Imaging systems from multiple vendors and a wide range of vintages co-exist in the same department and employ data communication protocols that are not fully standardized or implemented making harmonization complex. Many different solutions for radiation dose monitoring have been implemented by imaging facilitiesmore » over the past few years. Such systems are based on commercial software, home-grown IT solutions, manual PACS data dumping, etc., and diverse pathways can be used to bring the data to impact clinical practice. The speakers will share their experiences with creating or tailoring radiation dose monitoring/management systems and procedures over the past few years, which vary significantly in design and scope. Topics to cover: (1) fluoroscopic dose monitoring and high radiation event handling from a large academic hospital; (2) dose monitoring and protocol optimization in pediatric radiology; and (3) development of a home-grown IT solution and dose data analysis framework. Learning Objectives: Describe the scope and range of radiation dose monitoring and protocol management in a modern radiology practice Review examples of data available from a variety of systems and how it managed and conveyed. Reflect on the role of the physicist in radiation dose awareness.« less

Management of climatic heat stress risk in construction: a review of practices, methodologies, and future research.

PubMed

Rowlinson, Steve; Yunyanjia, Andrea; Li, Baizhan; Chuanjingju, Carrie

2014-05-01

Climatic heat stress leads to accidents on construction sites brought about by a range of human factors emanating from heat induced illness, and fatigue leading to impaired capability, physical and mental. It is an occupational characteristic of construction work in many climates and the authors take the approach of re-engineering the whole safety management system rather than focusing on incremental improvement, which is current management practice in the construction industry. From a scientific viewpoint, climatic heat stress is determined by six key factors: (1) air temperature, (2) humidity, (3) radiant heat, and (4) wind speed indicating the environment, (5) metabolic heat generated by physical activities, and (6) "clothing effect" that moderates the heat exchange between the body and the environment. By making use of existing heat stress indices and heat stress management processes, heat stress risk on construction sites can be managed in three ways: (1) control of environmental heat stress exposure through use of an action-triggering threshold system, (2) control of continuous work time (CWT, referred by maximum allowable exposure duration) with mandatory work-rest regimens, and (3) enabling self-paced working through empowerment of employees. Existing heat stress practices and methodologies are critically reviewed and the authors propose a three-level methodology for an action-triggering, localized, simplified threshold system to facilitate effective decisions by frontline supervisors. The authors point out the need for "regional based" heat stress management practices that reflect unique climatic conditions, working practices and acclimatization propensity by local workers indifferent geographic regions. The authors set out the case for regional, rather than international, standards that account for this uniqueness and which are derived from site-based rather than laboratory-based research. Copyright © 2013 Elsevier Ltd. All rights reserved.

A systematic review of US rangeland social science

USDA-ARS?s Scientific Manuscript database

Rangeland science aims to create knowledge to sustain rangeland social-ecological systems over the long term. Range science has made substantial progress on understanding ecological dynamics of rangeland systems and the management practices that sustain them, and these findings have been systematica...

Reprint of: Synthesising the effects of land use on natural and managed landscapes.

PubMed

Thackway, Richard; Specht, Alison

2015-11-15

To properly manage our natural and managed landscapes, and to restore or repair degraded areas, it is important to know the changes that have taken place over time, particularly with respect to land use and its cumulative effect on ecological function. In common with many places in the world, where the industrial revolution resulted in profound changes to land use and management, Australia's landscapes have been transformed in the last 200 years. Initially the VAST (Vegetation Assets, States and Transitions) system was developed to describe and map changes in vegetation over time through a series of condition states or classes; here we describe an enhancement to the VAST method which will enable identification of the factors contributing to those changes in state as a result of changes in management practice. The 'VAST-2' system provides a structure in which to compile, interpret and sequence a range of data about past management practices, their effect on site and vegetation condition. Alongside a systematic chronology of land use and management, a hierarchy of indices is used to build a picture of the condition of the vegetation through time: 22 indicators within ten criteria representing three components of vegetation condition-regenerative capacity, vegetation structure and species composition-are scored using information from a variety of sources. These indicators are assessed relative to a pre-European reference state, either actual or synthetic. Each component is weighted proportionally to its contribution to the whole, determined through expert opinion. These weighted condition components are used to produce an aggregated transformation score for the vegetation. The application of this system to a range of sites selected across Australia's tropical, sub-tropical and temperate bioregions is presented, illustrating the utility of the system. Notably, the method accommodates a range of different types of information to be aggregated. Copyright © 2015 Elsevier B.V. All rights reserved.

A pharmacy business management simulation exercise as a practical application of business management material and principles.

PubMed

Rollins, Brent L; Gunturi, Rahul; Sullivan, Donald

2014-04-17

To implement a pharmacy business management simulation exercise as a practical application of business management material and principles and assess students' perceived value. As part of a pharmacy management and administration course, students made various calculations and management decisions in the global categories of hours of operation, inventory, pricing, and personnel. The students entered the data into simulation software and a realistic community pharmacy marketplace was modeled. Course topics included accounting, economics, finance, human resources, management, marketing, and leadership. An 18-item posttest survey was administered. Students' slightly to moderately agreed the pharmacy simulation program enhanced their knowledge and understanding, particularly of inventory management, cash flow statements, balance sheets, and income statements. Overall attitudes toward the pharmacy simulation program were also slightly positive and students also slightly agreed the pharmacy simulation program enhanced their learning of pharmacy business management. Inventory management was the only area in which students felt they had at least "some" exposure to the assessed business management topics during IPPEs/internship, while all other areas of experience ranged from "not at all" to "a little." The pharmacy simulation program is an effective active-learning exercise and enhanced students' knowledge and understanding of the business management topics covered.

A Pharmacy Business Management Simulation Exercise as a Practical Application of Business Management Material and Principles

PubMed Central

Rollins, Brent L.; Gunturi, Rahul; Sullivan, Donald

2014-01-01

Objective. To implement a pharmacy business management simulation exercise as a practical application of business management material and principles and assess students’ perceived value. Design. As part of a pharmacy management and administration course, students made various calculations and management decisions in the global categories of hours of operation, inventory, pricing, and personnel. The students entered the data into simulation software and a realistic community pharmacy marketplace was modeled. Course topics included accounting, economics, finance, human resources, management, marketing, and leadership. Assessment. An 18-item posttest survey was administered. Students’ slightly to moderately agreed the pharmacy simulation program enhanced their knowledge and understanding, particularly of inventory management, cash flow statements, balance sheets, and income statements. Overall attitudes toward the pharmacy simulation program were also slightly positive and students also slightly agreed the pharmacy simulation program enhanced their learning of pharmacy business management. Inventory management was the only area in which students felt they had at least “some” exposure to the assessed business management topics during IPPEs/internship, while all other areas of experience ranged from “not at all” to “a little.” Conclusion. The pharmacy simulation program is an effective active-learning exercise and enhanced students’ knowledge and understanding of the business management topics covered. PMID:24761023

Hearing conservation and noise management practices in professional orchestras.

PubMed

O'Brien, Ian; Driscoll, Tim; Ackermann, Bronwen

2012-01-01

Hearing conservation and noise exposure management for professional orchestras is a difficult issue resistant to standard control measures as used in other industries with excessive noise problems. Although there has been a great deal of research into this area in terms of the audiological status of musicians and their exposure to noise, there are relatively few industry-specific strategies that can be adopted by an orchestra looking to address these issues. Australia does not have a uniform approach to hearing conservation management in its orchestras; however, each orchestra actively grapples with the challenges of balancing legal, practical, and artistic concerns. This study systematically investigated hearing conservation practices, noise exposure management, and audiological screening protocols in eight professional orchestras. The research involved personal interviews with staff at each orchestra, including inspection of venues and facilities. While all these orchestras were aware of the risks and were actively taking significant steps to reduce noise exposure, a range of approaches, with varying degrees of effectiveness and understanding of the issue, were found across the sector. There was limited evidence of educational programs for either the musicians at risk of excessive noise exposure or the staff responsible for devising and implementing control measures. In addition, the reported use of adequate personal hearing protection by musicians was poor. As Australia has recently introduced a national approach to workplace health and safety, a similar approach to noise and audiological management across the country's orchestral sector is proposed, drawn from existing research and practice. This will enable both consistent procedures and meaningful dialogue between the orchestras on the topics of hearing conservation, audiological monitoring, and educational practices.

Husbandry practices employed by private aviculturists, bird markets and zoo collections, which may be conducive to fostering infectious diseases.

PubMed

Wolff, P L

1996-03-01

Zoos, quarantine stations, and bird markets, dealers and breeders are in the business of propagating or moving birds. Facilities often house and transport birds which have unknown histories of exposure to disease. As few tests are available for disease screening and monitoring in exotic avian species, familiarization with significant avian pathogens will enable the manager and veterinarian to recognize and prevent a disease outbreak. Implementing aviary management practices which minimize the spread of pathogens, in conjunction with quarantine and the proper handling of birds during shipment, can greatly reduce the threat of disease. The author reviews the husbandry practices (caging, nutrition, transport, quarantine) which can reduce the incidence and spread of infectious disease. Significant avian pathogens (bacteria, viruses, parasites) are listed, together with their host range and modes of transmission.

Repeat prescribing of medications: A system‐centred risk management model for primary care organisations

PubMed Central

Price, Julie; Man, Shu Ling; Bartlett, Stephen; Taylor, Kate; Dinwoodie, Mark

2017-01-01

Abstract Rationale, aims and objectives Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care. Methods All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web‐based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses. Results Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1‐33; SD = 7.13). Seven hundred sixty‐seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0‐34; SD = 8.0). Conclusions The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System‐wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally. PMID:28370904

Effects of different management practices on fungal biodiversity in agricultural soils

NASA Astrophysics Data System (ADS)

Borriello, R.; Lumini, E.; Bonfante, P.; Bianciotto, V.

2009-04-01

Symbiotic associations between arbuscular mycorrhizal fungi (AMF) and plant roots are widespread in natural environments and provide a range of benefits to the host plant. These include improved nutrition, enhanced resistance to soil-borne pests, diseases, and drought, as well as tolerance to heavy metals. In addition, the presence of a well developed AMF hyphal network improve the soil structure. As obligate mutualistic symbionts these fungi colonize the roots of many agricultural crops and it is often claimed that agricultural practices (use of fertilizers and biocides, tillage, dominance of monocultures and the growing of non-mycorrhizal crops) are detrimental to AMF. As a result, agro ecosystems impoverished in AMF may not get the fully expected range of benefits from these fungi. Using molecular markers on DNA extracted directly from soil and roots we studied the effects of different management practices (tillage and nitrogen fertilization) on the AMF populations colonizing an experimental agro ecosystem in Central Italy. Fungi in roots and soil were identified by cloning and sequencing a region of ~550bp of the 18S rDNA and ~600bp of the 28S rDNA. In symbiosis with the maize roots we detected only members of Glomeraceae group A that showed decrement in number under nitrogen fertilization. Instead in soil were mainly present members of two AMF groups, respectively Gigasporaceae and Glomeraceae group A. In addition only the low input management practices preserve also members of Diversisporaceae and Glomeraceae group B. From our study we can conclude that agricultural practices can directly or indirectly influence AMF biodiversity. The result of this study highlight the importance and significant effects of the long term nitrogen fertilization and tillage practices on specific groups of fungi playing a key role in arable soils. The research was founded by Biodiversity Project (IPP-CNR) and by SOILSINK (FISR-MIUR)

Conflicts and natural disaster management: a comparative study of flood control in the Republic of Korea and the United States.

PubMed

Chung, Jibum

2016-07-01

The purpose of this research is to analyse the conflicts that arise among major stakeholders during the process of disaster management and to suggest policy recommendations for improving disaster management systems. It describes several important conflict cases that have occurred among major stakeholders, such as governments, private-sector entities, and non-governmental organisations, during natural disaster management. In addition, it probes the similarities and the differences between such conflicts in the Republic of Korea and the United States. The differences between them may originate from a range of factors, such as the disaster itself, cultural features, management practices, and government organisation. However, the conflicts also are very similar in some ways, as the motivations and the behaviour of stakeholders during a disaster are alike in both countries. Based on this comparison, the study presents some common and important implications for successful disaster management practices in Korea and the US, as well as in many other nations around the world. © 2016 The Author(s). Disasters © Overseas Development Institute, 2016.

Ergonomic design for dental offices.

PubMed

Ahearn, David J; Sanders, Martha J; Turcotte, Claudia

2010-01-01

The increasing complexity of the dental office environment influences productivity and workflow for dental clinicians. Advances in technology, and with it the range of products needed to provide services, have led to sprawl in operatory setups and the potential for awkward postures for dental clinicians during the delivery of oral health services. Although ergonomics often addresses the prevention of musculoskeletal disorders for specific populations of workers, concepts of workflow and productivity are integral to improved practice in work environments. This article provides suggestions for improving workflow and productivity for dental clinicians. The article applies ergonomic principles to dental practice issues such as equipment and supply management, office design, and workflow management. Implications for improved ergonomic processes and future research are explored.

Organizational climate and hospital nurses' caring practices: a mixed-methods study.

PubMed

Roch, Geneviève; Dubois, Carl-Ardy; Clarke, Sean P

2014-06-01

Organizational climate in healthcare settings influences patient outcomes, but its effect on nursing care delivery remains poorly understood. In this mixed-methods study, nurse surveys (N = 292) were combined with a qualitative case study of 15 direct-care registered nurses (RNs), nursing personnel, and managers. Organizational climate explained 11% of the variation in RNs' reported frequency of caring practices. Qualitative data suggested that caring practices were affected by the interplay of organizational climate dimensions with patients and nurses characteristics. Workload intensity and role ambiguity led RNs to leave many caring practices to practical nurses and assistive personnel. Systemic interventions are needed to improve organizational climate and to support RNs' involvement in a full range of caring practices. © 2014 Wiley Periodicals, Inc.

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

PubMed

Sharp, Richard R

2011-03-01

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

Variation in practice and resource utilization associated with the diagnosis and management of appendicitis at freestanding children's hospitals: implications for value-based comparative analysis.

PubMed

Rice-Townsend, Samuel; Barnes, Jeff N; Hall, Matthew; Baxter, Jessica L; Rangel, Shawn J

2014-06-01

To characterize the scope and magnitude of practice variation associated with the diagnosis and treatment of appendicitis at freestanding children's hospitals. Variation in care has been associated with poor outcomes and is believed to be a key driver of excess health care spending. Retrospective cohort study of 13,328 patients treated with appendicitis at 34 children's hospitals (9/2010-9/2011). Patients were divided into complicated and uncomplicated cohorts and examined for interhospital variation in the use of diagnostic imaging (computed tomography or ultrasonography), laboratory tests, parenteral nutrition (PN), peripherally inserted central catheters (PICC), and hospital cost. The number and distribution of statistical outliers were calculated for all measures. Significant variation was found for all measures, including a 3.5-fold difference in preoperative imaging (aggregate rate: 49.0%, range across hospitals: 21.2%-73.5%, P < 0.001) and a 5-fold difference in preoperative laboratory utilization (aggregate median: 2 tests/encounter, range: 1-5 tests/encounter, P < 0.001). For patients with complicated appendicitis, we characterized a 12-fold difference in postoperative imaging (aggregate rate: 19.4%, range: 4.9%-61.6%, P < 0.001), a 48-fold difference in PICC lines (aggregate rate: 18.9%, range: 1.7%-81.8%, P < 0.001), and a 100-fold difference in PN utilization (aggregate rate: 9.3%, range: 0.4%-42.0%, P < 0.001). Median hospital cost differed 4-fold for patients with uncomplicated disease (aggregate median: $6804, range: $4200-$16,796, P < 0.001) and 4.6-fold for patients with complicated disease (aggregate median: $13,138, range: $5419-$24,779, P < 0.001). Statistical outliers on the basis of high and low utilization were identified for all measures. Significant variation exists in practice, resource utilization, and treatment-related cost associated with the management of appendicitis at freestanding children's hospitals. Value-based measures are needed for benchmarking and to prioritize collaborative quality improvement efforts.

Scaling Forest Management Practices in Earth System Models: Case Study of Southeast and Pacific Northwest Forests

NASA Astrophysics Data System (ADS)

Pourmokhtarian, A.; Becknell, J. M.; Hall, J.; Desai, A. R.; Boring, L. R.; Duffy, P.; Staudhammer, C. L.; Starr, G.; Dietze, M.

2014-12-01

A wide array of human-induced disturbances can alter the structure and function of forests, including climate change, disturbance and management. While there have been numerous studies on climate change impacts on forests, interactions of management with changing climate and natural disturbance are poorly studied. Forecasts of the range of plausible responses of forests to climate change and management are need for informed decision making on new management approaches under changing climate, as well as adaptation strategies for coming decades. Terrestrial biosphere models (TBMs) provide an excellent opportunity to investigate and assess simultaneous responses of terrestrial ecosystems to climatic perturbations and management across multiple spatio-temporal scales, but currently do not represent a wide array of management activities known to impact carbon, water, surface energy fluxes, and biodiversity. The Ecosystem Demography model 2 (ED2) incorporates non-linear impacts of fine-scale (~10-1 km) heterogeneity in ecosystem structure both horizontally and vertically at a plant level. Therefore it is an ideal candidate to incorporate different forest management practices and test various hypotheses under changing climate and across various spatial scales. The management practices that we implemented were: clear-cut, conversion, planting, partial harvest, low intensity fire, restoration, salvage, and herbicide. The results were validated against observed data across 8 different sites in the U.S. Southeast (Duke Forest, Joseph Jones Ecological Research Center, North Carolina Loblolly Pine, and Ordway-Swisher Biological Station) and Pacific Northwest (Metolius Research Natural Area, H.J. Andrews Experimental Forest, Wind River Field Station, and Mount Rainier National Park). These sites differ in regards to climate, vegetation, soil, and historical land disturbance as well as management approaches. Results showed that different management practices could successfully and realistically be implemented in the ED2 model at a site level. Moreover, sensitivity analyses determined the most important processes at different spatial scales, and also those which could be ignored while minimizing overall error.

Enhancing Self-Efficacy for Optimized Patient Outcomes through the Theory of Symptom Self-Management

PubMed Central

Hoffman, Amy J.

2012-01-01

Background In today’s world, greater patient empowerment is imperative since 90 million Americans live with one or more chronic conditions such as cancer. Evidence reveals that healthy behaviors such as effective symptom self-management can prevent or reduce much of the suffering from cancer. Oncology nurses play a pivotal role in developing a symptom self-management plan that is critical to optimizing a patient’s symptom self-management behaviors. Objective This article uses exemplars to describe how oncology nurses can apply a tested middle-range theory, the Theory of Symptom Self-Management, to clinical practice by incorporating interventions to increase a patient’s perceived self-efficacy to optimize patient outcomes. Methods The Theory of Symptom Self-Management provides a means to understand the dynamic aspects of symptom self-management and provides a tested framework for the development of efficacy enhancing interventions for use by oncology nurses in clinical practice. Results Exemplars based on the Theory of Symptom Self-Management that depict how oncology nursing can use perceived self-efficacy enhancing symptom self-management interventions to improve the functional status and quality of life of their patients. Conclusion Guided by a theoretical approach, oncology nurses can have a significant positive impact on the lives of their patients by reducing the symptom burden associated with cancer and its treatment. Implications for Practice Oncology nurses can partner with their patients to design tailored approaches to symptom self-management. These tailored approaches provide the ability to implement patient specific behaviors that recognize, prevent, relieve, or decrease the timing, intensity, distress, concurrence, and unpleasant quality of symptoms. PMID:22495550

Managing heat and immune stress in athletes with evidence-based strategies.

PubMed

Pyne, David B; Guy, Joshua H; Edwards, Andrew M

2014-09-01

Heat and immune stress can affect athletes in a wide range of sports and environmental conditions. The classical thermoregulatory model of heat stress has been well characterized, as has a wide range of practical strategies largely centered on cooling and heat-acclimation training. In the last decade evidence has emerged of an inflammatory pathway that can also contribute to heat stress. Studies are now addressing the complex and dynamic interplay between hyperthermia, the coagulation cascade, and a systemic inflammatory response occurring after transient damage to the gastrointestinal tract. Damage to the intestinal mucosal membrane increases permeability, resulting in leakage of endotoxins into the circulation. Practical strategies that target both thermoregulatory and inflammatory causes of heat stress include precooling; short-term heat-acclimation training; nutritional countermeasures including hydration, energy replacement, and probiotic supplementation; pacing strategies during events; and postevent cooling measures. Cooperation between international, national, and local sporting organizations is required to ensure that heat-management policies and strategies are implemented effectively to promote athletes' well-being and performance.

Visitor diversity through the recreation manager lens: comparing Forest Service Regions 8 (U S South) and 5 (California)

Treesearch

Cassandra Johnson Gaither; Nina S. Roberts; Kristin L. Hanula

2015-01-01

In response to changing demographics and cultural shifts in the U.S. population, the Forest Service, U.S. Department of Agriculture has initiated a range of “culturally transforming” management practices and priorities aimed at better reflecting both the current and future U.S. population (USDA 2011). This makeover also calls attention to the various publics served by...

Governance for clinical decision support: case studies and recommended practices from leading institutions

PubMed Central

Sittig, Dean F; Ash, Joan S; Bates, David W; Feblowitz, Joshua; Fraser, Greg; Maviglia, Saverio M; McMullen, Carmit; Nichol, W Paul; Pang, Justine E; Starmer, Jack; Middleton, Blackford

2011-01-01

Objective Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study. Design Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems. Measurements Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys. Results Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted. Conclusion Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support. PMID:21252052

Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercise in the management of hip osteoarthritis.

PubMed

Brosseau, Lucie; Wells, George A; Pugh, Arlanna G; Smith, Christine Am; Rahman, Prinon; Àlvarez Gallardo, Inmaculada C; Toupin-April, Karine; Loew, Laurianne; De Angelis, Gino; Cavallo, Sabrina; Taki, Jade; Marcotte, Rachel; Fransen, Marlene; Hernandez-Molina, Gabriela; Kenny, Glen P; Regnaux, Jean-Philippe; Lefevre-Colau, Marie-Martine; Brooks, Sydney; Laferriere, Lucie; McLean, Linda; Longchamp, Guy

2016-10-01

The primary objective is to identify effective land-based therapeutic exercise interventions and provide evidence-based recommendations for managing hip osteoarthritis. A secondary objective is to develop an Ottawa Panel evidence-based clinical practice guideline for hip osteoarthritis. The search strategy and modified selection criteria from a Cochrane review were used. Studies included hip osteoarthritis patients in comparative controlled trials with therapeutic exercise interventions. An Expert Panel arrived at a Delphi survey consensus to endorse the recommendations. The Ottawa Panel hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) considered the study design (level I: randomized controlled trial and level II: controlled clinical trial), statistical significance (p < 0.5), and clinical importance (⩾15% improvement). Four high-quality studies were included, which demonstrated that variations of strength training, stretching, and flexibility exercises are generally effective for improving the management of hip osteoarthritis. Strength training exercises displayed the greatest improvements for pain (Grade A), disability (Grades A and C+), physical function (Grade A), stiffness (Grade A), and range of motion (Grade A) within a short time period (8-24 weeks). Stretching also greatly improved physical function (Grade A), and flexibility exercises improved pain (Grade A), range of motion (Grade A), physical function (Grade A), and stiffness (Grade C+). The Ottawa Panel recommends land-based therapeutic exercise, notably strength training, for management of hip osteoarthritis in reducing pain, stiffness and self-reported disability, and improving physical function and range of motion. © The Author(s) 2015.

Addressing parental concerns about pain during childhood vaccination: is there enough time to include pain management in the ambulatory setting?

PubMed

Taddio, Anna; Hogan, Mary-Ellen; Gerges, Sandra; Girgis, Angela; Moyer, Paul; Wang, Linda; Murphy, Claire; Ho, Tommy; Greenberg, Saul; Ipp, Moshe

2012-01-01

Pain from vaccine injections remains undertreated, despite the availability of numerous pain-relieving strategies. Healthcare providers report lack of time within current office workflows as a major barrier to routine pain management. The objective was to document the total time involved in outpatient vaccine appointments to test the hypothesis that offering pain-relieving strategies can be practically implemented when considering the element of time to vaccine injection. Prospective naturalistic study in 8 urban outpatient primary care clinics (4 pediatric and 4 family practice) in Toronto. For 48 to 59 consecutive childhood vaccination appointments at each site, child waiting time from clinic arrival until first vaccine injection was tracked. Altogether, 405 vaccine appointments were included. The median age of the child undergoing vaccination was 12 months. The mean (SD) time from clinic arrival until first vaccine injection was 41.6 minutes (20.9), with a range of 7 to 132 minutes. Linear regression identified a significant (P<0.05) difference according to clinic [ranging from 19.4 min (6.5) to 57.5 min (20.2)] and number of family members in the appointment [ranging from 40.6 min (21.0) for an appointment in the index child only to 50 min (14.3) for an appointment in the index child and 2 other family members]. Contrary to healthcare provider perceptions, the timing of outpatient childhood vaccine appointments allows for the inclusion of pain management interventions. Efforts should now focus on educating healthcare providers and parents about the value of pain management and how to implement evidence-based strategies.

Detection and Management of Diabetes during Pregnancy in Low Resource Settings: Insights into Past and Present Clinical Practices.

PubMed

Utz, Bettina; Delamou, Alexandre; Belaid, Loubna; De Brouwere, Vincent

2016-01-01

Background. Timely and adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. Objective . To identify modalities of gestational diabetes detection and management in low and lower middle income countries. Methods . We conducted a scoping review of published literature and searched the databases PubMed, Web of Science, Embase, and African Index Medicus. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. Results . We identified 23 articles mainly from Asia and sub-Saharan Africa. The majority of studies were conducted in large tertiary care centers and hospital admission was reported in a third of publications. Ambulatory follow-up was generally done by weekly to fortnightly visits, whereas self-monitoring of blood glucose was not the norm. The cesarean section rate for pregnancies affected by diabetes ranged between 20% and 89%. Referral of newborns to special care units was common. Conclusion . The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation.

[The Jena Anxiety Monitoring List (JAMoL) - a tool for the evidence-based treatment of panic disorder with or without agoraphobia in primary care].

PubMed

Hiller, Thomas Stephan; Freytag, Antje; Breitbart, Jörg; Teismann, Tobias; Schöne, Elisabeth; Blank, Wolfgang; Schelle, Mercedes; Vollmar, Horst Christian; Margraf, Jürgen; Gensichen, Jochen

2018-04-01

Behavior therapy-oriented methods are recommended for treating anxiety disorders in primary care. The treatment of patients with long-term conditions can be improved by case management and structured clinical monitoring. The present paper describes the rationale, design and application of the 'Jena Anxiety Monitoring List' (JAMoL), a monitoring tool for the treatment of patients with panic disorder, with or without agoraphobia, in primary care. JAMoL's design was based on established clinical measures, the rationale of exposure-based anxiety treatment, and research on family practice-based case management. After piloting, the JAMoL was used in the clinical study 'Jena-PARADISE' (ISRCTN64669297), where non-physician practice staff monitored patients with panic disorder by telephone. Using semi-structured interviews in concomitant studies, study participants were asked about the instrument's functionality. The JAMoL assesses the severity of anxiety symptoms (6 items) as well as the patient's adherence to therapy (4 items) and fosters the case management-related information exchange (3 items). An integrated traffic light scheme facilitates the evaluation of monitoring results. Within the clinical study, non-physician practice staff carried out a total of 1,525 JAMoL-supported monitoring calls on 177 patients from 30 primary care practices (median calls per patient: 10 [interquartile range, 9-10]). Qualitative analyses revealed that most practice teams and patients rated the JAMoL as a practicable and treatment-relevant tool. The JAMoL enables primary care practice teams to continuously monitor anxiety symptoms and treatment adherence in patients with panic disorder with or without agoraphobia. Within the behavior therapy-oriented treatment program 'Jena-PARADISE', the JAMoL constitutes an important case management tool. Copyright © 2018. Published by Elsevier GmbH.

Management of severe blunt hepatic injury in the era of computed tomography and transarterial embolization: A systematic review and critical appraisal of the literature.

PubMed

Melloul, Emmanuel; Denys, Alban; Demartines, Nicolas

2015-09-01

During the last decade, the management of blunt hepatic injury has considerably changed. Three options are available as follows: nonoperative management (NOM), transarterial embolization (TAE), and surgery. We aimed to evaluate in a systematic review the current practice and outcomes in the management of Grade III to V blunt hepatic injury. The MEDLINE database was searched using PubMed to identify English-language citations published after 2000 using the key words blunt, hepatic injury, severe, and grade III to V in different combinations. Liver injury was graded according to the American Association for the Surgery of Trauma classification on computed tomography (CT). Primary outcome analyzed was success rate in intention to treat. Critical appraisal of the literature was performed using the validated National Institute for Health and Care Excellence "Quality Assessment for Case Series" system. Twelve articles were selected for critical appraisal (n = 4,946 patients). The median quality score of articles was 4 of 8 (range, 2-6). Overall, the median Injury Severity Score (ISS) at admission was 26 (range, 0.6-75). A median of 66% (range, 0-100%) of patients was managed with NOM, with a success rate of 94% (range, 86-100%). TAE was used in only 3% of cases (range, 0-72%) owing to contrast extravasation on CT with a success rate of 93% (range, 81-100%); however, 9% to 30% of patients required a laparotomy. Thirty-one percent (range, 17-100%) of patients were managed with surgery owing to hemodynamic instability in most cases, with 12% to 28% requiring secondary TAE to control recurrent hepatic bleeding. Mortality was 5% (range, 0-8%) after NOM and 51% (range, 30-68%) after surgery. NOM of Grade III to V blunt hepatic injury is the first treatment option to manage hemodynamically stable patients. TAE and surgery are considered in a highly selective group of patients with contrast extravasation on CT or shock at admission, respectively. Additional standardization of the reports is necessary to allow accurate comparisons of the various management strategies. Systematic review, level IV.

Integrated Pest Management of Coffee Berry Borer: Strategies from Latin America that Could Be Useful for Coffee Farmers in Hawaii

PubMed Central

Aristizábal, Luis F.; Bustillo, Alex E.; Arthurs, Steven P.

2016-01-01

The coffee berry borer (CBB), Hypothenemus hampei Ferrari (Coleoptera: Curculionidae: Scolytinae) is the primary arthropod pest of coffee plantations worldwide. Since its detection in Hawaii (September 2010), coffee growers are facing financial losses due to reduced quality of coffee yields. Several control strategies that include cultural practices, biological control agents (parasitoids), chemical and microbial insecticides (entomopathogenic fungi), and a range of post-harvest sanitation practices have been conducted to manage CBB around the world. In addition, sampling methods including the use of alcohol based traps for monitoring CBB populations have been implemented in some coffee producing countries in Latin America. It is currently unclear which combination of CBB control strategies is optimal under economical, environmental, and sociocultural conditions of Hawaii. This review discusses components of an integrated pest management program for CBB. We focus on practical approaches to provide guidance to coffee farmers in Hawaii. Experiences of integrated pest management (IPM) of CBB learned from Latin America over the past 25 years may be relevant for establishing strategies of control that may fit under Hawaiian coffee farmers’ conditions. PMID:26848690

Weight management practices associated with PCOS and their relationships with diet and physical activity.

PubMed

Moran, L J; Brown, W J; McNaughton, S A; Joham, A E; Teede, H J

2017-03-01

Do weight management practices differ in women with and without PCOS? Women in the general population with self-reported PCOS are more likely to be using healthy weight management practices and alternative non-lifestyle measures for weight management than women without PCOS. Lifestyle management is the first-line treatment in PCOS. However, the specific weight management practices used by women with PCOS and their effect on diet and physical activity are unclear. The study was a population-based observational cross-sectional study involving women in the 1973-1978 cohort (n = 7767 total; n = 556 with PCOS, n = 7211 without PCOS). Women with and without self-reported PCOS were included. Self-reported outcome measures included healthy lifestyle-related or alternative non-lifestyle-related (e.g. laxatives or smoking) weight management practices, dietary intake and physical activity. Women with PCOS were more likely to be following both healthy [reducing meal or snack size (odds ratio (OR) 1.50, 95% CI 1.14, 1.96, P = 0.004) and reducing fat or sugar intake (OR 1.32, 95% CI 1.03, 1.69, P = 0.027) or following a low glycaemic index diet (OR 2.88, 95% CI 2.30, 3.59, P < 0.001)] and alternative [smoking (OR 1.60, 95% CI 1.02, 2.52, P = 0.043) or use of laxative, diet pills, fasting or diuretics (OR 1.45, 95% CI 1.07, 1.97, P = 0.017)] weight management practices than women without PCOS. In PCOS, the use of a range of healthy weight management practices was associated with increases in physical activity (P < 0.001), diet quality (P < 0.001), percentage protein intake (P < 0.001) and decreases in glycaemic index (P < 0.001), and percentages of fat (P = 0.001), saturated fat (P < 0.001) or fibre (P = 0.003). Use of alternative weight management practices was associated with decreases in diet quality. Limitations include the use of self-reported data for PCOS, height, weight, diet, physical activity and weight management behaviours. In PCOS, we should focus on improving healthy weight practices across both diet quality and quantity, and on assessing alternative weight practices and their potential adverse effect on dietary intake. L.M. is supported by a South Australian Cardiovascular Research Development Program Fellowship (ID AC11S374); a program collaboratively funded by the National Heart Foundation, the South Australian Department of Health and the South Australian Health and Medical Research Institute. H.T. is supported by the NHMRC. S.A.M. is supported by an NHMRC Career Development Fellowship Level 2, ID1104636 and was previously supported by an ARC Future Fellowship (2011-2015, FT100100581). The authors declare no conflict of interest. Not applicable. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Possible global environmental impacts of solid waste practices

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

Davis, M.M.; Holter, G.M.; DeForest, T.J.

1994-09-01

Pollutants resulting from the management of solid waste have been shown to affect the air, land, oceans, and waterways. In addition, solid wastes have other, more indirect impacts such as reduction in feedstocks of natural resources, because useful materials are disposed of rather than recycled. The objective of this study is to evaluate solid waste management practices that have negative implications on the global environment and develop recommendations for reducing such impacts. Recommendations identifying needed changes are identified that will reduce global impacts of solid waste practices in the future. The scope of this study includes the range of non-hazardousmore » solid wastes produced within our society, including municipal solid waste (MSW) and industrial solid waste (ISW), as well as industry-specific wastes from activities such as construction, demolition, and landclearing. Most solid waste management decisions continue to be made and implemented at very local levels, predominantly with a short-term focus to respond to relatively immediate pressures of landfill shortages, funding problems, political considerations, and the like. In this rush to address immediate local problems, little consideration is being given to potential impacts, either short- or long-term, at the national or global level resulting from solid waste management practices. More and more, the cumulative impacts from local decisions concerning solid waste management are beginning to manifest themselves in broader, longer-term impacts than are being addressed by the decision-makers or, at the very least, are presenting a greater and greater potential for such impacts.« less

KSC-04pd1654

NASA Image and Video Library

2004-08-05

KENNEDY SPACE CENTER, FLA. - At the ribbon cutting for the Enhanced Firing Range on Schwartz Rd. at Kennedy Space Center, Dave Saleeba (left with weapon) and Center Director Jim Kennedy (right, with weapon) practice firing on the new range. Saleeba is assistant administrator with the Office of Security Management and Safeguards at NASA Headquarters and was a guest speaker at the ceremony. NASA’s Federal Law Enforcement Training Academy’s firing range has been upgraded to include a “rifle-grade” shoot house, a portable, tactical “shoot-back” trailer for cover and concealment drills, automated running targets and a new classroom facility. They are added to the existing three firearms ranges, “pistol-grade” shoot house, obstacle course and rappel tower. NASA’s Security Management and Safeguards Office funded the enhancements in order to improve ability to train the KSC security force and to support local, state and federal law enforcement agencies in Homeland Security.

KSC-04PD-1654

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. At the ribbon cutting for the Enhanced Firing Range on Schwartz Rd. at Kennedy Space Center, Dave Saleeba (left with weapon) and Center Director Jim Kennedy (right, with weapon) practice firing on the new range. Saleeba is assistant administrator with the Office of Security Management and Safeguards at NASA Headquarters and was a guest speaker at the ceremony. NASAs Federal Law Enforcement Training Academys firing range has been upgraded to include a rifle-grade shoot house, a portable, tactical shoot-back trailer for cover and concealment drills, automated running targets and a new classroom facility. They are added to the existing three firearms ranges, pistol-grade shoot house, obstacle course and rappel tower. NASAs Security Management and Safeguards Office funded the enhancements in order to improve ability to train the KSC security force and to support local, state and federal law enforcement agencies in Homeland Security.

Ending disruptive behavior: staff nurse recommendations to nurse educators.

PubMed

Lux, Kathleen M; Hutcheson, Jane B; Peden, Ann R

2014-01-01

The purpose of this qualitative descriptive study was to identify educational strategies that can prepare new graduates to manage disruptive behavior (DB) in the workplace. DB is any inappropriate behavior, confrontation, or conflict - ranging from verbal abuse to sexual harassment - that harms or intimidates others to the extent that quality of care or patient safety could be compromised. Individual interviews were conducted with nine staff nurses currently in practice in acute care settings in the United States. Staff nurses recommended educational strategies that focused on communication skills for professional practice. These included learning how to communicate with hostile individuals, and giving and receiving constructive criticism. Descriptions that participants provided about their work culture were an unexpected finding that has relevance for nurse educators as they prepare students for transition to practice Nurses described lack of management support and intervention for DB situations, personality clashes with coworkers, and devaluation of nursing work as affecting professional practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mind the Gap: How do climate and agricultural management explain the "yield gap" of croplands around the world?

NASA Astrophysics Data System (ADS)

Licker, R.; Foley, J. A.; Johnston, M.

2007-12-01

At present, cultivated lands extend across approximately fifteen million square kilometers of the Earth's surface, making it one of the most dominant land cover types. The management practices used on these lands have become increasingly intensified, requiring large inputs of fertilizers and water, in addition to mechanization and biotechnology. These intensified practices have had implications for ecosystem goods and services ranging from water quality and availability to carbon sequestration. However, the billions of additional people that are projected to inhabit the planet in the twenty-first century will require further outputs from our global agricultural system. Given our food system's already expansive and intensive state, it is important to consider where the additional yields might come from and what additional management inputs this might require. In this study, we compare yields both within crop types and within regions of similar climate to determine where yield gaps exist. We do so using recently created, five-minute datasets of the area harvested and yield of 175 different crop types for the year 2000. We also explore the links of these yield gaps to global patterns of management. For example, we consider the ways in which management practices such as irrigation and fire are influencing yields around the world - analyses that can help critically evaluate the level of management currently employed and help imagine what management might be necessary to achieve higher yields in the future. These data will be needed in the next generation of Earth System models, in order to better represent the practices of agricultural land use in more realistic ways, thereby improving our understanding of land use / land cover change on the global carbon and water cycles, and the climate system.

Analysis of genotype by environment interaction in Louisiana sugarcane research plots by GGE biplots

USDA-ARS?s Scientific Manuscript database

Genotype by environment (G x E) interactions complicate genotype selection in breeding programs. In south Louisiana, sugarcane is cultivated under a wide range of environments including soil types and cultural management practices. To evaluate experimental genotypes in different environments, the va...

INFLUENCE OF DIET ON THE PERFORMANCE OF BOVINE FECAL POLLUTION DETECTION METHODS AND MICROBIAL POPULATION STRUCTURE

EPA Science Inventory

ABSTRACT Background and Aims. Waterborne diseases originating from bovine fecal material are a significant public health issue. Ensuring water quality requires the use of methods that can consistently identify pollution across a broad range of management practices. One practi...

BIM: Enabling Sustainability and Asset Management through Knowledge Management

PubMed Central

2013-01-01

Building Information Modeling (BIM) is the use of virtual building information models to develop building design solutions and design documentation and to analyse construction processes. Recent advances in IT have enabled advanced knowledge management, which in turn facilitates sustainability and improves asset management in the civil construction industry. There are several important qualifiers and some disadvantages of the current suite of technologies. This paper outlines the benefits, enablers, and barriers associated with BIM and makes suggestions about how these issues may be addressed. The paper highlights the advantages of BIM, particularly the increased utility and speed, enhanced fault finding in all construction phases, and enhanced collaborations and visualisation of data. The paper additionally identifies a range of issues concerning the implementation of BIM as follows: IP, liability, risks, and contracts and the authenticity of users. Implementing BIM requires investment in new technology, skills training, and development of new ways of collaboration and Trade Practices concerns. However, when these challenges are overcome, BIM as a new information technology promises a new level of collaborative engineering knowledge management, designed to facilitate sustainability and asset management issues in design, construction, asset management practices, and eventually decommissioning for the civil engineering industry. PMID:24324392

United States Department of Agriculture-Agricultural Research Service research programs on microbes for management of plant-parasitic nematodes.

PubMed

Meyer, Susan L F

2003-01-01

Restrictions on the use of conventional nematicides have increased the need for new methods of managing plant-parasitic nematodes. Consequently, nematode-antagonistic microbes, and active compounds produced by such organisms, are being explored as potential additions to management practices. Programs in this area at the USDA Agricultural Research Service investigate applied biocontrol agents, naturally occurring beneficial soil microbes and natural compounds. Specific research topics include use of plant growth-promoting rhizobacteria and cultural practices for management of root-knot and ring nematodes, determination of management strategies that enhance activity of naturally occurring Pasteuria species (bacterial obligate parasites of nematodes), studies on interactions between biocontrol bacteria and bacterial-feeding nematodes, and screening of microbes for compounds active against plant-parasitic nematodes. Some studies involve biocontrol agents that are active against nematodes and soil-borne plant-pathogenic fungi, or combinations of beneficial bacteria and fungi, to manage a spectrum of plant diseases or to increase efficacy over a broader range of environmental conditions. Effective methods or agents identified in the research programs are investigated as additions to existing management systems for plant-parasitic nematodes.

BIM: enabling sustainability and asset management through knowledge management.

PubMed

Kivits, Robbert Anton; Furneaux, Craig

2013-11-10

Building Information Modeling (BIM) is the use of virtual building information models to develop building design solutions and design documentation and to analyse construction processes. Recent advances in IT have enabled advanced knowledge management, which in turn facilitates sustainability and improves asset management in the civil construction industry. There are several important qualifiers and some disadvantages of the current suite of technologies. This paper outlines the benefits, enablers, and barriers associated with BIM and makes suggestions about how these issues may be addressed. The paper highlights the advantages of BIM, particularly the increased utility and speed, enhanced fault finding in all construction phases, and enhanced collaborations and visualisation of data. The paper additionally identifies a range of issues concerning the implementation of BIM as follows: IP, liability, risks, and contracts and the authenticity of users. Implementing BIM requires investment in new technology, skills training, and development of new ways of collaboration and Trade Practices concerns. However, when these challenges are overcome, BIM as a new information technology promises a new level of collaborative engineering knowledge management, designed to facilitate sustainability and asset management issues in design, construction, asset management practices, and eventually decommissioning for the civil engineering industry.

Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units.

PubMed

Render, Marta L; Freyberg, Ron W; Hasselbeck, Rachael; Hofer, Timothy P; Sales, Anne E; Deddens, James; Levesque, Odette; Almenoff, Peter L

2011-06-01

BACKGROUND Veterans Health Administration (VA) intensive care units (ICUs) develop an infrastructure for quality improvement using information technology and recruiting leadership. METHODS Setting Participation by the 183 ICUs in the quality improvement program is required. Infrastructure includes measurement (electronic data extraction, analysis), quarterly web-based reporting and implementation support of evidence-based practices. Leaders prioritise measures based on quality improvement objectives. The electronic extraction is validated manually against the medical record, selecting hospitals whose data elements and measures fall at the extremes (10th, 90th percentile). results are depicted in graphic, narrative and tabular reports benchmarked by type and complexity of ICU. RESULTS The VA admits 103 689±1156 ICU patients/year. Variation in electronic business practices, data location and normal range of some laboratory tests affects data quality. A data management website captures data elements important to ICU performance and not available electronically. A dashboard manages the data overload (quarterly reports ranged 106-299 pages). More than 85% of ICU directors and nurse managers review their reports. Leadership interest is sustained by including ICU targets in executive performance contracts, identification of local improvement opportunities with analytic software, and focused reviews. CONCLUSION Lessons relevant to non-VA institutions include the: (1) need for ongoing data validation, (2) essential involvement of leadership at multiple levels, (3) supplementation of electronic data when key elements are absent, (4) utility of a good but not perfect electronic indicator to move practice while improving data elements and (5) value of a dashboard.

Empowering European communities to improve natural resource management for human well-being: the OPPLA web portal & communities of practice

NASA Astrophysics Data System (ADS)

Metzger, M.; Brown, C.; Pérez-Soba, M.; Rounsevell, M.; Verweij, P.; Delbaere, B.; Cojocaru, G.; Saarikoski, H.; Harrison, P.; Zellmer, K.

2014-12-01

The ecosystem services concept is seen by many as a useful paradigm to support decision-making at the complex interface between science, policy and practice. However, to be successful, it requires a strong willingness for collaboration and joint understanding. In support of this aspiration, OPPLA is being developed as a web portal to enable European communities to better manage ecosystems for human well-being and livelihoods. OPPLA will provide access to a variety of online resources such as tools, case studies, lessons learned, videos, manuals and training and educational materials. It will also provide expert forums and spaces for discussions between researchers, practitioners and decision makers. Hence a critical aspect of the success of OPPLA is the co-evolution of communities of practice. An example of a community of practice is the recently launched Ecosystem Services Community - Scotland (ESCom-Scotland; escomscotland.wordpress.com). ESCom-Scotland aims to support better management of Scotland's natural resources by helping to establish a community of practice between individuals and groups involved in the science, policy and practice behind sustainable ecosystem management. It aspires to encourage the sharing of ideas, increase collaboration and to initiate a support network for those engaging with the ecosystem services concept and it will use the OPPLA resources to support these activities. OPPLA is currently at the developmental stage and was instigated by two large European Commission funded research projects: OPERAs (www.operas-project.eu) and OpenNESS (www.openness-project.eu), with a combined budget of ca. €24m. These projects aim to improve understanding of how ecosystem services contribute to human well-being in different social-ecological systems. Research will establish whether, how and under what conditions the ecosystem services concept can move beyond the academic domain towards practical implementation in support of sustainable ecosystem management. New insights, and improved or novel tools and instruments, will be tested in practice in case studies that cover a range of socio-ecological systems across locales, sectors, scales and time. This presentation will discuss the development of OPPLA and the communities of practice that are emerging around it.

Towards an integrated flood management approach to address trade-offs between ecosystem services: Insights from the Dutch and German Rhine, Hungarian Tisza, and Chinese Yangtze basins

NASA Astrophysics Data System (ADS)

Halbe, Johannes; Knüppe, Kathrin; Knieper, Christian; Pahl-Wostl, Claudia

2018-04-01

The utilization of ecosystem services in flood management is challenged by the complexity of human-nature interactions and practical implementation barriers towards more ecosystem-based solutions, such as riverine urban areas or technical infrastructure. This paper analyses how flood management has dealt with trade-offs between ecosystem services and practical constrains towards more ecosystem-based solutions. To this end, we study the evolution of flood management in four case studies in the Dutch and German Rhine, the Hungarian Tisza, and the Chinese Yangtze basins during the last decades, focusing on the development and implementation of institutions and their link to ecosystem services. The complexity of human-nature interactions is addressed by exploring the impacts on ecosystem services through the lens of three management paradigms: (1) the control paradigm, (2) the ecosystem-based paradigm, and (3) the stakeholder involvement paradigm. Case study data from expert interviews and a literature search were structured using a database approach prior to qualitative interpretation. Results show the growing importance of the ecosystem-based and stakeholder involvement paradigms which has led to the consideration of a range of regulating and cultural ecosystem services that had previously been neglected. We detected a trend in flood management practice towards the combination of the different paradigms under the umbrella of integrated flood management, which aims at finding the most suitable solution depending on the respective regional conditions.

Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study.

PubMed

Blakeman, Tom; Protheroe, Joanne; Chew-Graham, Carolyn; Rogers, Anne; Kennedy, Anne

2012-04-01

Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. To explore processes underpinning the implementation of CKD management in primary care. Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity.

CQESTR Simulation of Soil Organic Matter Dynamics in Long-term Agricultural Experiments across USA

NASA Astrophysics Data System (ADS)

Gollany, H.; Liang, Y.; Albrecht, S.; Rickman, R.; Follett, R.; Wilhelm, W.; Novak, J.

2009-04-01

Soil organic matter (SOM) has important chemical (supplies nutrients, buffers and adsorbs harmful chemical compounds), biological (supports the growth of microorganisms and micro fauna), and physical (improves soil structure and soil tilth, stores water, and reduces surface crusting, water runoff) functions. The loss of 20 to 50% of soil organic carbon (SOC) from USA soils after converting native prairie or forest to production agriculture is well documented. Sustainable management practices for SOC is critical for maintaining soil productivity and responsible utilization of crop residues. As crop residues are targeted for additional uses (e.g., cellulosic ethanol feedstock) developing C models that predict change in SOM over time with change in management becomes increasingly important. CQESTR, pronounced "sequester," is a process-based C balance model that relates organic residue additions, crop management and soil tillage to SOM accretion or loss. The model works on daily time-steps and can perform long-term (100-year) simulations. Soil organic matter change is computed by maintaining a soil C budget for additions, such as crop residue or added amendments like manure, and organic C losses through microbial decomposition. Our objective was to simulate SOM changes in agricultural soils under a range of soil parent materials, climate and management systems using the CQESTR model. Long-term experiments (e.g. Champaign, IL, >100 yrs; Columbia, MO, >100 yrs; Lincoln, NE, 20 yrs) under various tillage practices, organic amendments, crop rotations, and crop residue removal treatments were selected for their documented history of the long-term effects of management practice on SOM dynamics. Simulated and observed values from the sites were significantly related (r2 = 94%, P < 0.001) with slope not significantly different from 1. Recent interest in crop residue removal for biofuel feedstock prompted us to address that as a management issue. CQESTR successfully simulated a substantial decline in SOM with 90% of crop residue removal for 50 years under various rotations at Columbia, MO and Champaign, IL. An increase in SOM following addition of manure was also well simulated. However, the model underestimated SOM for a fertilized treatment at Columbia. We estimated that a minimum of 8.0 Mg/ha/yr of crop residue and organic amendments (4.0 Mg C ha/yr) was required to prevent a decline in SOM at the Morrow Plots in Champaign, IL. More studies are needed to evaluate the CQESTR model's performance in predicting the amount of crop residue required to maintain the SOM concentration in different soils under a wide range of management and climatic conditions. Given the high correlation of simulated and observed SOM changes, CQESTR can be used to consider a wide range of scenarios before making recommendations or implementing proposed changes. CQESTR in conjunction with the local conditions can guide planning and development of sustainable crop and soil management practices.

Still a difficult business? Negotiating alcohol-related problems in general practice consultations.

PubMed

Rapley, Tim; May, Carl; Frances Kaner, Eileen

2006-11-01

This paper describes general practitioners' (GPs) experiences of detecting and managing alcohol and alcohol-related problems in consultations. We undertook qualitative research in two phases in the North-East of England. Initially, qualitative interviews with 29 GPs explored their everyday work with patients with alcohol-related issues. We then undertook group interviews--two with GPs and one with a primary care team--where they discussed and challenged findings of the interviews. The GPs reported routinely discussing alcohol with patients with a range of alcohol-related problems. GPs believed that this work is important, but felt that until patients were willing to accept that their alcohol consumption was problematic they could achieve very little. They tentatively introduced alcohol as a potential problem, re-introduced the topic periodically, and then waited until the patient decided to change their behaviour. They were aware that they could identify and manage more patients. A lack of time and having to work with the multiple problems that patients brought to consultations were the main factors that stopped GPs managing more risky drinkers. Centrally, we compared the results of our study with [Thom, B., & Tellez, C. (1986). A difficult business-Detecting and managing alcohol-problems in general-practice. British Journal of Addiction, 81, 405-418] seminal study that was undertaken 20 years ago. We show how the intellectual, moral, emotional and practical difficulties that GPs currently face are quite similar to those faced by GPs from 20 years ago. As the definition of what could constitute abnormal alcohol consumption has expanded, so the range of consultations that they may have to negotiate these difficulties in has also expanded.

The trophy hunting of African lions: scale, current management practices and factors undermining sustainability.

PubMed

Lindsey, Peter Andrew; Balme, Guy Andrew; Funston, Paul; Henschel, Philipp; Hunter, Luke; Madzikanda, Hilary; Midlane, Neil; Nyirenda, Vincent

2013-01-01

The trophy hunting of lions Panthera leo is contentious due to uncertainty concerning conservation impacts and because of highly polarised opinions about the practice. African lions are hunted across at least ~558,000 km(2), which comprises 27-32% of the lion range in countries where trophy hunting of the species is permitted. Consequently, trophy hunting has potential to impart significant positive or negative impacts on lions. Several studies have demonstrated that excessive trophy harvests have driven lion population declines. There have been several attempts by protectionist non-governmental organisations to reduce or preclude trophy hunting via restrictions on the import and export of lion trophies. We document the management of lion hunting in Africa and highlight challenges which need addressing to achieve sustainability. Problems include: unscientific bases for quota setting; excessive quotas and off-takes in some countries; fixed quotas which encourage over-harvest; and lack of restrictions on the age of lions that can be hunted. Key interventions needed to make lion hunting more sustainable, include implementation of: enforced age restrictions; improved trophy monitoring; adaptive management of quotas and a minimum length of lion hunts of at least 21 days. Some range states have made important steps towards implementing such improved management and off-takes have fallen steeply in recent years. For example age restrictions have been introduced in Tanzania and in Niassa in Mozambique, and are being considered for Benin and Zimbabwe, several states have reduced quotas, and Zimbabwe is implementing trophy monitoring. However, further reforms are needed to ensure sustainability and reduce conservation problems associated with the practice while allowing retention of associated financial incentives for conservation.

The Trophy Hunting of African Lions: Scale, Current Management Practices and Factors Undermining Sustainability

PubMed Central

Lindsey, Peter Andrew; Balme, Guy Andrew; Funston, Paul; Henschel, Philipp; Hunter, Luke; Madzikanda, Hilary; Midlane, Neil; Nyirenda, Vincent

2013-01-01

The trophy hunting of lions Panthera leo is contentious due to uncertainty concerning conservation impacts and because of highly polarised opinions about the practice. African lions are hunted across at least ∼558,000 km2, which comprises 27–32% of the lion range in countries where trophy hunting of the species is permitted. Consequently, trophy hunting has potential to impart significant positive or negative impacts on lions. Several studies have demonstrated that excessive trophy harvests have driven lion population declines. There have been several attempts by protectionist non-governmental organisations to reduce or preclude trophy hunting via restrictions on the import and export of lion trophies. We document the management of lion hunting in Africa and highlight challenges which need addressing to achieve sustainability. Problems include: unscientific bases for quota setting; excessive quotas and off-takes in some countries; fixed quotas which encourage over-harvest; and lack of restrictions on the age of lions that can be hunted. Key interventions needed to make lion hunting more sustainable, include implementation of: enforced age restrictions; improved trophy monitoring; adaptive management of quotas and a minimum length of lion hunts of at least 21 days. Some range states have made important steps towards implementing such improved management and off-takes have fallen steeply in recent years. For example age restrictions have been introduced in Tanzania and in Niassa in Mozambique, and are being considered for Benin and Zimbabwe, several states have reduced quotas, and Zimbabwe is implementing trophy monitoring. However, further reforms are needed to ensure sustainability and reduce conservation problems associated with the practice while allowing retention of associated financial incentives for conservation. PMID:24058491

Challenges for Sustainable Land Management through Climate-Smart Agriculture

NASA Astrophysics Data System (ADS)

Dougill, Andrew; Stringer, Lindsay

2017-04-01

There are increasing pushes for agricultural land management to be both sustainable and climate-smart (in terms of increasing productivity, building resilience to climate change and enhancing carbon storage). Climate-smart agriculture initiatives include conservation agriculture, based on minimum soil disturbance, permanent soil cover and crop rotation, and agroforestry. Such efforts address key international goals of the United Nations Convention to Combat Desertification (UNCCD) and United Nations Framework Convention on Climate Change (UNFCCC), but as yet have not seen widespread uptake. Based on analyses of different project interventions from across a range of southern African countries, we outline the inter-related challenges that are preventing adoption of climate-smart agriculture initiatives. We then identify routes to building multi-stakeholder partnerships and empowering communities through participatory monitoring with the aim of increasing uptake of such sustainable land management practices. Good practice examples remain largely restricted to local-level project interventions with significant donor (or private-sector) support, aligned to short-term community priorities relating to access to inputs or reduced labour requirements. Scaling-up to district- and national-level initiatives is yet to be widely successful due to problems of: limited policy coherence; a lack of communication between stakeholders at different levels; and limited understanding of long-term benefits associated with changes in agricultural practices. We outline opportunities associated with improved communication of climate information, empowerment of district-level adaptation planning and diversification of agricultural livelihood strategies as key routes to guide farmers towards more sustainable, and climate-smart, land management practices. Recent experiences in Malawi, which has experienced significant floods and an El Niño drought year in the last two years, are used to empirically illustrate the extent of the remaining challenges in moving from 'win-win' conceptualisations to implementing significant changes in land management practices.

Prioritizing Crop Management to Increase Nitrogen Use Efficiency in Australian Sugarcane Crops.

PubMed

Thorburn, Peter J; Biggs, Jody S; Palmer, Jeda; Meier, Elizabeth A; Verburg, Kirsten; Skocaj, Danielle M

2017-01-01

Sugarcane production relies on the application of large amounts of nitrogen (N) fertilizer. However, application of N in excess of crop needs can lead to loss of N to the environment, which can negatively impact ecosystems. This is of particular concern in Australia where the majority of sugarcane is grown within catchments that drain directly into the World Heritage listed Great Barrier Reef Marine Park. Multiple factors that impact crop yield and N inputs of sugarcane production systems can affect N use efficiency (NUE), yet the efficacy many of these factors have not been examined in detail. We undertook an extensive simulation analysis of NUE in Australian sugarcane production systems to investigate (1) the impacts of climate on factors determining NUE, (2) the range and drivers of NUE, and (3) regional variation in sugarcane N requirements. We found that the interactions between climate, soils, and management produced a wide range of simulated NUE, ranging from ∼0.3 Mg cane (kg N) -1 , where yields were low (i.e., <50 Mg ha -1 ) and N inputs were high, to >5 Mg cane (kg N) -1 in plant crops where yields were high and N inputs low. Of the management practices simulated (N fertilizer rate, timing, and splitting; fallow management; tillage intensity; and in-field traffic management), the only practice that significantly influenced NUE in ratoon crops was N fertilizer application rate. N rate also influenced NUE in plant crops together with the management of the preceding fallow. In addition, there is regional variation in N fertilizer requirement that could make N fertilizer recommendations more specific. While our results show that complex interrelationships exist between climate, crop growth, N fertilizer rates and N losses to the environment, they highlight the priority that should be placed on optimizing N application rate and fallow management to improve NUE in Australian sugarcane production systems. New initiatives in seasonal climate forecasting, decisions support systems and enhanced efficiency fertilizers have potential for making N fertilizer management more site specific, an action that should facilitate increased NUE.

Prioritizing Crop Management to Increase Nitrogen Use Efficiency in Australian Sugarcane Crops

PubMed Central

Thorburn, Peter J.; Biggs, Jody S.; Palmer, Jeda; Meier, Elizabeth A.; Verburg, Kirsten; Skocaj, Danielle M.

2017-01-01

Sugarcane production relies on the application of large amounts of nitrogen (N) fertilizer. However, application of N in excess of crop needs can lead to loss of N to the environment, which can negatively impact ecosystems. This is of particular concern in Australia where the majority of sugarcane is grown within catchments that drain directly into the World Heritage listed Great Barrier Reef Marine Park. Multiple factors that impact crop yield and N inputs of sugarcane production systems can affect N use efficiency (NUE), yet the efficacy many of these factors have not been examined in detail. We undertook an extensive simulation analysis of NUE in Australian sugarcane production systems to investigate (1) the impacts of climate on factors determining NUE, (2) the range and drivers of NUE, and (3) regional variation in sugarcane N requirements. We found that the interactions between climate, soils, and management produced a wide range of simulated NUE, ranging from ∼0.3 Mg cane (kg N)-1, where yields were low (i.e., <50 Mg ha-1) and N inputs were high, to >5 Mg cane (kg N)-1 in plant crops where yields were high and N inputs low. Of the management practices simulated (N fertilizer rate, timing, and splitting; fallow management; tillage intensity; and in-field traffic management), the only practice that significantly influenced NUE in ratoon crops was N fertilizer application rate. N rate also influenced NUE in plant crops together with the management of the preceding fallow. In addition, there is regional variation in N fertilizer requirement that could make N fertilizer recommendations more specific. While our results show that complex interrelationships exist between climate, crop growth, N fertilizer rates and N losses to the environment, they highlight the priority that should be placed on optimizing N application rate and fallow management to improve NUE in Australian sugarcane production systems. New initiatives in seasonal climate forecasting, decisions support systems and enhanced efficiency fertilizers have potential for making N fertilizer management more site specific, an action that should facilitate increased NUE. PMID:28928756

Global bioanalytical support.

PubMed

John Lin, Zhongping; Zhang, Tianyi; Pasas-Farmer, Stephanie; Brooks, Stephen D; Moyer, Michael; Connolly, Ron

2014-05-01

With the globalization of drug development, there is an increasing need for global bioanalytical support. Bioanalysis provides pivotal data for toxicokinetic, pharmacokinetic, bioavailability and bioequivalence studies used for regional or global regulatory submission. There are many known complications in building a truly global bioanalytical operation, ranging from lack of global regulatory guidelines and global standard operating procedures to barriers in regional requirements on sample shipping, importation and exportation. The primary objective of this article is to discuss common experiences and challenges facing the biopharmaceutical industry when providing bioanalytical support in a global setting. The key components of global bioanalytical services include the supporting infrastructure, spanning project management, IT support of data management, best practices in bioanalytical method transfer and sample analysis, and comprehensive knowledge of the requirements of bioanalysis guidelines and differences in these guidelines. A case study will highlight best practices for successful management of a global project.

Managing Systemic Change: Future Roles for Social Learning Systems and Communities of Practice?

NASA Astrophysics Data System (ADS)

Blackmore, Chris

The Open University course that prompted this book, and for which it is part of the required reading, focuses on managing systemic change. The course is designed for people who want to develop their skills and understanding in systems thinking and practice, to be used in a range of different domains. Most of the examples in the course come from work-based settings. The idea of managing in this context is mainly about appreciating situations with others, recognising what actions are desirable and feasible and for whom, and getting organised, in order to affect or respond to change in a positive way. It has little to do with control. As Vickers (1978, p. 81) said 'I do not think it too much to hope that an understanding of systemic relations may bring us a better understanding of our limitations and even our possibilities.'

Summary of the Chronic Obstructive Pulmonary Disease Clinical Practice Guideline Revised in 2014 by the Korean Academy of Tuberculosis and Respiratory Disease

PubMed Central

Yoon, Hyoung Kyu; Park, Yong-Bum; Rhee, Chin Kook; Lee, Jin Hwa

2017-01-01

Chronic obstructive pulmonary disease (COPD) results in high morbidity and mortality among patients both domestically and globally. The Korean clinical practice guideline for COPD was revised in 2014. It was drafted by the members of the Korean Academy of Tuberculosis and Respiratory Diseases, as well as participating members of the Health Insurance Review and Assessment Service, Korean Physicians' Association, and Korea Respiration Trouble Association. This revised guideline covers a wide range of topics, including the epidemiology, diagnosis, assessment, monitoring, management, exacerbation, and comorbidities of COPD in Korea. We drafted a guideline on COPD management by performing systematic reviews on the topic of management with the help of a meta-analysis expert. We expect this guideline will be helpful medical doctors treating patients with respiratory conditions, other health care professionals, and government personnel in South Korea. PMID:28747955

A systematic checklist approach to immunosuppression risk management: An audit of practice at two clinical neuroimmunology centers.

PubMed

Mori, Amelia M; Agarwal, Smriti; Lee, Monique W M; Rafferty, Martina; Hardy, Todd A; Coles, Alasdair; Reddel, Stephen W; Riminton, D Sean

2017-11-15

There is no consensus approach to safety screening for immune intervention in clinical neuroimmunology. An immunosuppression risk evaluation checklist was used as an audit tool to assess real-world immunosuppression risk management and formulate recommendations for quality improvements in patient safety. Ninety-nine patients from two centres with 27 non-MS diagnoses were included. An average of 1.9 comorbidities with the potential to adversely impact morbidity and mortality associated with immunosuppression were identified. Diabetes and smoking were the most common, however a range of rarer but potentially life-threatening co-morbid disorders in the context of immunosuppression were identified. Inadequate documentation of risk mitigation tasks was common at 40.1% of total tasks across both cohorts. A routine, systematic immunosuppression checklist approach should be considered to improve immunosuppression risk management in clinical neuroimmunology practice. Copyright © 2017 Elsevier B.V. All rights reserved.

Primary Medical Care Provider Accreditation (PMCPA): pilot evaluation

PubMed Central

Campbell, Stephen M; Chauhan, Umesh; Lester, Helen

2010-01-01

Background While practice-level or team accreditation is not new to primary care in the UK and there are organisational indicators in the Quality and Outcomes Framework (QOF) organisational domain, there is no universal system of accreditation of the quality of organisational aspects of care in the UK. Aim To describe the development, content and piloting of version 1 of the Primary Medical Care Provider Accreditation (PMCPA) scheme, which includes 112 separate criteria across six domains: health inequalities and health promotion; provider management; premises, records, equipment, and medicines management; provider teams; learning organisation; and patient experience/involvement, and to present the results from the pilot service evaluation focusing on the achievement of the 30 core criteria and feedback from practice staff. Design of study Observational service evaluation using evidence uploaded onto an extranet system in support of 30 core summative pilot PMCPA accreditation criteria. Setting Thirty-six nationally representative practices across England, between June and December 2008. Method Study population: interviews with GPs, practice managers, nurses and other relevant staff from the participating practices were conducted, audiotaped, transcribed, and analysed using a thematic approach. For each practice, the number of core criteria that had received either a‘good’or‘satisfactory’rating from a RCGP-trained assessment team, was counted and expressed as a percentage. Results Thirty-two practices completed the scheme, with nine practices passing 100% of core criteria (range: 27–100%). There were no statistical differences in achievement between practices of different sizes and in different localities. Practice feedback highlighted seven key issues: (1) overall view of PMCPA; (2) the role of accreditation; (3) different motivations for taking part; (4) practice managers dominated the workload associated with implementing the scheme; (5) facilitators for implementation; (6) patient benefit — relevance of PMCPA to quality improvement; (7) recommendations for improving the scheme. Conclusion Version 1 of PMCPA has been piloted as a primary care accreditation scheme and shown to be relevant to different types of practice. The scheme is undergoing revision in accordance with the findings from the pilot and ongoing consultation.

Readiness for organisational change among general practice staff.

PubMed

Christl, B; Harris, M F; Jayasinghe, U W; Proudfoot, J; Taggart, J; Tan, J

2010-10-01

Increasing demands on general practice to manage chronic disease may warrant organisational change at the practice level. Staff's readiness for organisational change can act as a facilitator or barrier to implementing interventions aimed at organisational change. To explore general practice staff readiness for organisational change and its association with staff and practices characteristics. This is a cross-sectional study of practices in three Australian states involved in a randomised control trial on the effectiveness of an intervention to enhance the role of non-general practitioner staff in chronic disease management. Readiness for organisational change, job satisfaction and practice characteristics were assessed using questionnaires. 502 staff from 58 practices completed questionnaires. Practice characteristics were not associated with staff readiness for change. A multilevel regression analysis showed statistically significant associations between staff readiness for organisational change (range 1 to 5) and having a non-clinical staff role (vs general practitioner; B=-0.315; 95% CI -0.47 to -0.16; p<0.001), full-time employment (vs part-time; B=0.175, 95% CI 0.06 to 0.29; p<0.01) and lower job satisfaction (B=-0.277, 95% CI -0.40 to -0.15; p<0.001). The results suggest that different approaches are needed to facilitate change which addresses the mix of practice staff. Moderately low job satisfaction may be an opportunity for organisational change.

An assessment tool to help producers improve cow comfort on their farms.

PubMed

Vasseur, E; Gibbons, J; Rushen, J; Pellerin, D; Pajor, E; Lefebvre, D; de Passillé, A M

2015-01-01

Effective management and an appropriate environment are essential for dairy cattle health and welfare. Codes of practice provide dairy producers with best practice guidance for the care and handling of their cattle. New Canadian recommendations have been established for the dairy industry. The objectives of this study were to develop an on-farm assessment tool that helps producers assess how well they are meeting their code of practice and that identifies management and environment modifications that could improve dairy cow comfort on their farms. The assessment tool addressed critical areas of dairy cow comfort, including accommodation and housing (stall design, space allowance, stall management, pen management, milking parlor, and transfer alleys), feed and water (body condition scoring, nutrition), and health and welfare (lameness, claw health, and hoof-trimming). Targets of good practices were identified from the requirements and recommendations of the code of practice. Each farm received a score for each target, ranging from 0 (target not reached) to 100 (target reached). One hundred tiestall and 110 freestall farms were surveyed in 3 provinces of Canada (Quebec, Ontario, and Alberta). The duration of the assessment, in 2 visits lasting, on average, 8 and 9h (range between freestall and tiestall farms) and 4 and 4.1h, was beyond the targeted 3 to 4h due mainly to the animal-based measures; strategies to reduce the duration of the assessment were discussed. Standard operating procedures were developed to ensure consistency in measuring and recording data. Periodical checks were conducted by trainers to ensure all 15 assessors remained above target agreement of weighted kappa ≥0.6. Average scores for all critical areas ranged from 25 to 89% for freestall farms and from 48 to 95% for tiestall farms. These scores need to be considered with caution when comparing farms because scores could not always be calculated the same way between housing systems. An evaluation report was provided and discussed with each producer, identifying strengths and areas for improvement that could benefit dairy cow comfort on their farms. The producers were convinced of the effectiveness of our tool for assessing cow comfort (freestall: 86%; tiestall: 95%) and in assisting them to make decisions for improvements (freestall: 83%; tiestall: 93%). Our cow comfort assessment tool served as background material for the Dairy Farmers of Canada animal care assessment program. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Effects of nutrient management on nitrate levels in ground water near Ephrata Pennsylvania

USGS Publications Warehouse

Hall, David W.

1992-01-01

Effects of the implementation of nutrient management practices on ground-water quality were studied at a 55-acre farm in Lancaster County, Pennsylvania, from 1985-90. After nutrient management practices were implemented at the site in October 1986, statistically significant decreases (Wilcoxon Mann-Whitney test) in median nitrate concentrations in ground-water samples occurred at four of the five wells monitored. The largest decreases in nitrate concentration occurred in samples collected at the wells that had the largest nitrate concentrations prior to nutrient management. The decreases in median nitrate concentrations in ground-water samples ranged from 8 to 32 percent of the median concentrations prior to nutrient management and corresponded to nitrogen application decreases of 39 to 67 percent in contributing areas that were defined upgradient of these wells. Changes in nitrogen applications to the contributing areas of five water wells were correlated (Spearman rank-sum test) with nitrate concentrations of the well water. Changes in ground-water nitrate concentrations lagged behind the changes in applied-nitrogen fertilizers (primarily manure) by approximately 4 to 19 months.

The Integration of Behavioral Science Theory and Clinical Experience for Second-Year Medical Students.

ERIC Educational Resources Information Center

Taylor, Kathryn M.; And Others

1983-01-01

A program is described that relates behavioral science research to cancer care, encourages frank discussion and objective analysis of oncology practice, and attempts to dispell the myth that cancer patients are not medically manageable. A wide range of teaching methods are used. (MSE)

"Green-friendly" best management practices (BMPs) for interstate rest areas -- phase II.

DOT National Transportation Integrated Search

2013-06-01

Interstate rest area buildings in Illinois range in age from 10 to nearly 50 years old and are on display and used 365 days a : year by nearly 40 million people annually. The rest area sites comprise 53 buildings that provide restroom facilities, ven...

Chapter 7. Assessing soil factors in wildland improvement programs

Treesearch

Arthur R. Tiedemann; Carlos F. Lopez

2004-01-01

Soil factors are an important consideration for successful wildland range development or improvement programs. Even though many soil improvement and amelioration practices are not realistic for wildlands, their evaluation is an important step in selection of adapted plant materials for revegetation. This chapter presents information for wildland managers on: the...

Marketing the Arts: A Selected and Annotated Bibliography.

ERIC Educational Resources Information Center

Nakamoto, Kent, Comp.; Levin, Kathi, Comp.

Compiled from the marketing, arts, and arts management literature, this selected list includes materials ranging from theoretical articles and reports of studies to practical guides for marketing techniques. It consists of three sections: Primary Sources, Secondary Sources, and Surveys. Of particular interest to the arts administrator, the first…

Long-range Perspectives in Environmental Education: Producing Practical Problem-solvers.

ERIC Educational Resources Information Center

Barratt, Rod

1997-01-01

Addresses postgraduate environmental education by supported distance learning as offered by the Open University in Great Britain. Refers to techniques for regularly updating material in rapidly developing areas as well as integrating teaching and research. Also refers to the modular course Integrated Safety, Health and Environmental Management.…

Understanding Horizontal Governance. Research Brief

ERIC Educational Resources Information Center

Ferguson, Daniel

2009-01-01

Horizontal governance is an umbrella term that covers a range of approaches to policy development, service delivery issues, and management practices. A horizontal initiative may take place across levels of government, across boundaries between units of a single department or agency or among multiple departments or agencies, or across public,…

Washington Manual: A New Tool for Local School Accounting

ERIC Educational Resources Information Center

Federal Aid Planner, 1972

1972-01-01

An advance glimpse of the revised financial accounting methods for school districts recommended in a new manual from the U. S. Office of Education. The manual is designed to help school districts modernize their financial accounting procedures and their entire range of fiscal management practices. (Author/DN)

Nutrient Uptake and Outcome network (NUOnet): Connecting a Wide Range of Natural Resource Conservation Networks

USDA-ARS?s Scientific Manuscript database

Nutrient application and its uptake by crops are essential to increasing agricultural production, which is essential to feed a growing world population. Efficiency in management of nutrients could be increased with conservation practices that reduce nutrient losses to the environment and promote con...

Effects of Management on Soil Carbon Pools in California Rangeland Ecosystems

NASA Astrophysics Data System (ADS)

Silver, W. L.; Ryals, R.; Lewis, D. J.; Creque, J.; Wacker, M.; Larson, S.

2008-12-01

Rangeland ecosystems managed for livestock production represent the largest land-use footprint globally, covering more than one-quarter of the world's land surface (Asner et al. 2004). In California, rangelands cover an estimated 17 million hectares or approximately 40% of the land area (FRAP 2003). These ecosystems have considerable potential to sequester carbon (C) in soil and offset greenhouse gas emissions through changes in land management practices. Climate policies and C markets may provide incentives for rangeland managers to pursue strategies that optimize soil C storage, yet we lack a thorough understanding of the effects of management on soil C pools in rangelands over time and space. We sampled soil C pools on rangelands in a 260 km2 region of Marin and Sonoma counties to determine if patterns in soil C storage exist with management. Replicate soil samples were collected from 35 fields that spanned the dominant soil orders, plant communities, and management practices in the region while controlling for slope and bioclimatic zone (n = 1050). Management practices included organic amendments, intensive (dairy) and extensive (other) grazing practices, and subsoiling. Soil C pools ranged from approximately 50 to 140 Mg C ha-1 to 1 m depth, with a mean of 99 ± 22 (sd) Mg C ha-1. Differences among sites were due primarily to C concentrations, which exhibited a much larger coefficient of variation than bulk density at all depths. There were no statistically significant differences among the dominant soil orders. Subsoiling appeared to significantly increase soil C content in the top 50 cm, even though subsoiling had only occurred for the first time the previous Nov. Organic amendments also appeared to greatly increase soil C pools, and was the dominant factor that distinguished soil C pools in intensive and extensive land uses. Our results indicate that management has the potential to significantly increase soil C pools. Future research will determine the location of sequestered C within the soil matrix and its turnover time.

The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists

PubMed Central

Fisher, Nathan E.; Cooper, David J.; Rosen, Rochelle K.

2017-01-01

Buddhist-derived meditation practices are currently being employed as a popular form of health promotion. While meditation programs draw inspiration from Buddhist textual sources for the benefits of meditation, these sources also acknowledge a wide range of other effects beyond health-related outcomes. The Varieties of Contemplative Experience study investigates meditation-related experiences that are typically underreported, particularly experiences that are described as challenging, difficult, distressing, functionally impairing, and/or requiring additional support. A mixed-methods approach featured qualitative interviews with Western Buddhist meditation practitioners and experts in Theravāda, Zen, and Tibetan traditions. Interview questions probed meditation experiences and influencing factors, including interpretations and management strategies. A follow-up survey provided quantitative assessments of causality, impairment and other demographic and practice-related variables. The content-driven thematic analysis of interviews yielded a taxonomy of 59 meditation-related experiences across 7 domains: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Even in cases where the phenomenology was similar across participants, interpretations of and responses to the experiences differed considerably. The associated valence ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring. In order to determine what factors may influence the valence, impact, and response to any given experience, the study also identified 26 categories of influencing factors across 4 domains: practitioner-level factors, practice-level factors, relationships, and health behaviors. By identifying a broader range of experiences associated with meditation, along with the factors that contribute to the presence and management of experiences reported as challenging, difficult, distressing or functionally impairing, this study aims to increase our understanding of the effects of contemplative practices and to provide resources for mediators, clinicians, meditation researchers, and meditation teachers. PMID:28542181

Leading interprofessional practice: a conceptual framework to support practitioners in the field of learning disability.

PubMed

McCray, Janet

2003-11-01

One of the key challenges for practitioners in present day health and social care has been responding effectively in the interprofessional teamwork setting, where collaboration is at the centre of professional activity. For whilst practitioners are expected to work interprofessionally there often remains limited attention to the actual process of interprofessional practice itself, within organizational strategy, local workforce development planning and individual continuing professional development. These concerns were a driver for this research with practitioners in the field of learning disability which resulted in the development of a conceptual framework for interprofessional practice. This paper sets out the process of conceptual framework development, underpinned by the concepts of knowledge of learning disabilities, contextual socialisation, empowerment, conflict management, transforming capability and interprofessional reflection on action. The researcher suggests that the framework may offer clinical leaders in learning disabilities and a range of other practice settings a tool to facilitate individual practitioner development, enabling as it does, the identification of a range of critical factors which impact on the outcomes of interprofessional practice intervention.

Supporting chronic disease self-management: translating policies and principles into clinical practice.

PubMed

Higgins, Rosemary; Murphy, Barbara; Worcester, Marian; Daffey, Angela

2012-01-01

To support self-management, health professionals need to adopt a client-centred approach and learn to deliver evidence-based behaviour change interventions. This paper reports on the evaluation of 1- and 2-day training programs developed to improve health professionals' capacity to support chronic disease self-management (CDSM). The 321 participants attended one of eighteen supporting CDSM courses held in urban and rural settings. Participants included nurses, allied health professionals, Aboriginal health workers and general practitioners. Data were collected at three time points: before participation; immediately after the training; and, for a sub-sample of 37 participants, 2 months after the training. Results revealed a significant and sustained increase in CDSM self-efficacy following training regardless of participants' gender, age or qualifications. A thematic analysis of the responses concerning intended practice revealed four main areas of intended practice change, namely: use behavioural strategies; improve communication with clients; adopt a client-centred approach; and improve goal setting. The number of practice changes at 2 months reported by a sub-sample of participants ranged from 1 to 20 with a mean of 14 (s.d.=4). The three most common areas of practice change point to the adoption by health professionals of a collaborative approach with chronic disease patients. Lack of staff trained in CDSM was seen as a major barrier to practice change, with lack of support and finance also named as barriers to practice change. Participants identified that increased training, support and awareness of the principles of supporting CDSM would help to overcome barriers to practice change. These results indicate a readiness among health professionals to adopt a more collaborative approach given the skills and the tools to put this approach into practice.

Safeguarding the provision of ecosystem services in catchment systems.

PubMed

Everard, Mark

2013-04-01

A narrow technocentric focus on a few favored ecosystem services (generally provisioning services) has led to ecosystem degradation globally, including catchment systems and their capacities to support human well-being. Increasing recognition of the multiple benefits provided by ecosystems is slowly being translated into policy and some areas of practice, although there remains a significant shortfall in the incorporation of a systemic perspective into operation management and decision-making tools. Nevertheless, a range of ecosystem-based solutions to issues as diverse as flooding and green space provision in the urban environment offers hope for improving habitat and optimization of beneficial services. The value of catchment ecosystem processes and their associated services is also being increasingly recognized and internalized by the water industry, improving water quality and quantity through catchment land management rather than at greater expense in the treatment costs of contaminated water abstracted lower in catchments. Parallel recognition of the value of working with natural processes, rather than "defending" built assets when catchment hydrology is adversely affected by unsympathetic upstream development, is being progressively incorporated into flood risk management policy. This focus on wider catchment processes also yields a range of cobenefits for fishery, wildlife, amenity, flood risk, and other interests, which may be optimized if multiple stakeholders and their diverse value systems are included in decision-making processes. Ecosystem services, particularly implemented as a central element of the ecosystem approach, provide an integrated framework for building in these different perspectives and values, many of them formerly excluded, into commercial and resource management decision-making processes, thereby making tractable the integrative aspirations of sustainable development. This can help redress deeply entrenched inherited assumptions, habits, and vested interests, replacing them in many management situations with wider recognition of the multiple values of ecosystems and their services. Global interest in taking an ecosystem approach is promoting novel scientific and policy thinking, yet there is a shortfall in its translation into practical management tools. Professional associations may have key roles to play in breaking down barriers to the "mainstreaming" of systemic perspectives into common practice, particularly through joining u different sectors of society essential to their implementation and ongoing adaptive management. Copyright © 2012 SETAC.

Case-mix fails to explain variation in mastectomy rates: management of screen-detected breast cancer in a UK region 1997–2003

PubMed Central

Caldon, L J M; Walters, S J; Reed, J A; Murphy, A; Worley, A; Reed, M W R

2004-01-01

Wide variation in the surgical management of breast cancer exists at hospital, regional, national and international level. To demonstrate whether variation in surgical practice observed at aggregate level between breast units persists following adjustment for case-mix, individual patient-level data from the Trent Breast Screening Programme Quality Assurance database (1997–2003) was analysed. Expected case-mix adjusted mastectomy rates were derived by logistic regression using the variables tumour size, site and grade, patient age and year of presentation, employing the region's overall case-mix adjusted practice as the reference population. The region's 11 breast screening units detected 5109 (3989 invasive) surgically managed primary breast cancers over the 6-year period. A total of 1828 mastectomies (Mx) were performed (Mx rate 35.8%, 95% confidence interval: 34.5–37.1%). Significant variation in mastectomy rates were observed between units (range 25–45%, P<0.0001), and persists following case-mix adjustment (P<0.0001). Two-fold variation in observed to expected unit mastectomy rate coefficient is demonstrated overall (range 0.66–1.36), increasing to almost four-fold variation in cancers less than 15 mm diameter (range 0.55–1.95). Significant variation in surgery for screen-detected primary breast cancer is not explained by case-mix. Further research is required to investigate potential patient and professional causative factors. PMID:15611797

Recruitment and Hiring Strategies of Private Practitioners and Implications for Practice Management Training of Veterinary Students.

PubMed

Kogan, Lori R; Hellyer, Peter W; Stewart, Sherry M; Dowers, Kristy L

2015-01-01

Hiring new employees is one of the most important and difficult decisions all veterinary practice managers and owners face. In an effort to improve hiring decisions, many employers are choosing to screen potential employees more thoroughly through the use of interviews, background checks, personality assessments, and online research including social and professional networking websites. The current study reports results from an anonymous online survey created to evaluate practicing veterinarians' attitudes and practices related to the use of recruitment and hiring tools. Results suggest that, compared to those in other professions, veterinarians underutilize these evaluative tools. The profession could benefit from more opportunities for both practitioners and veterinary students to learn how to utilize a broader range of hiring and recruitment techniques. One area of particular and growing concern is the use of Internet social media for evaluation of potential employees. Despite the fairly low number of participants who indicated they currently research applicants online, a significant number plan to implement this practice in the future. Many students are unaware of how their online postings can affect their future job possibilities and career. It is therefore important to designate time within continuing education programs and professional veterinary curricula to educate these populations about hiring and recruitment tool options and about how to manage their personal Internet interactions (especially social media) to enhance and maintain their professional image (e-professionalism).

Factors influencing how senior nurses and midwives acquire and integrate coaching skills into routine practice: a grounded theory study.

PubMed

Rafferty, Rae; Fairbrother, Greg

2015-06-01

To introduce a theory which describes the process of and explicates the factors moderating, the acquisition and integration of leadership coaching skills into the routine practice of senior nurses and midwives. Organizations invest significant resources in leadership coaching programs to ensure that coaching is embedded as a core function of the manager's role. However, even after training, many managers remain unable to undertake this role successfully. The process by which health professionals translate 'manager as coach' training into successful practice outcomes, has remained largely unexplored. A grounded theory study design. Data, collected between February 2012-May 2013, included in-depth interviews with 20 senior nurses and midwives who had attended a leadership coaching program and analysis of nine reflective practice journals. Multiple researchers coded and analysed the data using constant comparative techniques. The outcomes of coaching training ranged from inappropriate use of the coaching skills through to transformed managerial practice. These outcomes were influenced by the dynamic interaction of three central domains of the emergent theoretical model: pre-existing individual perceptions, program elements and contemporaneous experiences. Interactions occurred within the domains and between them, impacting on activators such as courage, motivation, commitment and confidence. The study offers new insights into how senior nurses and midwives acquire and integrate coaching skills into their routine practice. The process is described as multifactorial and dynamic and has implications for the training design, delivery and organizational support of future leadership coaching programs. © 2015 John Wiley & Sons Ltd.

Energy Use and Carbon Dioxide Emissions from Cropland Production in the United States, 1990-2004

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

West, Tristram O.; Brandt, Craig C; Marland, Gregg

2009-01-01

Changes in cropland production and management influence energy consumption and emissions of CO2 from fossil-fuel combustion. A method was developed to calculate on-site and off-site energy and CO2 emissions for cropping practices in the US at the county scale. Energy consumption and emissions occur on-site from the operation of farm machinery and occur off-site from the manufacture and transport of cropland production inputs, such as fertilizers, pesticides, and agricultural lime. Estimates of fossil-fuel consumption and associated CO2 emissions for cropping practices enable (a) the monitoring of energy and emissions with changes in land management, and (b) the calculation and balancingmore » of regional and national carbon budgets. Results indicate on-site energy use and total energy use (i.e., the sum of on-site and off-site) on US croplands in 2004 ranged from 1.6-7.9 GJ ha-1 yr-1 and from 5.5-20.5 GJ ha-1 yr-1, respectively. On-site and total CO2 emissions in 2004 ranged from 23-176 kg C ha-1 yr-1 and from 91-365 kg C ha-1 yr-1, respectively. During the period of this analysis (1990-2004), national total energy consumption for crop production ranged from 1204-1297 PJ yr-1 (Petajoule = 1 1015 Joule) with associated total fossil CO2 emissions ranging from 22.0-23.2 Tg C yr-1 (Teragram = 1 1012 gram). The annual proportion of on-site CO2 to total CO2 emissions changed depending on the diversity of crops planted. Adoption of reduced tillage practices in the US from 1990 to 2004 resulted in a net emissions reduction of 2.4 Tg C.« less

Healthcare waste management status in Lagos State, Nigeria: a case study from selected healthcare facilities in Ikorodu and Lagos metropolis.

PubMed

Longe, Ezechiel O

2012-06-01

A survey of healthcare waste management practices and their implications for health and the environment was carried out. The study assessed waste management practices in 20 healthcare facilities ranging in capacity from 40 to 600 beds in Ikorodu and metropolitan Lagos, Lagos State, Nigeria. The prevailing healthcare waste management status was analysed. Management issues on quantities and proportion of different constituents of waste, segregation, collection, handling, transportation, treatment and disposal methods were assessed. The waste generation averaged 0.631 kg bed(-1) day(-1) over the survey area. The waste stream from the healthcare facilities consisted of general waste (59.0%), infectious waste (29.7%), sharps and pathological (8.9%), chemical (1.45%) and others (0.95%). Sharps/pathological waste includes disposable syringes. In general, the waste materials were collected in a mixed form, transported and disposed of along with municipal solid waste with attendant risks to health and safety. Most facilities lacked appropriate treatment systems for a variety of reasons that included inadequate funding and little or no priority for healthcare waste management as well as a lack of professionally competent waste managers among healthcare providers. Hazards associated with healthcare waste management and shortcomings in the existing system were identified.

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

PubMed

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

2009-01-01

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

Adherence To Diabetes Mellitus Treatment Guidelines From Theory To Practice: The Missing Link.

PubMed

Hashmi, Noreen Rahat; Khan, Shahzad Ali

2016-01-01

Diabetes mellitus is a complex multisystem disease that requires high quality care. Clinical practice guidelines help physicians and patients make the best possible health care decisions and improve health care management of diabetic patients. These guidelines provide the norms for clinical management as well as monitoring of diabetes care. They are not simple algorithms but are based on structured evidence based diabetic management protocols developed from randomized controlled trials. Despite the widespread availability of this diabetic guideline, their use is suboptimal at best. There are several factors blamed for contributing to this missing link from available theoretical guideline recommendations to practical applications of these guidelines. We present a brief review based on available literature review for an ongoing interventional study being done by authors in two tertiary care hospital in Lahore Pakistan for improving adherence to diabetes guidelines. We will discuss guideline implementation cycle and also present a framework encompassing various factors involved in adherence to guidelines. Until recently the emphasis to improve the guideline adherence targeted the factors relating to individual health care professionals in reference to their knowledge, attitude practice of the guidelines. However, we will discuss that broader range of health care systems, organizational factors, and factors relating to patients which may also significantly impact the adherence to the guidelines. The framework emphasises that it is important to understand the factors that act as barriers and contribute to the missing link between theory and practice of diabetic guidelines. This will help plan appropriate strategies in the pre-implementation stage for effective and improved diabetes guidelines adherence and management.

Avian species richness in relation to intensive forest management practices in early seral tree plantations.

PubMed

Jones, Jay E; Kroll, Andrew J; Giovanini, Jack; Duke, Steven D; Ellis, Tana M; Betts, Matthew G

2012-01-01

Managers of landscapes dedicated to forest commodity production require information about how practices influence biological diversity. Individual species and communities may be threatened if management practices truncate or simplify forest age classes that are essential for reproduction and survival. For instance, the degradation and loss of complex diverse forest in young age classes have been associated with declines in forest-associated Neotropical migrant bird populations in the Pacific Northwest, USA. These declines may be exacerbated by intensive forest management practices that reduce hardwood and broadleaf shrub cover in order to promote growth of economically valuable tree species in plantations. We used a Bayesian hierarchical model to evaluate relationships between avian species richness and vegetation variables that reflect stand management intensity (primarily via herbicide application) on 212 tree plantations in the Coast Range, Oregon, USA. Specifically, we estimated the influence of broadleaf hardwood vegetation cover, which is reduced through herbicide applications, on bird species richness and individual species occupancy. Our model accounted for imperfect detection. We used average predictive comparisons to quantify the degree of association between vegetation variables and species richness. Both conifer and hardwood cover were positively associated with total species richness, suggesting that these components of forest stand composition may be important predictors of alpha diversity. Estimates of species richness were 35-80% lower when imperfect detection was ignored (depending on covariate values), a result that has critical implications for previous efforts that have examined relationships between forest composition and species richness. Our results revealed that individual and community responses were positively associated with both conifer and hardwood cover. In our system, patterns of bird community assembly appear to be associated with stand management strategies that retain or increase hardwood vegetation while simultaneously regenerating the conifer cover in commercial tree plantations.

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature.

PubMed

Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James Sa

2018-01-01

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs - including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don'ts) when setting up MDT-driven cancer care.

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature

PubMed Central

Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James SA

2018-01-01

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs – including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don’ts) when setting up MDT-driven cancer care. PMID:29403284

Good Data Can Be Better Data - How Data Management Maturity Can Help Repositories Improve Operations, Data Quality, And Usability, Helping Researchers

NASA Astrophysics Data System (ADS)

Stall, S.

2015-12-01

Much earth and space science data and metadata are managed and supported by an infrastructure of repositories, ranging from large agency or instrument facilities, to institutions, to smaller repositories including labs. Scientists face many challenges in this ecosystem both on storing their data and in accessing data from others for new research. Critical for all uses is ensuring the credibility and integrity of the data and conveying that and provenance information now and in the future. Accurate information is essential for future researchers to find (or discover) the data, evaluate the data for use (content, temporal, geolocation, precision) and finally select (or discard) that data as meeting a "fit-for-purpose" criteria. We also need to optimize the effort it takes in describing the data for these determinations, which means making it efficient for the researchers who collect the data. At AGU we are developing a program aimed at helping repositories, and thereby researchers, improve data quality and data usability toward these goals. AGU has partnered with the CMMI Institute to develop their Data Management Maturity (DMM) framework within the Earth and space sciences. The CMMI DMM framework guides best practices in a range of data operations, and the application of the DMM, through an assessment, reveals how repositories and institutions can best optimize efforts to improve operations and functionality throughout the data lifecycle and elevate best practices across a variety of data management operations. Supporting processes like data operations, data governance, and data architecture are included. An assessment involves identifying accomplishment, and weaknesses compared to leading practices for data management. Broad application of the DMM can help improve quality in data and operations, and consistency across the community that will facilitate interoperability, discovery, preservation, and reuse. Good data can be better data. Consistency results in sustainability.

The management of vocal fold nodules in children: a national survey of speech-language pathologists.

PubMed

Signorelli, Monique E; Madill, Catherine J; McCabe, Patricia

2011-06-01

The purpose of this study was to determine the management options and voice therapy techniques currently being used by practicing speech-language pathologists (SLPs) to treat vocal fold nodules (VFNs) in children. The sources used by SLPs to inform and guide their clinical decisions when managing VFNs in children were also explored. Sixty-two SLPs completed a 23-item web-based survey. Data was analysed using frequency counts, content analyses, and supplementary analyses. SLPs reported using a range of management options and voice therapy techniques to treat VFNs in children. Voice therapy was reportedly the most frequently used management option across all respondents, with the majority of SLPs using a combination of indirect and direct voice therapy techniques. When selecting voice therapy techniques, the majority of SLPs reported that they did not use the limited external evidence available to guide their clinical decisions. Additionally, the majority of SLPs reported that they frequently relied on lower levels of evidence or non-evidence-based sources to guide clinical practice both in the presence and absence of higher quality evidence. Further research needs to investigate strategies to remove the barriers that impede SLPs use of external evidence when managing VFNs in children.

You and your manager: reducing workplace stress by creating and maintaining a good relationship.

PubMed

Hills, Laura Sachs

2007-01-01

The relationship a medical practice employee has with his or her practice manager is probably the most important relationship the employee will have at work. No matter what position an employee has in the medical practice, it's to his or her advantage to get along well with the practice manager. This article offers concrete suggestions to medical practice employees to help them establish and cultivate a positive working relationship with their practice managers. It examines different working styles of practice managers and suggests strategies for medical practice employees who want or need different amounts and styles of supervision. It describes five personal characteristics a practice manager expects in employees and two basic rules of thumb for using the practice manager's time efficiently. This article also emphasizes the importance of good communication with the practice manager and offers 12 practical and specific tips for building the employee-practice manager relationship. Finally, this article offers advice to medical practice employees about what to do when they disagree with their practice managers.

How accurate are medical oncologists' impressions of management of metastatic colorectal cancer in Australia?

PubMed

Au, Lewis; Turner, Natalie; Wong, Hui-Li; Field, Kathryn; Lee, Belinda; Boadle, David; Cooray, Prasad; Karikios, Deme; Kosmider, Suzanne; Lipton, Lara; Nott, Louise; Parente, Phillip; Tie, Jeanne; Tran, Ben; Wong, Rachel; Yip, Desmond; Shapiro, Jeremy; Gibbs, Peter

2018-04-01

Current efforts to understand patient management in clinical practice are largely based on clinician surveys with uncertain reliability. The TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) database is a multisite registry collecting comprehensive treatment and outcome data on consecutive metastatic colorectal cancer (mCRC) patients at multiple sites across Australia. This study aims to determine the accuracy of oncologists' impressions of real-word practice by comparing clinicians' estimates to data captured by TRACC. Nineteen medical oncologists from nine hospitals contributing data to TRACC completed a 34-question survey regarding their impression of the management and outcomes of mCRC at their own practice and other hospitals contributing to the database. Responses were then compared with TRACC data to determine how closely their impressions reflected actual practice. Data on 1300 patients with mCRC were available. Median clinician estimated frequency of KRAS testing within 6 months of diagnosis was 80% (range: 20-100%); the TRACC documented rate was 43%. Clinicians generally overestimated the rates of first-line treatment, particularly in patients over 75 years. Estimate for bevacizumab in first line was 60% (35-80%) versus 49% in TRACC. Estimated rate for liver resection varied substantially (5-35%), and the estimated median (27%) was inconsistent with the TRACC rate (12%). Oncologists generally felt their practice was similar to other hospitals. Oncologists' estimates of current clinical practice varied and were discordant with the TRACC database, often with a tendency to overestimate interventions. Clinician surveys alone do not reliably capture contemporary clinical practices in mCRC. © 2017 John Wiley & Sons Australia, Ltd.

Enabling and enacting 'practical action' in catchments: responding to the 'wicked problem' of nonpoint source pollution in coastal subtropical Australia.

PubMed

Patterson, James J; Smith, Carl; Bellamy, Jennifer

2015-02-01

Enabling and enacting 'practical action' (i.e., purposeful and concerted collective action) in catchments is a key challenge in responding to a wide range of pressing catchment and natural resource management (NRM) issues. It is particularly a challenge in responding to 'wicked problems,' where generating action is not straightforward and cannot be brought about solely by any single actor, policy or intervention. This paper responds to the critical need to better understand how practical action can be generated in catchments, by conducting an in-depth empirical case study of efforts to manage nonpoint source (NPS) pollution in South East Queensland (SEQ), Australia. SEQ has seen substantial concerted efforts to manage waterway and catchment issues over two decades, yet NPS pollution remains a major problem for waterway health. A novel framework was applied to empirically analyze practical action in three local catchment cases embedded within the broader SEQ region. The analysis focuses on 'enabling capacities' underpinning practical action in catchments. Findings reveal that capacities manifested in different ways in different cases, yet many commonalities also occurred across cases. Interplay between capacities was critical to the emergence of adaptive and contextual forms of practical action in all cases. These findings imply that in order to enable and enact practical action in catchments, it is vital to recognize and support a diversity of enabling capacities across both local and regional levels of decision making and action. This is likely to have relevance for other 'wicked' catchment and NRM problems requiring local responses within broader multiscalar regional problem situations.

Development of a waste management protocol based on assessment of knowledge and practice of healthcare personnel in surgical departments.

PubMed

Mostafa, Gehan M A; Shazly, Mona M; Sherief, Wafaa I

2009-01-01

Good healthcare waste management in a hospital depends on a dedicated waste management team, good administration, careful planning, sound organization, underpinning legislation, adequate financing, and full participation by trained staff. Hence, waste management protocols must be convenient and sensible. To assess the knowledge and practice related to waste management among doctors, nurses, and housekeepers in the surgical departments at Al-Mansoura University Hospital, and to design and validate a waste management protocol for the health team in these settings. This cross-sectional study was carried out in the eight surgical departments at Al-Mansoura University Hospital. All health care personnel and their assistants were included: 38 doctors, 106 nurses, and 56 housekeepers. Two groups of jury were included for experts' opinions validation of the developed protocol, one from academia (30 members) and the other from service providers (30 members). Data were collected using a self-administered knowledge questionnaire for nurses and doctors, and an interview questionnaire for housekeepers. Observation checklists were used for assessment of performance. The researchers developed the first draft of the waste management protocol according to the results of the analysis of the data collected in the assessment phase. Then, the protocol was presented to the jury group for validation, and then was implemented. Only 27.4% of the nurses, 32.1% of the housekeepers, and 36.8% of the doctors had satisfactory knowledge. Concerning practice, 18.9% of the nurses, 7.1% of the housekeepers, and none of the doctors had adequate practice. Nurses' knowledge score had a statistically significant weak positive correlation with the attendance of training courses (r=0.23, p<0.05). Validation of the developed protocol was done, and the percent of agreement ranged between 60.0% and 96.7% for the service group, and 60.0% and 90.0% for the academia group. The majority of the doctors, nurses, and housekeepers have unsatisfactory knowledge and inadequate practice related to health care waste management. The knowledge among nurses is positively affected by attendance of training programs. Based on the findings, a protocol for healthcare waste management was developed and validated. It is recommended to implement the developed waste management protocol for the surgical departments in the designed hospital, with establishment of waste management audits.

Socio-hydrological implications of water management in the dry zone of Sri Lanka

NASA Astrophysics Data System (ADS)

Upeksha Gamage, Isurun; Arachchige Hemachandra Jayasena, Hetti

2018-06-01

Water management plays a vital role in the agricultural economy and living conditions of people in Sri Lanka. Though government and non-government organizations have been readily contributing to water management, it is still inefficient, especially in terms of water allocation, consumption and conservation. To identify factors which could be used to implement integrated water resources management (IWRM), a socio-hydrological study was performed in five areas within the dry zone in Sri Lanka. The study covers a comprehensive analysis of how the household income, demography and education level correlating to water usage, purification and disposal methods. The average household income ranges from LKR 2500 to 15 000 per month. The results show that the average daily usage for drinking, cooking, washing, toiletries and bathing are 3, 5, 10, 7, and 85 L per person, respectively. Majority of the families use dug wells and pipe-borne water as the primary source. Correlation coefficients suggest that higher household income or level of education leads to increased water consumption (R = 0.91, 0.94). There is no linear relationship between the level of education with the good practices of water purification and disposal. Though these results indicate preliminary assessments based on the dry zone practices, efficient water management could be enhanced by strong socio-hydrological implications through educating people on conservation, usage, disposal practices and health concerns.

Final Environmental Assessment for the Establishment of an Air-to-Surface Helicopter Gunnery Training Target Set at White Sands Missile Range, New Mexico

DTIC Science & Technology

2007-12-01

AQCR Air Quality Control Region AR Army Regulation ARC Acoustic Research Complex BLM Bureau of Land Management BMP best management practice CAA...night average A-weighted sound level mg/m3 milligrams per cubic meter MSL mean sea level NAAQS National Ambient Air Quality Standards NASA ...unique characteristics required by the U.S. Army, U.S. Navy, USAF, National Aeronautics and Space Administration ( NASA ), and other Federal and

Patterns of space and habitat use by northern bobwhites in South Florida, USA

USGS Publications Warehouse

Singh, A.; Hines, T.C.; Hostetler, J.A.; Percival, H.F.; Oli, M.K.

2011-01-01

The manner by which animals use space and select resources can have important management consequences. We studied patterns of habitat selection by northern bobwhites (Colinus virginianus) on Babcock-Webb Wildlife Management Area, Charlotte County, Florida and evaluated factors influencing the sizes of their home ranges. A total of 1,245 radio-tagged bobwhites were monitored for 19,467 radio days during 2002-2007. The mean (?? 1 SE) annual home range size, estimated using the Kernel density method, was 88. 43 (?? 6. 16) ha and did not differ between genders. Winter home ranges of bobwhites (69. 27 ?? 4. 92 ha) were generally larger than summer home ranges (53. 90 ?? 4. 93 ha). Annual and winter home ranges were smaller for bobwhites whose ranges contained food plots compared to those that did not; however, the presence of food plots did not influence summer home ranges. We used distance-based methods to investigate habitat selection by bobwhites at two scales: selection of home ranges within the study site (second-order selection) and selection of habitats within home ranges (third-order selection). Across both scales, bobwhites generally preferred food plots and dry prairie habitat and avoided wet prairies and roads. This pattern was generally consistent between genders and across years. Our data indicate that management practices aimed at increasing and maintaining a matrix of food plots and dry prairie habitat would provide the most favorable environment for bobwhites. ?? 2010 Springer-Verlag.

Implementation and evaluation of the 5As framework of obesity management in primary care: design of the 5As Team (5AsT) randomized control trial

PubMed Central

2014-01-01

Background Obesity is a pressing public health concern, which frequently presents in primary care. With the explosive obesity epidemic, there is an urgent need to maximize effective management in primary care. The 5As of Obesity Management™ (5As) are a collection of knowledge tools developed by the Canadian Obesity Network. Low rates of obesity management visits in primary care suggest provider behaviour may be an important variable. The goal of the present study is to increase frequency and quality of obesity management in primary care using the 5As Team (5AsT) intervention to change provider behaviour. Methods/design The 5AsT trial is a theoretically informed, pragmatic randomized controlled trial with mixed methods evaluation. Clinic-based multidisciplinary teams (RN/NP, mental health, dietitians) will be randomized to control or the 5AsT intervention group, to participate in biweekly learning collaborative sessions supported by internal and external practice facilitation. The learning collaborative content addresses provider-identified barriers to effective obesity management in primary care. Evidence-based shared decision making tools will be co-developed and iteratively tested by practitioners. Evaluation will be informed by the RE-AIM framework. The primary outcome measure, to which participants are blinded, is number of weight management visits/full-time equivalent (FTE) position. Patient-level outcomes will also be assessed, through a longitudinal cohort study of patients from randomized practices. Patient outcomes include clinical (e.g., body mass index [BMI], blood pressure), health-related quality of life (SF-12, EQ5D), and satisfaction with care. Qualitative data collected from providers and patients will be evaluated using thematic analysis to understand the context, implementation and effectiveness of the 5AsT program. Discussion The 5AsT trial will provide a wide range of insights into current practices, knowledge gaps and barriers that limit obesity management in primary practice. The use of existing resources, collaborative design, practice facilitation, and integrated feedback loops cultivate an applicable, adaptable and sustainable approach to increasing the quantity and quality of weight management visits in primary care. Trial registration NCT01967797. PMID:24947045

Implementation and evaluation of the 5As framework of obesity management in primary care: design of the 5As Team (5AsT) randomized control trial.

PubMed

Campbell-Scherer, Denise L; Asselin, Jodie; Osunlana, Adedayo M; Fielding, Sheri; Anderson, Robin; Rueda-Clausen, Christian F; Johnson, Jeffrey A; Ogunleye, Ayodele A; Cave, Andrew; Manca, Donna; Sharma, Arya M

2014-06-19

Obesity is a pressing public health concern, which frequently presents in primary care. With the explosive obesity epidemic, there is an urgent need to maximize effective management in primary care. The 5As of Obesity Management™ (5As) are a collection of knowledge tools developed by the Canadian Obesity Network. Low rates of obesity management visits in primary care suggest provider behaviour may be an important variable. The goal of the present study is to increase frequency and quality of obesity management in primary care using the 5As Team (5AsT) intervention to change provider behaviour. The 5AsT trial is a theoretically informed, pragmatic randomized controlled trial with mixed methods evaluation. Clinic-based multidisciplinary teams (RN/NP, mental health, dietitians) will be randomized to control or the 5AsT intervention group, to participate in biweekly learning collaborative sessions supported by internal and external practice facilitation. The learning collaborative content addresses provider-identified barriers to effective obesity management in primary care. Evidence-based shared decision making tools will be co-developed and iteratively tested by practitioners. Evaluation will be informed by the RE-AIM framework. The primary outcome measure, to which participants are blinded, is number of weight management visits/full-time equivalent (FTE) position. Patient-level outcomes will also be assessed, through a longitudinal cohort study of patients from randomized practices. Patient outcomes include clinical (e.g., body mass index [BMI], blood pressure), health-related quality of life (SF-12, EQ5D), and satisfaction with care. Qualitative data collected from providers and patients will be evaluated using thematic analysis to understand the context, implementation and effectiveness of the 5AsT program. The 5AsT trial will provide a wide range of insights into current practices, knowledge gaps and barriers that limit obesity management in primary practice. The use of existing resources, collaborative design, practice facilitation, and integrated feedback loops cultivate an applicable, adaptable and sustainable approach to increasing the quantity and quality of weight management visits in primary care. NCT01967797.

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-02-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-12-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

My46: a web-based tool for self-guided management of genomic test results in research and clinical settings

PubMed Central

Tabor, Holly K.; Jamal, Seema M.; Yu, Joon-Ho; Crouch, Julia M.; Shankar, Aditi G.; Dent, Karin M.; Anderson, Nick; Miller, Damon A.; Futral, Brett T.; Bamshad, Michael J.

2016-01-01

A major challenge to implementing precision medicine is the need for an efficient and cost-effective strategy for returning individual genomic test results that is easily scalable and can be incorporated into multiple models of clinical practice. My46 is a web-based tool for managing the return of genetic results that was designed and developed to support a wide range of approaches to results disclosure, ranging from traditional face-to-face disclosure to self-guided models. My46 has five key functions: set and modify results return preferences, return results, educate, manage return of results, and assess return of results. These key functions are supported by six distinct modules and a suite of features that enhance the user experience, ease site navigation, facilitate knowledge sharing, and enable results return tracking. My46 is a potentially effective solution for returning results and supports current trends toward shared decision-making between patient and provider and patient-driven health management. PMID:27632689

The Darwin cure for apiculture? Natural selection and managed honeybee health.

PubMed

Neumann, Peter; Blacquière, Tjeerd

2017-03-01

Recent major losses of managed honeybee, Apis mellifera, colonies at a global scale have resulted in a multitude of research efforts to identify the underlying mechanisms. Numerous factors acting singly and/or in combination have been identified, ranging from pathogens, over nutrition to pesticides. However, the role of apiculture in limiting natural selection has largely been ignored. This is unfortunate, because honeybees are more exposed to environmental stressors compared to other livestock and management can severely compromise bee health. Here, we briefly review apicultural factors that influence bee health and focus on those most likely interfering with natural selection, which offers a broad range of evolutionary applications for field practice. Despite intense breeding over centuries, natural selection appears to be much more relevant for the health of managed A. mellifera colonies than previously thought. We conclude that sustainable solutions for the apicultural sector can only be achieved by taking advantage of natural selection and not by attempting to limit it.

Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California.

PubMed

Lundsberg, Lisbet S; Lee, Henry C; Dueñas, Grace Villarin; Gregory, Kimberly D; Grossetta Nardini, Holly K; Pettker, Christian M; Illuzzi, Jessica L; Xu, Xiao

2018-02-01

To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests. Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04). Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.

Intergenerational Learning Practices--Digital Leaders in Schools

ERIC Educational Resources Information Center

Passey, Don

2014-01-01

This paper explores the management and outcomes of a specific model of intergenerational learning, concerned with student digital leader support in a number of secondary schools in England. A local educational partnership set up a student digital leader project late in 2011, which aimed to develop a range of skills and outcomes for both the…

Forest practices and stream flow in western Oregon.

Treesearch

R. Dennis. Harr

1976-01-01

Forest management activities, including roadbuilding, clearcut logging, and broadcast burning, can change certain portions of the forest hydrologic cycle. Watershed studies and other hydrologic research in the Coast and western Cascade Ranges of Oregon have shown that these changes may increase annual water yield up to 62 centimeters, double minimum flows in summer,...

On the Contemporary Applications of Mindfulness: Some Implications for Education

ERIC Educational Resources Information Center

Hyland, Terry

2015-01-01

Interest in the Buddhist concept of mindfulness has burgeoned over the last few decades as a result of its application as a therapeutic strategy in mind-body medicine, psychotherapy, psychiatry, education, leadership and management, and a wide range of other theoretical and practical domains. Although many commentators welcome this extension of…

Management Practices: A Major Cause of Stress among Teachers.

ERIC Educational Resources Information Center

Mersky, Ronald

This research studies task-based stress among teachers in a rural setting. A 51-item instrument was administered to teachers in 12 schools to determine (1) the extent of differential reactions to a wide range of task-based teaching events, as correlated with situational characteristics (sex, age, elementary or secondary affiliation, school size);…

Stress in Early Childhood: Helping Children and Their Carers

ERIC Educational Resources Information Center

Thomas, Patrice

2006-01-01

This book offers practical and effective strategies for stress management for both early childhood staff and the children in their care. Here, the author uncovers valuable insights into the causes of stress and outlines a range of activities to counteract it. Early childhood practitioners know that theirs is both a stressful and rewarding…

Carabid beetle responses to herbicide application, shelterwood seed cut and insect defoliator outbreaks

Treesearch

Matthew D. Trager; Todd E. Ristau; Scott H. Stoleson; Robert L. Davidson; Robert E. Acciavatti

2013-01-01

Managing forests to promote biodiversity requires understanding the effects of silvicultural practices on a range of forest species and communities. We evaluated carabid beetle (Coleoptera; Carabidae) responses to operational herbicide and shelterwood seed cut treatments in northern hardwood stands on the Allegheny National Forest, Pennsylvania, USA, from 1992 to 2000...

Status, distribution, and movements of martens in northeastern Minnesota.

Treesearch

L. David Mech; Lynn L. Rogers

1977-01-01

The decline of martens in Minnesota is reviewed and a recent increase documented. Adjacent and partially overlapping home ranges of 4.3 to 19.9 km2 were determined by telemetry for a female and three males. Habitat use is described. If current trapping and timber management practices persist, martens should continue to increase.

The promise, practice and state of planning tools to assess site vulnerability to runoff phosphorus loss

USDA-ARS?s Scientific Manuscript database

Over the past 20 years, there has been a proliferation of phosphorus (P) site assessment tools for nutrient management planning, particularly in the United State. These decision support tools, range from the P Index to fate-and-transport models to weather-forecast based risk calculators. All require...

Teaching Research Methodology Using a Project-Based Three Course Sequence Critical Reflections on Practice

ERIC Educational Resources Information Center

Braguglia, Kay H.; Jackson, Kanata A.

2012-01-01

This article presents a reflective analysis of teaching research methodology through a three course sequence using a project-based approach. The authors reflect critically on their experiences in teaching research methods courses in an undergraduate business management program. The introduction of a range of specific techniques including student…

Reflecting on the Early Interventionist's ROLE Using a Logic Model Approach

ERIC Educational Resources Information Center

Kashinath, Shubha; Coston, Jade; Woods, Juliann

2015-01-01

On any given day, early intervention (EI) providers must manage the individual needs of children with a range of disabilities in a variety of contexts and with varying caregiver/family priorities. Recommended and evidence-based practices as defined by Part C policy (Individuals With Disabilities Education Improvement Act, 2004) and the Division…

Collaborative Learning through Formative Peer Review: Pedagogy, Programs and Potential

ERIC Educational Resources Information Center

Sondergaard, Harald; Mulder, Raoul A.

2012-01-01

We examine student peer review, with an emphasis on formative practice and collaborative learning, rather than peer grading. Opportunities to engage students in such formative peer assessment are growing, as a range of online tools become available to manage and simplify the process of administering student peer review. We consider whether…

The Clinical Practice Library of Medicine (CPLM): An on-line biomedical computer library. System documentation

NASA Technical Reports Server (NTRS)

Grams, R. R.

1982-01-01

A system designed to access a large range of available medical textbook information in an online interactive fashion is described. A high level query type database manager, INQUIRE, is used. Operating instructions, system flow diagrams, database descriptions, text generation, and error messages are discussed. User information is provided.

Potential synergistic effects of cereal rye biomass and soybean planting density on weed suppression

USDA-ARS?s Scientific Manuscript database

Increasing crop density is a cultural weed management practice that can complement the use of cover crops for weed suppression. In this research, we created a range of cover crop biomass and soybean densities in order to assess their weed suppressive ability alone and in combination. The experiment ...

Interactive effects of animal manure and cover crop use in improving agricultural soil quality in Kentucky

USDA-ARS?s Scientific Manuscript database

With greater awareness of the wide-ranging implications degraded soils have in the food chain, there is growing interest in developing technologies and management practices to improve soil quality. To date, such initiatives are at the forefront of soil science as climate change is expected to alter ...

A Student Guide to Tropical Forest Conservation

Treesearch

J. Louise Mastrantonio; John K. Francis

1997-01-01

Tropical forests, which circle the globe, are surprisingly diverse, ranging from rain forests to savannas. Tropical forests are disappearing at an alarming rate as they are converted to farmland and other uses. Modern forest management practices can help stem the tide by providing income and valuable products while maintaining forest cover. Puerto Rico has already gone...

Green Investment, Green Return: How Practical Conservation Projects Save Millions on America's Campuses.

ERIC Educational Resources Information Center

Eagan, David J.; Keniry, Julian

This report presents examples of exemplary academic institutions that have achieved both a healthy environment and the goal of saving economically. Twenty-three public and private institutions' cost-effective environmental management stories are presented. Institutional size ranges from a few thousand to 40,000 students. Contents include: (1)…

Management of Mason type 1 radial head fractures: a regional survey and a review of literature.

PubMed

Mahmoud, Samer S S; Moideen, Abdul Nazeer; Kotwal, Rahul; Mohanty, Khitish

2014-10-01

Despite being the most common fracture around the elbow, the management of Mason type 1 radial head fractures lacks a clear protocol in literature. The aims of this study were to assess our practice of managing this injury and to create guidance for the management of these fractures based on literature review. We designed a survey investigating the practice of orthopaedic surgeons in the management of Mason type 1 fracture. The literature review was carried out looking for the best practice guidelines. Forty-nine surgeons (out of 56) responded, and mean duration of immobilisation was 11.69 days with the collar and cuff sling as the preferred method. 65.3% offered physiotherapy service to their patients. 20.4% recommended plain radiographic imaging follow-up. Mean duration of follow-up was 43.9 days. Decision to discharge the patient was mostly (77.6%) dependent on clinical improvement at time of last examination. 4.1% of treatment decisions were evidence based. We observed a wide variation in the management of this common injury. Based on the current literature, the best protocol for the management of type 1 radial head fractures should be joint aspiration, followed by immobilisation in a broad arm sling for 2 days. At the first outpatient visit, assessment of the collateral stability should be performed. Patients with stable elbows should be encouraged to stretch these beyond the painful range. Patients can be discharged at this stage with an advice to come back for a clinical and radiographic assessment if there is no improvement at 6 weeks.

Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study

PubMed Central

Blakeman, Tom; Protheroe, Joanne; Chew-Graham, Carolyn; Rogers, Anne; Kennedy, Anne

2012-01-01

Background Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. Aim To explore processes underpinning the implementation of CKD management in primary care. Design and setting Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. Method Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. Results A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. Conclusion Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity. PMID:22520910

Understanding enabling capacities for managing the 'wicked problem' of nonpoint source water pollution in catchments: a conceptual framework.

PubMed

Patterson, James J; Smith, Carl; Bellamy, Jennifer

2013-10-15

Nonpoint source (NPS) water pollution in catchments is a 'wicked' problem that threatens water quality, water security, ecosystem health and biodiversity, and thus the provision of ecosystem services that support human livelihoods and wellbeing from local to global scales. However, it is a difficult problem to manage because water catchments are linked human and natural systems that are complex, dynamic, multi-actor, and multi-scalar in nature. This in turn raises questions about understanding and influencing change across multiple levels of planning, decision-making and action. A key challenge in practice is enabling implementation of local management action, which can be influenced by a range of factors across multiple levels. This paper reviews and synthesises important 'enabling' capacities that can influence implementation of local management action, and develops a conceptual framework for understanding and analysing these in practice. Important enabling capacities identified include: history and contingency; institutional arrangements; collaboration; engagement; vision and strategy; knowledge building and brokerage; resourcing; entrepreneurship and leadership; and reflection and adaptation. Furthermore, local action is embedded within multi-scalar contexts and therefore, is highly contextual. The findings highlight the need for: (1) a systemic and integrative perspective for understanding and influencing change for managing the wicked problem of NPS water pollution; and (2) 'enabling' social and institutional arenas that support emergent and adaptive management structures, processes and innovations for addressing NPS water pollution in practice. These findings also have wider relevance to other 'wicked' natural resource management issues facing similar implementation challenges. Copyright © 2013 Elsevier Ltd. All rights reserved.

Integrating Climate Change Adaptation into Public Health Practice: Using Adaptive Management to Increase Adaptive Capacity and Build Resilience

PubMed Central

McDowell, Julia Z.; Luber, George

2011-01-01

Background: Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems. Objectives: We explored possible explanations for the lack of work on adaptive capacity, outline climate–health challenges that may lie outside public health’s coping range, and consider changes in practice that could increase public health’s adaptive capacity. Methods: We conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity. Discussion: There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health’s adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. We illustrate its application to extreme heat in an urban setting. Conclusions: Increasing public health capacity will be necessary for certain climate–health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change. PMID:21997387

How do paramedics manage the airway during out of hospital cardiac arrest?

PubMed Central

Voss, Sarah; Rhys, Megan; Coates, David; Greenwood, Rosemary; Nolan, Jerry P.; Thomas, Matthew; Benger, Jonathan

2014-01-01

Aim The best method of initial airway management during resuscitation for out of hospital cardiac arrest (OHCA) is unknown. The airway management techniques used currently by UK paramedics during resuscitation for OHCA are not well documented. This study describes the airway management techniques used in the usual practice arm of the REVIVE-Airways feasibility study, and documents the pathway of interventions to secure and sustain ventilation during OHCA. Method Data were collected from OHCAs attended by paramedics participating in the REVIVE-Airways trial between March 2012 and February 2013. Patients were included if they were enrolled in the usual practice arm of the study, fulfilled the main study eligibility criteria and did not receive either of the intervention supraglottic airway devices during the resuscitation attempt. Results Data from 196 attempted resuscitations were included in the analysis. The initial approach to airway management was bag-mask for 108 (55%), a supraglottic airway device (SAD) for 39 (20%) and tracheal intubation for 49 (25%). Paramedics made further airway interventions in 64% of resuscitations. When intubation was the initial approach, there was no further intervention in 76% of cases; this compares to 16% and 44% with bag-mask and SAD respectively. The most common reason cited by paramedics for changing from bag-mask was to carry out advanced life support, followed by regurgitation and inadequate ventilation. Inadequate ventilation was the commonest reason cited for removing a SAD. Conclusion Paramedics use a range of techniques to manage the airway during OHCA, and as the resuscitation evolves. It is therefore desirable to ensure that a range of techniques and equipment, supported by effective training, are available to paramedics who attend OHCA. PMID:25260723

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

PubMed

Kastner, Monika; Straus, Sharon E

2008-12-01

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

Organising primary health care for people with asthma: the patient's perspective.

PubMed Central

Paterson, C; Britten, N

2000-01-01

BACKGROUND: The 1993 chronic disease management contract encourages United Kingdom general practices to implement a standardised package of care with an emphasis on regular visits to an asthma clinic. AIM: To explore the views of people with asthma about the organisation of asthma care in general practice. METHOD: Semi-structured interviews with 20 patients registered with one practice with a nurse-run asthma clinic. The sample was selected to provide people with a wide range of ages and disease severity, and included parents of children. RESULTS: The age range of the interviewees was five to 87 years (parents of children were interviewed) and half of the interviewees had attended the asthma clinic at some time. In describing how they managed their asthma, people identified their medical care alongside other important factors, such as avoiding smoking and pollution, and a decision to seek medical help was made in the context of all of life's other priorities. People expressed diverse views about the organisation of care, describing how their needs changed over time and how they balanced up several factors in deciding what was best for them. These factors were encompassed by four themes: the accessibility of care, severity of asthma and dealing with uncertainty, self-knowledge and self-management, and expert knowledge and therapeutic relationships. Interviewees were evenly split between wishing to be seen regularly in the clinic and wishing only to attend when needing help. CONCLUSION: Patients required asthma services that allow individual choice and flexibility, and eight service objectives were identified that would cover most people's needs. PMID:10897514

Demographics and practices of semi-intensive free-range farming systems in Australia with an outdoor stocking density of ≤1500 hens/hectare

PubMed Central

Ruhnke, Isabelle; de Koning, Carolyn; Drake, Kelly; Skerman, Alan G.; Hinch, Geoff N.; Glatz, Philip C.

2017-01-01

Baseline information on demographics and practices on semi-intensive free-range egg farms with an outdoor stocking density of ≤1500 hens/hectare in Australia is presented. Free-range egg production is changing the structure of the egg industry in Australia and a broad variety and tiers of free-range systems have emerged due to lack of concrete legislative standards on outdoor stocking densities in the past. Information was extracted from a pre-existing online free-range poultry survey dataset, consisting of a total of 79 questions related to nutrition, pasture management, welfare and health, animal housing, environmental impact and economics. Forty-one free-range egg farms, with an outdoor stocking density of ≤1500 hens/hectare, were identified in the dataset from all major Australian states. Two types of semi-intensive free-range housing systems were documented: mobile (modified caravan/trailer) housing (56%), and fixed sheds (44%). Seventy-two percent of respondents reported >75% of the hens in the flock used the outdoor range. All respondents reported ingestion of range components by hens in the form of vegetation, insects, stones and grit. Up to 10% mortality was reported by 40% respondents with predation (34%), cannibalism (29%), heat stress (24%) and grass impaction (19.5%) as major causes. Biosecurity on farms was sub-optimal with 8 of the 10 actions implemented by <50% respondents. Customer demand, consumer sentiment and welfare were the major factors for farmers moving into free-range egg production. This study resulted in identification of current practices and key challenges on semi-intensive free-range egg farms. Applied research and communication of results to farmers is highly recommended to ensure optimum health and welfare of free-range laying hens and sustained egg production. PMID:29065169

Demographics and practices of semi-intensive free-range farming systems in Australia with an outdoor stocking density of ≤1500 hens/hectare.

PubMed

Singh, Mini; Ruhnke, Isabelle; de Koning, Carolyn; Drake, Kelly; Skerman, Alan G; Hinch, Geoff N; Glatz, Philip C

2017-01-01

Baseline information on demographics and practices on semi-intensive free-range egg farms with an outdoor stocking density of ≤1500 hens/hectare in Australia is presented. Free-range egg production is changing the structure of the egg industry in Australia and a broad variety and tiers of free-range systems have emerged due to lack of concrete legislative standards on outdoor stocking densities in the past. Information was extracted from a pre-existing online free-range poultry survey dataset, consisting of a total of 79 questions related to nutrition, pasture management, welfare and health, animal housing, environmental impact and economics. Forty-one free-range egg farms, with an outdoor stocking density of ≤1500 hens/hectare, were identified in the dataset from all major Australian states. Two types of semi-intensive free-range housing systems were documented: mobile (modified caravan/trailer) housing (56%), and fixed sheds (44%). Seventy-two percent of respondents reported >75% of the hens in the flock used the outdoor range. All respondents reported ingestion of range components by hens in the form of vegetation, insects, stones and grit. Up to 10% mortality was reported by 40% respondents with predation (34%), cannibalism (29%), heat stress (24%) and grass impaction (19.5%) as major causes. Biosecurity on farms was sub-optimal with 8 of the 10 actions implemented by <50% respondents. Customer demand, consumer sentiment and welfare were the major factors for farmers moving into free-range egg production. This study resulted in identification of current practices and key challenges on semi-intensive free-range egg farms. Applied research and communication of results to farmers is highly recommended to ensure optimum health and welfare of free-range laying hens and sustained egg production.

Stable occupancy by breeding hawks (Buteo spp.) over 25 years on a privately managed bunchgrass prairie in northeastern Oregon, USA

USGS Publications Warehouse

Kennedy, Patricia L.; Bartuszevige, Anne M.; Houle, Marcy; Humphrey, Ann B.; Dugger, Katie M.; Williams, John

2014-01-01

Potential for large prairie remnants to provide habitat for grassland-obligate wildlife may be compromised by nonsustainable range-management practices. In 1979–1980, high nesting densities of 3 species of hawks in the genus Buteo—Ferruginous Hawk (Buteo regalis), Red-tailed Hawk (B. jamaicensis), and Swainson's Hawk (B. swainsoni)—were documented on the Zumwalt Prairie and surrounding agricultural areas (34,361 ha) in northeastern Oregon, USA. This area has been managed primarily as livestock summer range since it was homesteaded. Unlike in other prairie remnants, land management on the Zumwalt Prairie was consistent over the past several decades; thus, we predicted that territory occupancy of these 3 species would be stable. We also predicted that territory occupancy would be positively related to local availability of nesting structures within territories. We evaluated these hypotheses using a historical dataset, current survey and habitat data, and occupancy models. In support of our predictions, territory occupancy of all 3 species has not changed over the study period of ∼25 yr, which suggests that local range-management practices are not negatively affecting these taxa. Probability of Ferruginous Hawk occupancy increased with increasing area of aspen, an important nest structure for this species in grasslands. Probability of Swainson's Hawk occupancy increased with increasing area of large shrubs, and probability of Red-tailed Hawk occupancy was weakly associated with area of conifers. In the study area, large shrubs and conifers are commonly used as nesting structures by Swainson's Hawks and Red-tailed Hawks, respectively. Availability of these woody species is changing (increases in conifers and large shrubs, and decline in aspen) throughout the west, and these changes may result in declines in Ferruginous Hawk occupancy and increases in Swainson's Hawk and Red-tailed Hawk occupancy in the future.

Leadership capabilities of physiotherapy leaders in Ireland: Part 1 physiotherapy managers.

PubMed

McGowan, Emer; Elliott, Naomi; Stokes, Emma

2018-05-07

Investigation of the leadership capabilities of physiotherapists is needed to allow understanding of current leadership practice and to enable appropriate training programs to be developed. To explore physiotherapy managers´ perceptions of their leadership capabilities. Semi-structured interviews were conducted with a purposive sample of 18 physiotherapy managers from a range of public services and private practices in Ireland. The interviews were analyzed using template analysis and the coding template was based on the Bolman and Deal Leadership framework which details four leadership frames: structural, human resource, political, and symbolic. The physiotherapy managers described demonstrating leadership capabilities associated with each of the four leadership frames. However, the language used by the physiotherapy managers suggested that they work predominantly through the structural and human resource frames. The employment of capabilities associated with the political frame varied between participants; some participants described working through this frame while others reported difficulties. The symbolic frame was underused; there were fewer examples given of capabilities such as communicating their vision, demonstrating passion and facilitating a positive workplace culture. Physiotherapy managers work predominantly through the structural and human resource frames. To successfully meet the leadership requirements of their roles physiotherapy managers may benefit from specific leadership development training to develop leadership capabilities in the political and symbolic frames.

Evaluation of Facility Management by Multivariate Statistics - Factor Analysis

NASA Astrophysics Data System (ADS)

Singovszki, Miloš; Vranayová, Zuzana

2013-06-01

Facility management is evolving, there is no exact than other sciences, although its development is fast forward. The knowledge and practical skills in facility management is not replaced, on the contrary, they complement each other. The existing low utilization of science in the field of facility management is mainly caused by the management of support activities are many variables and prevailing immediate reaction to the extraordinary situation arising from motives of those who have substantial experience and years of proven experience. Facility management is looking for a system that uses organized knowledge and will form the basis, which grows from a wide range of disciplines. Significant influence on its formation as a scientific discipline is the "structure, which follows strategy". The paper deals evaluate technology building as part of an facility management by multivariate statistic - factor analysis.

Biocontainment, biosecurity, and security practices in beef feedyards.

PubMed

Brandt, Aric W; Sanderson, Michael W; DeGroot, Brad D; Thomson, Dan U; Hollis, Larry C

2008-01-15

To determine the biocontainment, biosecurity, and security practices at beef feedyards in the Central Plains of the United States. Survey. Managers of feedyards in Colorado, Kansas, Nebraska, Oklahoma, and Texas that feed beef cattle for finish before slaughter; feedyards had to have an active concentrated animal feeding operation permit with a 1-time capacity of >or= 1,000 cattle. A voluntary survey of feedyard personnel was conducted. Identified feedyard personnel were interviewed and responses regarding facility design, security, employees, disease preparedness, feedstuffs, hospital or treatment systems, sanitation, cattle sources, handling of sick cattle, and disposal of carcasses were collected in a database questionnaire. The survey was conducted for 106 feedyards with a 1-time capacity that ranged from 1,300 to 125,000 cattle. Feedyards in general did not have high implementation of biocontainment, biosecurity, or security practices. Smaller feedyards were, in general, less likely to use good practices than were larger feedyards. Results of the survey provided standard practices for biocontainment, biosecurity, and security in feedyards located in Central Plains states. Information gained from the survey results can be used by consulting veterinarians and feedyard managers as a basis for discussion and to target training efforts.

"How do I say that?": Using communication principles to enhance medication therapy management instruction.

PubMed

Denvir, Paul M; Cardone, Katie E; Parker, Wendy M; Cerulli, Jennifer

2018-02-01

Medication therapy management (MTM) is a comprehensive, patient-centered approach to improving medication use, reducing the risk of adverse events and improving medication adherence. Given the service delivery model and required outputs of MTM services, communication skills are of utmost importance. The objectives of this study were to identify and describe communication principles and instructional practices to enhance MTM training. Drawing on formative assessment data from interviews of both pharmacy educators and alumni, this article identifies and describes communication principles and instructional practices that pharmacy educators can use to enhance MTM training initiatives to develop student communication strategies. Analysis revealed five key communication challenges of MTM service delivery, two communication principles that pharmacy teachers and learners can use to address those challenges, and a range of specific strategies, derived from communication principles, that students can use when challenges emerge. Implications of the analysis for pharmacy educators and researchers are described. Proactive communication training provided during MTM advanced pharmacy practice experiences enabled students to apply the principles and instructional strategies to specific patient interactions during the advanced pharmacy practice experiences and in their post-graduation practice settings. Copyright © 2017 Elsevier Inc. All rights reserved.

Prognostics and Health Management of Wind Turbines -- Current Status and Future Opportunities

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

Sheng, Shuangwen

The global wind industry has seen tremendous growth during the past two decades. However, the industry is challenged by premature component failures, which lead to increased turbine downtime and subsequently, cost of energy for wind power. To mitigate the impacts from these failures, the wind industry has been exploring various areas for improvements ranging from product design, new materials or lubricants, to operation and maintenance (O&M) practices. Condition-based maintenance or prognostics and health management (PHM) has been explored as one enabling technology for improving O&M practices. This chapter provides a brief overview of wind turbine PHM with a focus onmore » operational data mining and condition monitoring of drivetrains. Some future research and development opportunities in wind turbine PHM are also briefly discussed.« less

Elephant Management in North American Zoos: Environmental Enrichment, Feeding, Exercise, and Training.

PubMed

Greco, Brian J; Meehan, Cheryl L; Miller, Lance J; Shepherdson, David J; Morfeld, Kari A; Andrews, Jeff; Baker, Anne M; Carlstead, Kathy; Mench, Joy A

2016-01-01

The management of African (Loxodonta africana) and Asian (Elephas maximus) elephants in zoos involves a range of practices including feeding, exercise, training, and environmental enrichment. These practices are necessary to meet the elephants' nutritional, healthcare, and husbandry needs. However, these practices are not standardized, resulting in likely variation among zoos as well as differences in the way they are applied to individual elephants within a zoo. To characterize elephant management in North America, we collected survey data from zoos accredited by the Association of Zoos and Aquariums, developed 26 variables, generated population level descriptive statistics, and analyzed them to identify differences attributable to sex and species. Sixty-seven zoos submitted surveys describing the management of 224 elephants and the training experiences of 227 elephants. Asian elephants spent more time managed (defined as interacting directly with staff) than Africans (mean time managed: Asians = 56.9%; Africans = 48.6%; p<0.001), and managed time increased by 20.2% for every year of age for both species. Enrichment, feeding, and exercise programs were evaluated using diversity indices, with mean scores across zoos in the midrange for these measures. There were an average of 7.2 feedings every 24-hour period, with only 1.2 occurring during the nighttime. Feeding schedules were predictable at 47.5% of zoos. We also calculated the relative use of rewarding and aversive techniques employed during training interactions. The population median was seven on a scale from one (representing only aversive stimuli) to nine (representing only rewarding stimuli). The results of our study provide essential information for understanding management variation that could be relevant to welfare. Furthermore, the variables we created have been used in subsequent elephant welfare analyses.

Elephant Management in North American Zoos: Environmental Enrichment, Feeding, Exercise, and Training

PubMed Central

Greco, Brian J.; Meehan, Cheryl L.; Miller, Lance J.; Shepherdson, David J.; Morfeld, Kari A.; Andrews, Jeff; Baker, Anne M.; Carlstead, Kathy; Mench, Joy A.

2016-01-01

The management of African (Loxodonta africana) and Asian (Elephas maximus) elephants in zoos involves a range of practices including feeding, exercise, training, and environmental enrichment. These practices are necessary to meet the elephants’ nutritional, healthcare, and husbandry needs. However, these practices are not standardized, resulting in likely variation among zoos as well as differences in the way they are applied to individual elephants within a zoo. To characterize elephant management in North America, we collected survey data from zoos accredited by the Association of Zoos and Aquariums, developed 26 variables, generated population level descriptive statistics, and analyzed them to identify differences attributable to sex and species. Sixty-seven zoos submitted surveys describing the management of 224 elephants and the training experiences of 227 elephants. Asian elephants spent more time managed (defined as interacting directly with staff) than Africans (mean time managed: Asians = 56.9%; Africans = 48.6%; p<0.001), and managed time increased by 20.2% for every year of age for both species. Enrichment, feeding, and exercise programs were evaluated using diversity indices, with mean scores across zoos in the midrange for these measures. There were an average of 7.2 feedings every 24-hour period, with only 1.2 occurring during the nighttime. Feeding schedules were predictable at 47.5% of zoos. We also calculated the relative use of rewarding and aversive techniques employed during training interactions. The population median was seven on a scale from one (representing only aversive stimuli) to nine (representing only rewarding stimuli). The results of our study provide essential information for understanding management variation that could be relevant to welfare. Furthermore, the variables we created have been used in subsequent elephant welfare analyses. PMID:27414654

A model-based economic evaluation of improved primary care management of patients with type 2 diabetes in Australia.

PubMed

Haji Ali Afzali, Hossein; Gray, Jodi; Beilby, Justin; Holton, Christine; Karnon, Jonathan

2013-12-01

There are few studies investigating the economic value of the Australian practice nurse workforce on the management of chronic conditions. This is particularly important in Australia, where the government needs evidence to inform decisions on whether to maintain or redirect current financial incentives that encourage practices to recruit practice nurses. The objective of this study was to estimate the lifetime costs and quality-adjusted life-years (QALYs) associated with two models of practice nurse involvement in clinical-based activities (high and low level) in the management of type 2 diabetes within the primary care setting. A previously validated state transition model (the United Kingdom Prospective Diabetes Study Outcomes Model) was adapted, which uses baseline prognostic factors (e.g. gender, haemoglobin A1c [HbA1c]) to predict the risk of occurrence of diabetes-related complications (e.g. stroke). The model was populated by data from Australian and UK observational studies. Costs and utility values associated with complications were summed over patients' lifetimes to estimate costs and QALY gains from the perspective of the health care system. All costs were expressed in 2011 Australian dollars (AU$). The base-case analysis assumed a 40-year time horizon with an annual discount rate of 5 %. Relative to low-level involvement of practice nurses in the provision of clinical-based activities, the high-level model was associated with lower mean lifetime costs of management of complications (-AU$8,738; 95 % confidence interval [CI] -AU$12,522 to -AU$4,954), and a greater average gain in QALYs (0.3; 95 % CI 0.2-0.4). A range of sensitivity analyses were performed, in which the high-level model was dominant in all cases. Our results suggest that the high-level model is a dominant management strategy over the low-level model in all modelled scenarios. These findings indicate the need for effective primary care-based incentives to encourage general practices not only to employ practice nurses, but to better integrate them into the provision of clinical services.

Ranking agricultural practices on soil water improvements: a meta-analysis

NASA Astrophysics Data System (ADS)

Basche, A.; DeLonge, M. S.; Gonzalez, J.

2016-12-01

Increased rainfall variability is well documented in the historic record and predicted to intensify with future climate change. Managing excess water in periods of heavy rain and a lack of water in periods of inadequate precipitation will continue to be a challenge. Improving soil resiliency through increased water storage is a promising strategy to combat effects of both rainfall extremes. The goal of this research is to quantify to what extent various conservation and ecological practices can improve soil hydrology. We are conducting a global meta-analysis focused on studies where conservation and ecological practices are compared to more conventional management. To date we have analyzed 100 studies with more than 450 paired comparisons to understand the effect of management on water infiltration rates, a critical process that ensures water enters the soil profile for crop use, water storage and runoff prevention. The database will be expanded to include studies measuring soil porosity and the water retained at field capacity. Statistical analysis has been done both with both a bootstrap method and a mixed model that weights studies based on precision while accounting for between-study variation. We find that conservation and ecological practices, ranging from no-till, cover crops, crop rotation, perennial crops and agroforestry, on average significantly increased water infiltration rates relative to more conventional practice controls (mean of 75%, standard error 25%). There were significant differences between practices, where perennial and agroforestry systems show the greatest potential for improving water infiltration rates (> 100% increase). Cover crops also lead to a significant increase in water infiltration rates (> 60%) while crop rotations and no-till systems did not consistently demonstrate increases. We also found that studies needed to include alternative management for more than two years to detect a significant increase. Overall this global meta-analysis improves understanding of how alternative management, notably the use of continuous cover in agricultural systems, improves water dynamics. Policies should be designed in a way that allows agricultural producers to prioritize and implement practices that offer greater water conservation while maintaining crop productivity.

Replacing Concrete with Natural and Social Engineering: Learning the Lessons of Stakeholder Engagement from South West Water's Upland Catchment Management Programme

NASA Astrophysics Data System (ADS)

Smith, David; Grand-Clement, Emile; Brazier, Richard

2014-05-01

Replacing Concrete with Natural and Social Engineering: Learning the Lessons of Stakeholder Engagement from South West Water's Upland Catchment Management Programme Smith, D., Grand-Clement, E., Anderson, K., Luscombe, D., G, N., Bratis, Brazier, R.E Peatlands in the South West of the British Isles have been extensively drained for agricultural reclamation and peat cutting. The improvement in food production resulting from this management practice has never clearly been observed. Instead, we are now faced with several detrimental consequences on a whole suite of ecosystem services, such as the delivery of water, water quality, biodiversity and carbon storage. Alongside the direct environmental implications, poor water quality is increasing water treatment costs and will drive significant future investment. As a result, water companies now need to find appropriate solutions to varying water levels and decreasing water quality through catchment management. The Mires Project, the catchment management programme used by South West Water (SWW) is working with a wide range of stakeholders to restore the hydrological functioning of peatlands, and the ecosystem services they provide. This programme is driven by overarching legal requirements (i.e. the water framework directive, Natura 2000), future climate change predictions, corporate responsibility and commercial needs. Post-restoration scientific monitoring is at the heart of the project improving of our understanding of the eco-hydrological and chemical process driving changes in management practice. The challenges faced from the involvement of a wide range of stakeholders will be explored, focusing on the benefits from stakeholder involvement in catchment management and hydrological research, but also considering the difficulties to be overcome. SWW is working with private land-owners, government agencies, local and national park Authorities, community and single interest groups and research institutions to achieve its catchment management objectives. To achieve this it has replaced the traditional water company approach of hard engineering solutions with a mixture of softer natural and social engineering.

Head trauma in the cat: 2. assessment and management of traumatic brain injury.

PubMed

Garosi, Laurent; Adamantos, Sophie

2011-11-01

Feline trauma patients are commonly seen in general practice and frequently have sustained some degree of brain injury. Cats with traumatic brain injuries may have a variety of clinical signs, ranging from minor neurological deficits to life-threatening neurological impairment. Appropriate management depends on prompt and accurate patient assessment, and an understanding of the pathophysiology of brain injury. The most important consideration in managing these patients is maintenance of cerebral perfusion and oxygenation. For cats with severe head injury requiring decompressive surgery, early intervention is critical. There is a limited clinical evidence base to support the treatment of traumatic brain injury in cats, despite its relative frequency in general practice. Appropriate therapy is, therefore, controversial in veterinary medicine and mostly based on experimental studies or human head trauma studies. This review, which sets out to describe the specific approach to diagnosis and management of traumatic brain injury in cats, draws on the current evidence, as far as it exists, as well as the authors' clinical experience. Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

Total centralisation and optimisation of an oncology management suite via Citrix®

NASA Astrophysics Data System (ADS)

James, C.; Frantzis, J.; Ripps, L.; Fenton, P.

2014-03-01

The management of patient information and treatment planning is traditionally an intra-departmental requirement of a radiation oncology service. Epworth Radiation Oncology systems must support the transient nature of Visiting Medical Officers (VMOs). This unique work practice created challenges when implementing the vision of a completely paperless solution that allows for a responsive and efficient service delivery. ARIA® and EclipseTM (Varian Medical Systems, Palo Alto, CA, USA) have been deployed across four dedicated Citrix® (Citrix Systems, Santa Clara, CA, USA) servers allowing VMOs to access these applications remotely. A range of paperless solutions were developed within ARIA® to facilitate clinical and organisational management whilst optimising efficient work practices. The IT infrastructure and paperless workflow has enabled VMOs to securely access the VarianTM (Varian Medical Systems, Palo Alto, CA, USA) oncology software and experience full functionality from any location on multiple devices. This has enhanced access to patient information and improved the responsiveness of the service. Epworth HealthCare has developed a unique solution to enable remote access to a centralised oncology management suite, while maintaining a secure and paperless working environment.

Effects of forest management practices in temperate beech forests on bacterial and fungal communities involved in leaf litter degradation.

PubMed

Purahong, Witoon; Kapturska, Danuta; Pecyna, Marek J; Jariyavidyanont, Katalee; Kaunzner, Jennifer; Juncheed, Kantida; Uengwetwanit, Tanaporn; Rudloff, Renate; Schulz, Elke; Hofrichter, Martin; Schloter, Michael; Krüger, Dirk; Buscot, François

2015-05-01

Forest management practices (FMPs) significantly influence important ecological processes and services in Central European forests, such as leaf litter decomposition and nutrient cycling. Changes in leaf litter diversity, and thus, its quality as well as microbial community structure and function induced by different FMPs were hypothesized to be the main drivers causing shifts in decomposition rates and nutrient release in managed forests. In a litterbag experiment lasting 473 days, we aimed to investigate the effects of FMPs (even-aged timber management, selective logging and unmanaged) on bacterial and fungal communities involved in leaf litter degradation over time. Our results showed that microbial communities in leaf litter were strongly influenced by both FMPs and sampling date. The results from nonmetric multidimensional scaling (NMDS) ordination revealed distinct patterns of bacterial and fungal successions over time in leaf litter. We demonstrated that FMPs and sampling dates can influence a range of factors, including leaf litter quality, microbial macronutrients, and pH, which significantly correlate with microbial community successions.

Advancing Psychologically Informed Practice for Patients With Persistent Musculoskeletal Pain: Promise, Pitfalls, and Solutions.

PubMed

Keefe, Francis J; Main, Chris J; George, Steven Z

2018-05-01

There has been growing interest in psychologically oriented pain management over the past 3 to 4 decades, including a 2011 description of psychologically informed practice (PIP) for low back pain. PIP requires a broader focus than traditional biomechanical and pathology-based approaches that have been traditionally used to manage musculoskeletal pain. A major focus of PIP is addressing the behavioral aspects of pain (ie, peoples' responses to pain) by identifying individual expectations, beliefs, and feelings as prognostic factors for clinical and occupational outcomes indicating progression to chronicity. Since 2011, the interest in PIP seems to be growing, as evidenced by its use in large trials, inclusion in scientific conferences, increasing evidence base, and expansion to other musculoskeletal pain conditions. Primary care physicians and physical therapists have delivered PIP as part of a stratified care approach involving screening and targeting of treatment for people at high risk for continued pain-associated disability. Furthermore, PIP is consistent with recent national priorities emphasizing nonpharmacological pain management options. In this perspective, PIP techniques that range in complexity are described, considerations for implementation in clinical practice are offered, and future directions that will advance the understanding of PIP are outlined.

Managing cows: an ethnography of breeding practices and uses of reproductive technology in contemporary dairy farming in Lombardy (Italy).

PubMed

Grasseni, Cristina

2007-06-01

The aim of this article is to contribute detailed ethnographic material to broaden the scope of what we mean by reproductive technology. Technology can be defined not only by a series of laboratory techniques (such as artificial insemination and embryo transfer) that are drafted into the daily management of the animal body, but also by a range of on-farm management strategies and working routines, as well as the cultural dispositions, social networks and tacit knowledge of the actors involved. RT is communicated to lay operators and disseminated amongst semi-professional figures such as breed experts, herd inspectors and technical consultants. The practical contexts in which reproductive knowledge is popularized and applied provide ample scope for local negotiations, resistance and conflict. Professional knowledge about breed-improvement is personalised and appropriated by operators and plays a role in power relations and the exercise of personal charisma as well as being specific to context, in particular the nuances of pre-existing relationships of trust, friendship, kinship or hierarchy. No wonder then that many ambivalences and compromises coexist in the practice of applying 'reproductive knowledge' to breed selection.

Developing a holistic approach to obesity management.

PubMed

Brown, Jenny; Wimpenny, Peter

2011-02-01

The aim of this paper is to discuss the theoretical background and relevance of a holistic approach to obesity management by nurses. There is a global rise in the number of people with obesity, such that it now represents one of the major health challenges. However, nurses are often influenced by physical and dietetic focused approaches and could fail to acknowledge a range of other factors that can impact on weight management. As part of the development of a holistic approach to obesity a literature search was undertaken to establish relevant theoretical perspectives that underpin practice in physical, psychological and social aspects of care (focused on the period 1995-2005). In addition, experiences of working in a secondary care weight management clinic were also drawn upon. Psychobiological, attribution and social support theories were identified that could contribute to a better understanding of obesity. If these theoretical perspectives and supporting evidence can be integrated in a holistic approach to care and management it might be possible to promote better health and well-being in those with obesity. Creating a greater understanding of the range of theoretical perspectives and supporting evidence related to obesity could, it is argued, provide enhanced care and management. © 2011 Blackwell Publishing Asia Pty Ltd.

Extravasation injuries: a review.

PubMed

Goutos, I; Cogswell, L K; Giele, H

2014-10-01

Extravasation injuries are common emergencies in clinical practice. If they are not recognized and treated promptly, they can lead to deleterious functional and cosmetic outcomes. There is a vast range of agents involved in these injuries and marked paucity of evidence to support their specific management. Following an extensive literature review, we outline management principles for clinicians involved in the care of patients with extravasation injuries. Key parameters in deciding appropriate management plans include the volume/toxicity of the agent, the necrosis interval of the injury, patient-related factors, as well as the facilities and expertise available in the setting of individual cases of extravasation. © The Author(s) 2014.

Effect of cattle management practices on raw milk quality on farms operating in a two-stage dairy chain.

PubMed

Sraïri, M T; Benhouda, H; Kuper, M; Le Gal, P Y

2009-02-01

In many developing countries, milk production varies greatly according to farm size, cattle breed, and milking practices. However, production systems often are dominated by smallholder farms. Therefore, relatively small volumes of milk are delivered daily from numerous farms to intermediate cooperatives which supply industrial units. This paper argues that in such two-stage dairy chains, milk quality could be improved by focusing on farming practices rather than on the testing of individual deliveries. Indeed, it is difficult to analyze their quality due to technical, economic, and logistic limitations. The objective of this study is to link on-farm practices with milk chemical quality parameters (fat and protein) and hygienic quality criteria (Aerobic Plate Count, APC and Coliforms). Cattle management practices were monitored monthly over one year on 23 farms located on an irrigation scheme in Morocco. 276 milk samples were analyzed. The monthly variability of milk quality parameters was then characterized. Results show that average cow milk chemical parameters vary within a normal range. They remain primarily linked to the genetic type of cows, the lactation stage, and the conversion of feed concentrates' net energy into milk. Overall milk hygienic quality was poor (APC and Coliforms counts were 100 fold international norms), due essentially to a lack of hygiene and inadequate milking conditions (hands, udder, and teat washing, type of bucket used, dirtiness of cows...). It is suggested that a close monitoring of herd management practices may allow the indirect control of milk quality parameters, thereby avoiding costly analyses of numerous smallholder milk deliveries.

Consumer product branding strategy and the marketing of physicians' services.

PubMed

Friedrich, H; Witt, J

1995-01-01

Hospitals have traditionally maintained physician referral programs as a means of attracting physicians to their network of affiliated providers. The advent of managed care and impending healthcare reform has altered the relationship of hospitals and physicians. An exploratory study of marketing approaches used by twelve healthcare organizations representing twenty-five hospitals in a large city was conducted. Strategies encountered in the study ranged from practice acquisition to practice promotion. This study suggests that healthcare providers might adopt consumer product branding strategies to secure market-share, build brand equity, and improve profitability.

Exploring the use of situation awareness in behaviors and practices of health and safety leaders.

PubMed

Willmer, D R

2017-01-01

An understanding of how health and safety management systems (HSMS) reduce worksite injuries, illnesses and fatalities may be gained in studying the behaviors of health and safety leaders. These leaders bear the accountability for identifying, understanding and managing the risks of a mining operation. More importantly, they have to transfer this knowledge of perception, recognition and response to risks in the mining environment to their workers. The leaders' efforts to build and maintain a mining operation's workforce that consistently executes safe work practices may be captured through more than just lagging indicators of health and safety performance. This exploratory study interviewed six leaders in occupations such as site-level safety supervisors, mine superintendents and/or general managers at surface and underground stone, sand and gravel and metal/nonmetal mine sites throughout the United States, with employee populations ranging from 40 to 175. In exploring leaders' perspectives on how they systematically manage health and safety, examples such as approaches to task training, handling near-miss incidents, identifying future leaders and providing workers with feedback offer insights into how leaders translate their knowledge and management of site-level risks to others.

Exploring the use of situation awareness in behaviors and practices of health and safety leaders

PubMed Central

Willmer, D.R.

2018-01-01

An understanding of how health and safety management systems (HSMS) reduce worksite injuries, illnesses and fatalities may be gained in studying the behaviors of health and safety leaders. These leaders bear the accountability for identifying, understanding and managing the risks of a mining operation. More importantly, they have to transfer this knowledge of perception, recognition and response to risks in the mining environment to their workers. The leaders’ efforts to build and maintain a mining operation’s workforce that consistently executes safe work practices may be captured through more than just lagging indicators of health and safety performance. This exploratory study interviewed six leaders in occupations such as site-level safety supervisors, mine superintendents and/or general managers at surface and underground stone, sand and gravel and metal/nonmetal mine sites throughout the United States, with employee populations ranging from 40 to 175. In exploring leaders’ perspectives on how they systematically manage health and safety, examples such as approaches to task training, handling near-miss incidents, identifying future leaders and providing workers with feedback offer insights into how leaders translate their knowledge and management of site-level risks to others. PMID:29593373

Soak Up the Rain New England Webinar Series: National ...

EPA Pesticide Factsheets

Presenters will provide an introduction to the most recent EPA green infrastructure tools to R1 stakeholders; and their use in making decisions about implementing green infrastructure. We will discuss structuring your green infrastructure decision, finding appropriate information and tools, evaluating options and selecting the right Best Management Practices mix for your needs.WMOST (Watershed Management Optimization Support Tool)- for screening a wide range of practices for cost-effectiveness in achieving watershed or water utilities management goals.GIWiz (Green Infrastructure Wizard)- a web application connecting communities to EPA Green Infrastructure tools and resources.Opti-Tool-designed to assist in developing technically sound and optimized cost-effective Stormwater management plans. National Stormwater Calculator- a desktop application for estimating the impact of land cover change and green infrastructure controls on stormwater runoff. DASEES-GI (Decision Analysis for a Sustainable Environment, Economy, and Society) – a framework for linking objectives and measures with green infrastructure methods. Presenters will provide an introduction to the most recent EPA green infrastructure tools to R1 stakeholders; and their use in making decisions about implementing green infrastructure. We will discuss structuring your green infrastructure decision, finding appropriate information and tools, evaluating options and selecting the right Best Management Pr

Movement patterns of exhibition swine and associations of influenza A virus infection with swine management practices.

PubMed

Bliss, Nola; Stull, Jason W; Moeller, Steven J; Rajala-Schultz, Päivi J; Bowman, Andrew S

2017-09-15

OBJECTIVE To identify the geographic distribution of exhibition swine in the Midwestern United States, characterize management practices used for exhibition swine, and identify associations between those practices and influenza A virus (IAV) detection in exhibition swine arriving at county or state agricultural fairs. DESIGN Cross-sectional survey. SAMPLE 480 swine exhibitors and 641 exhibition swine. PROCEDURES Inventories of swine exhibited at fairs in 6 selected Midwestern states during 2013 and of the total swine population (including commercial swine) in these regions in 2012 were obtained and mapped. In 2014, snout wipe samples were collected from swine on arrival at 9 selected fairs in Indiana (n = 5) and Ohio (4) and tested for the presence of IAV. Also at fair arrival, swine exhibitors completed a survey regarding swine management practices. RESULTS Contrary to the total swine population, the exhibition swine population was heavily concentrated in Indiana and Ohio. Many swine exhibitors reported attending multiple exhibitions within a season (median number, 2; range, 0 to 50), with exhibited swine often returned to their farm of origin. Rearing of commercial and exhibition swine on the same premises was reported by 13.3% (56/422) of exhibitors. Hosting an on-farm open house or sale was associated with an increased odds of IAV detection in snout wipe samples. CONCLUSIONS AND CLINICAL RELEVANCE The exhibition swine population was highly variable and differed from the commercial swine population in terms of pig density across geographic locations, population integrity, and on-farm management practices. Exhibition swine may be important in IAV transmission, and identified biosecurity deficiencies may have important public and animal health consequences.

A new view for resource managers

USGS Publications Warehouse

Haas, Robert H.

1986-01-01

In decades past, the rancher depended upon reports from cowboys to gather information he needed to make management decisions. Today, the vast open ranges of the cowboy era are mostly gone in the United States-fenced into pastures, paddocks, or fields that are now discrete management units. But fencing in the rangeland, while it has replaced much of the need for cowboys, has not replaced the need for information about the health and vigor of the forage on each parcel of land. Can a satellite, orbiting at more than 400 miles in space, serve this purpose? As ranchers and resource specialists are asked to make more and more complex management decisions, with less manpower for conducting inventories, they are wise to seek help in today's rapidly developing technologies. For the past few decades the range technician has accomplished most of his range assessment from a pickup truck, traveling periodically to each unit to determine its status. Now, satellite images of the Earth's resources might be able to help the modern range person do an even more efficient job of monitoring the availability of feed for livestock and wildlife. Yet some important questions need to be answered first. Can this new information source be used to evaluate the ecological condition of these lands? Or are satellite images of our Earth and its variety of landscapes just "pretty pictures," with little practical utility?

Information systems: the key to evidence-based health practice.

PubMed Central

Rodrigues, R. J.

2000-01-01

Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems. PMID:11143195

The influences of changing weather patterns and land management on runoff biogeochemistry in a snowmelt dominated agricultural region

NASA Astrophysics Data System (ADS)

Wilson, H. F.; Elliott, J. A.; Glenn, A. J.

2017-12-01

Runoff generation and the associated export of nitrogen, phosphorus, and organic carbon on the Northern Great Plains have historically been dominated by snowmelt runoff. In this region the transport of elements primarily occurs in dissolved rather than particulate forms, so cropland management practices designed to reduce particulate losses tend to be ineffective in reducing nutrient runoff. Over the last decade a higher frequency of high volume and intensity rainfall has been observed, leading to rainfall runoff and downstream flooding. To evaluate interactions between tillage, crop residue management, fertilization practices, weather, and runoff biogeochemistry a network of 18 single field scale watersheds (2-6 ha.) has been established in Manitoba, Canada over a range of fertilization (no input to high input) and tillage (zero tillage to frequent tillage). Soils in this network are typical of cropland in the region with clay or clay loam textures, but soil phosphorus differs greatly depending on input practices (3 to 25 mg kg-1 sodium bicarbonate extractable P). Monitoring of runoff chemistry and hydrology at these sites was initiated in 2013 and over the course of 5 years high volume snowmelt runoff from deep snowpack (125mm snow water equivalent), low volume snowmelt from shallow snowpack (25mm snow water equivalent) and extreme rainfall runoff events in spring have all been observed. Event based analyses of the drivers of runoff chemistry indicate that spring fertilization practices (depth, amount, and timing) influence concentrations of N and P in runoff during large rainfall runoff events, but for snowmelt runoff the near surface soil chemistry, tillage, and crop residue management are of greater importance. Management recommendations that might be suggested to reduce nutrient export and downstream eutrophication in the region differ for snowmelt and rainfall, but are not mutually exclusive.

A Multi-Institutional Project to Develop Discipline-Specific Data Literacy Instruction for Graduate Students

NASA Astrophysics Data System (ADS)

Wright, S. J.; Fosmire, M.; Jeffryes, J.; Stowell Bracke, M.; Westra, B.

2012-12-01

What data stewardship skills are needed by future scientists to fulfill their professional responsibilities and take advantage of opportunities in e-science? How can academic librarians contribute their expertise in information organization, dissemination and preservation to better serve modern science? With support from the Institute of Museum and Library Services (IMLS), four research libraries have formed a partnership to address these questions. The aims of the partnership are to identify the data stewardship skills, including data management and curation, needed by graduate students at the research discipline level, to identify trends that extend across the Science, Technology, Engineering, and Mathematics (STEM) disciplines, and to collaborate with faculty to develop and implement "data information literacy" (DIL) curricula to address those needs. Over the course of the first year, the authors have been working closely with faculty in hydrology, civil engineering, ecology/environmental science, and natural resources. At the outset, we performed structured interviews with faculty and graduate students using a modified version of the Data Curation Profiles Toolkit (http://datacurationprofiles.org) to gather detailed information about the practices, limitations, needs, and opportunities for improving data management and curation practices in each group. Project teams also conducted discipline-based literature reviews and environmental scans of the available resources pertaining to data management and curation issues to identify how (or if) these topics are currently addressed by the discipline. The results were used to develop and implement specific instructional interventions attuned to the needs of each research group. We will share the results of our interviews and information-gathering, summarizing similarities and differences in the data stewardship needs expressed by the graduate students and faculty from different STEM disciplines. We will also discuss some of the educational and support practices undertaken by the teams. The authors' approaches ranged from offering a one-credit special topics class, "Managing data to facilitate your research," to closely integrating resources and training with research projects and practices. A range of strategies will likely need to be employed to educate future scientists in the fundamentals of data stewardship; our strategies are intended to give attendees a starting point for how they can approach the issue at their own institution.

Potential effects of structural controls and street sweeping on stormwater loads to the lower Charles River, Massachusetts

USGS Publications Warehouse

Zarriello, Phillip J.; Breault, Robert F.; Weiskel, Peter K.

2002-01-01

The water quality of the lower Charles River is periodically impaired by combined sewer overflows (CSOs) and non-CSO stormwater runoff. This study examined the potential non-CSO load reductions of suspended solids, fecal coliform bacteria, total phosphorus, and total lead that could reasonably be achieved by implementation of stormwater best management practices, including both structural controls and systematic street sweeping. Structural controls were grouped by major physical or chemical process; these included infiltration-filtration (physical separation), biofiltration-bioretention (biological mechanisms), or detention-retention (physical settling). For each of these categories, upper and lower quartiles, median, and average removal efficiencies were compiled from three national databases of structural control performance. Removal efficiencies obtained indicated a wide range of performance. Removal was generally greatest for infiltration-filtration controls and suspended solids, and least for biofiltration-bioretention controls and fecal coliform bacteria. Street sweeping has received renewed interest as a water-quality control practice because of reported improvements in sweeper technology and the recognition that opportunities for implementing structural controls are limited in highly urbanized areas. The Stormwater Management Model that was developed by the U.S. Geological Survey for the lower Charles River Watershed was modified to simulate the effects of street sweeping in a single-family land-use basin. Constituent buildup and washoff variable values were calibrated to observed annual and storm-event loads. Once calibrated, the street sweeping model was applied to various permutations of four sweeper efficiencies and six sweeping frequencies that ranged from every day to once every 30 days. Reduction of constituent loads to the lower Charles River by the combined hypothetical practices of structural controls and street sweeping was estimated for a range of removal efficiencies because of their inherent variability and uncertainty. This range of efficiencies, with upper and lower estimates, provides reasonable bounds on the load that could be removed by the practices examined. The upper estimated load reduction from combined street sweeping and structural controls, as a percentage of the total non-CSO load entering the lower Charles River downstream of Watertown Dam, was 44 percent for suspended solids, 34 percent for total lead, 14 percent for total phosphorus, and 17 percent for fecal coliform bacteria. The lower estimated load reduction from combined street sweeping and structural controls from non-CSO sources downstream of Watertown Dam, was 14 percent for suspended solids, 11 percent for total lead, 4.9 percent for total phosphorus, and 7.5 percent for fecal coliform bacteria. Load reductions by these combined management practices can be a small as 1.4 percent for total phosphorus to about 4 percent for the other constituents if the total load above Watertown Dam is added to the load from below the dam. Although the reductions in stormwater loads to the lower Charles River from the control practices examined appear to be minor, these practices would likely provide water-quality benefits to portions of the river during those times that they are most impaired-during and immediately after storms. It should also be recognized that only direct measurements of changes in stormwater loads before and after implementation of control practices can provide definitive evidence of the beneficial effects of these practices on water-quality conditions in the lower Charles River.

Diarrhea management in children under five in sub-Saharan Africa: does the source of care matter? A Countdown analysis.

PubMed

Carvajal-Vélez, Liliana; Amouzou, Agbessi; Perin, Jamie; Maïga, Abdoulaye; Tarekegn, Hayalnesh; Akinyemi, Akanni; Shiferaw, Solomon; Young, Mark; Bryce, Jennifer; Newby, Holly

2016-08-19

Diarrhea remains a high burden disease, responsible for nine percent of deaths in children under five globally. We analyzed diarrhea management practices in young children and their association with the source of care. We used Demographic and Health Survey data from 12 countries in sub-Saharan Africa with high burdens of childhood diarrhea. We classified the quality of diarrhea management practices as good, fair, or poor based on mothers' reports for children with diarrhea, using WHO/UNICEF recommendations for appropriate treatment. We described the prevalence of diarrhea management by type and assessed the association between good management and source of care, adjusting for potential confounders. Prevalence of good diarrhea management is low in 11 of the 12 analyzed surveys, varying from 17 % in Cote d'Ivoire to 38 % in Niger. The exception is Sierra Leone, where prevalence of good practice is 67 %. Prevalence of good management was low even among children taken to health facilities [median 52 %, range: 34-64 %]. Diarrhea careseeking from health facilities or community providers was associated with higher odds of good management than care from traditional/informal sources or no care. Careseeking from facilities did not result systematically in a higher likelihood of good diarrhea management than care from community providers. The odds of good diarrhea management were similar for community versus facility providers in six countries, higher in community than facility providers in two countries, and higher in facility than in community providers in four countries. Many children's lives can be saved with correct management of childhood diarrhea. Too many children are not receiving adequate care for diarrhea in high-burden sub-Saharan African countries, even among those seen in health facilities. Redoubling efforts to increase careseeking and improve quality of care for childhood diarrhea in both health facilities and at community level is an urgent priority.

A Recipe for Streamlining Mission Management

NASA Technical Reports Server (NTRS)

Mitchell, Andrew E.; Semancik, Susan K.

2004-01-01

This paper describes a project's design and implementation for streamlining mission management with knowledge capture processes across multiple organizations of a NASA directorate. Thc project's focus is on standardizing processes and reports; enabling secure information access and case of maintenance; automating and tracking appropriate workflow rules through process mapping; and infusing new technologies. This paper will describe a small team's experiences using XML technologies through an enhanced vendor suite of applications integrated on Windows-based platforms called the Wallops Integrated Scheduling and Document Management System (WISDMS). This paper describes our results using this system in a variety of endeavors, including providing range project scheduling and resource management for a Range and Mission Management Office; implementing an automated Customer Feedback system for a directorate; streamlining mission status reporting across a directorate; and initiating a document management, configuration management and portal access system for a Range Safety Office's programs. The end result is a reduction of the knowledge gap through better integration and distribution of information, improved process performance, automated metric gathering, and quicker identification of problem areas and issues. However, the real proof of the pudding comes through overcoming the user's reluctance to replace familiar, seasoned processes with new technology ingredients blended with automated procedures in an untested recipe. This paper shares some of the team's observations that led to better implementation techniques, as well as an IS0 9001 Best Practices citation. This project has provided a unique opportunity to advance NASA's competency in new technologies, as well as to strategically implement them within an organizational structure, while wetting the appetite for continued improvements in mission management.

Supplemental feeding alters migration of a temperate ungulate.

PubMed

Jones, Jennifer D; Kauffman, Matthew J; Monteith, Kevin L; Scurlock, Brandon M; Albeke, Shannon E; Cross, Paul C

Conservation of migration requires information on behavior and environmental determinants. The spatial distribution of forage resources, which migration exploits, often are altered and may have subtle, unintended consequences. Supplemental feeding is a common management practice, particularly for ungulates in North America and Europe, and carryover effects on behavior of this anthropogenic manipulation of forage are expected in theory, but have received limited empirical evaluation, particularly regarding effects on migration. We used global positioning system (GPS) data to evaluate the influence of winter feeding on migration behavior of 219 adult female elk (Cervus elaphus) from 18 fed ranges and 4 unfed ranges in western Wyoming. Principal component analysis revealed that the migratory behavior of fed and unfed elk differed in distance migrated, and the timing of arrival to, duration on, and departure from summer range. Fed elk migrated 19.2 km less, spent 11 more days on stopover sites, arrived to summer range 5 days later, resided on summer range 26 fewer days, and departed in the autumn 10 days earlier than unfed elk. Time-to-event models indicated that differences in migratory behavior between fed and unfed elk were caused by altered sensitivity to the environmental drivers of migration. In spring, unfed elk migrated following plant green-up closely, whereas fed elk departed the feedground but lingered on transitional range, thereby delaying their arrival to summer range. In autumn, fed elk were more responsive to low temperatures and precipitation events, causing earlier departure from summer range than unfed elk. Overall, supplemental feeding disconnected migration by fed elk from spring green-up and decreased time spent on summer range, thereby reducing access to quality forage. Our findings suggest that ungulate migration can be substantially altered by changes to the spatial distribution of resources, including those of anthropogenic origin, and that management practices applied in one season may have unintended behavioral consequences in subsequent seasons.

Supplemental feeding alters migration of a temperate ungulate

USGS Publications Warehouse

Jones, Jennifer D; Kauffman, Matthew J.; Monteith, Kevin L.; Scurlock, Brandon M.; Albeke, Shannon E.; Cross, Paul C.

2014-01-01

Conservation of migration requires information on behavior and environmental determinants. The spatial distribution of forage resources, which migration exploits, often are altered and may have subtle, unintended consequences. Supplemental feeding is a common management practice, particularly for ungulates in North America and Europe, and carryover effects on behavior of this anthropogenic manipulation of forage are expected in theory, but have received limited empirical evaluation, particularly regarding effects on migration. We used global positioning system (GPS) data to evaluate the influence of winter feeding on migration behavior of 219 adult female elk (Cervus elaphus) from 18 fed ranges and 4 unfed ranges in western Wyoming. Principal component analysis revealed that the migratory behavior of fed and unfed elk differed in distance migrated, and the timing of arrival to, duration on, and departure from summer range. Fed elk migrated 19.2 km less, spent 11 more days on stopover sites, arrived to summer range 5 days later, resided on summer range 26 fewer days, and departed in the autumn 10 days earlier than unfed elk. Time-to-event models indicated that differences in migratory behavior between fed and unfed elk were caused by altered sensitivity to the environmental drivers of migration. In spring, unfed elk migrated following plant green-up closely, whereas fed elk departed the feedground but lingered on transitional range, thereby delaying their arrival to summer range. In autumn, fed elk were more responsive to low temperatures and precipitation events, causing earlier departure from summer range than unfed elk. Overall, supplemental feeding disconnected migration by fed elk from spring green-up and decreased time spent on summer range, thereby reducing access to quality forage. Our findings suggest that ungulate migration can be substantially altered by changes to the spatial distribution of resources, including those of anthropogenic origin, and that management practices applied in one season may have unintended behavioral consequences in subsequent seasons.

Harvesting impacts on steep slopes in Virginia

Treesearch

W.B. Stuart; S.L. Carr

1991-01-01

Ten tracts in the mountains of western Virginia were intensively sampled to determine the type and extent of soil disturbance from ground-based logging and the attendant erosion risk. Average slopes for the tracts ranged from 21 to 43 percent. Logged slopes exceeded 50 percent. All tracts surveyed were logged prior to the push for voluntary Best Management Practices...

Intercultural Dialogue in Practice: Managing Value Judgment through Foreign Language Education

ERIC Educational Resources Information Center

Houghton, Stephanie Ann

2012-01-01

The term intercultural dialogue has become a buzzword at policy level, but there is a pressing need to synchronise the terminology of policymakers with that of academics. An overarching aim of this book is to explore the wide-ranging terminology relevant to intercultural dialogue in order to promote clearer consideration of the underlying issues.…

Dr. Biswell's influence on the development of prescribed burning in California

Treesearch

Jan W.\\t van Wagtendonk

1995-01-01

Prescribed burning in California has evolved from the original practices of the Native Americans, through years of experimentation and controversy, to finally become an accepted ecosystem management activity. When Dr. Harold Biswell arrived in California, he began research on improving game range by using prescribed fires and on understory burning in ponderosa pine (...

Winter movements of Louisiana pine snakes (Pituophis ruthveni) in Texas and Louisiana

Treesearch

Josh B. Pierce; D. Craig Rudolph; Shirley J. Burgdorf; Richard R. Schaefer; Richard N. Conner; John G. Himes; C. Mike Duran; Laurence M. Hardy; Robert R. Fleet

2014-01-01

Despite concerns that the Louisiana Pine Snake (Pituophis ruthveni) has been extirpated from large portions of its historic range, only a limited number of studies on their movement patterns have been published. Winter movement patterns are of particular interest since it has been hypothesized that impacts of management practices would be reduced during the winter....

The Pastoral Care of International Students in New Zealand: Is It More Than a Consumer Protection Regime?

ERIC Educational Resources Information Center

Sawir, Erlenawati; Marginson, Simon; Nyland, Chris; Ramia, Gaby; Rawlings-Sanaei, Felicity

2009-01-01

Student security is a composite social practice that includes the domains of consumer rights, entitlement to a range of welfare supports and pastoral care, and freedom from exploitation and discrimination. Three traditions shape the systems used for managing and regulating international student security in the nations that export education:…

Twelve Commandments of Human Relations for the Diverse Academic Environment of Colleges and Universities

ERIC Educational Resources Information Center

Davis, William Young; Swartz, Caroline

2008-01-01

This paper focuses on applying proven industrial relations approaches and sound management practice to address a range of diversity issues in higher education. Issues addressed include the need to set a clear and consistent direction, the importance of effective policy setting and enforcement, the value of positive reinforcement, and the…

Phenology and trend indicators derived from spatially dynamic bi-weekly satellite imagery to support ecosystem monitoring

Treesearch

Barron J. Orr; Grant M. Casady; Daniel G. Tuttle; Willem J. D. van Leeuwen; Laura E. Baker; Colleen I. McDonald; Stuart E. Marsh

2005-01-01

Ground-based ecosystem monitoring presents some practical challenges to natural resource managers and ecologists tasked with assessing vegetation dynamics across large areas through time. RangeView (http://rangeview.arizona.edu) provides online access to spatially and temporally explicit biweekly vegetation indices derived from satellite data. It also permits side-by-...

From a social marketing perspective: a proposed customer relationship management technology transfer model

Treesearch

Delton Alderman; Kent Nakamoto; David Briberg

2007-01-01

Technology and knowledge transfer (TKT) is practiced for a plethora of causes, ranging from AIDS prevention to manufacturing competitiveness. The number of government, university, and association TKT efforts is exhausting and fraught with problems; we know anecdotally that the adoption of technology or knowledge is minimal across all contexts. There are a myriad of...

Expert searcher, teacher, content manager, and patient advocate: an exploratory study of clinical librarian roles.

PubMed

Tan, Maria C; Maggio, Lauren A

2013-01-01

The research explored the roles of practicing clinical librarians embedded in a patient care team. Six clinical librarians from Canada and one from the United States were interviewed to elicit detailed descriptions of their clinical roles and responsibilities and the context in which these were performed. Participants were embedded in a wide range of clinical service areas, working with a diverse complement of health professionals. As clinical librarians, participants wore many hats, including expert searcher, teacher, content manager, and patient advocate. Unique aspects of how these roles played out included a sense of urgency surrounding searching activities, the broad dissemination of responses to clinical questions, and leverage of the roles of expert searcher, teacher, and content manager to advocate for patients. Detailed role descriptions of clinical librarians embedded in patient care teams suggest possible new practices for existing clinical librarians, provide direction for training new librarians working in patient care environments, and raise awareness of the clinical librarian specialty among current and budding health information professionals.

Uncertainty, robustness, and the value of information in managing a population of northern bobwhites

USGS Publications Warehouse

Johnson, Fred A.; Hagan, Greg; Palmer, William E.; Kemmerer, Michael

2014-01-01

The abundance of northern bobwhites (Colinus virginianus) has decreased throughout their range. Managers often respond by considering improvements in harvest and habitat management practices, but this can be challenging if substantial uncertainty exists concerning the cause(s) of the decline. We were interested in how application of decision science could be used to help managers on a large, public management area in southwestern Florida where the bobwhite is a featured species and where abundance has severely declined. We conducted a workshop with managers and scientists to elicit management objectives, alternative hypotheses concerning population limitation in bobwhites, potential management actions, and predicted management outcomes. Using standard and robust approaches to decision making, we determined that improved water management and perhaps some changes in hunting practices would be expected to produce the best management outcomes in the face of uncertainty about what is limiting bobwhite abundance. We used a criterion called the expected value of perfect information to determine that a robust management strategy may perform nearly as well as an optimal management strategy (i.e., a strategy that is expected to perform best, given the relative importance of different management objectives) with all uncertainty resolved. We used the expected value of partial information to determine that management performance could be increased most by eliminating uncertainty over excessive-harvest and human-disturbance hypotheses. Beyond learning about the factors limiting bobwhites, adoption of a dynamic management strategy, which recognizes temporal changes in resource and environmental conditions, might produce the greatest management benefit. Our research demonstrates that robust approaches to decision making, combined with estimates of the value of information, can offer considerable insight into preferred management approaches when great uncertainty exists about system dynamics and the effects of management.

Irrigation and fertilization effects on Nantucket Pine Tip Moth (Lepidoptera: Tortricidae) Damage levels and pupal weight in an intensively-managed pine plantation.

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

Coyle, David, R.; Nowak, John, T.; Fettig, Christopher, J.

2003-10-01

The widespread application of intensive forest management practices throughout the southeastern U.S. has increased loblolly pine, Pinus taeda L., yields and shortened conventional rotation lengths. Fluctuations in Nantucket pine tip moth, Rhyacionia frustrana (Comstock), population density and subsequent damage levels have been linked to variations in management intensity. We examined the effects of two practices, irrigation and fertilization, on R. frustrana damage levels and pupal weights in an intensively-managed P. taeda plantation in South Carolina. Trees received intensive weed control and one of the following treatments; irrigation only. fertilization only, irrigation + fertilization, or control. Mean whole-tree tip moth damagemore » levels ranged from <1 to 48% during this study. Damage levels differed significantly among treatments in two tip moth generations in 2001, but not 2000. Pupal weight was significantly heavier in fertilization compared to the irrigation treatment in 2000, but no significant differences were observed in 2001. Tree diameter. height. and aboveground volume were significantly greater in the irrigation + fertilization than in the irrigation treatment after two growing seasons. Our data suggest that intensive management practices that include irrigation and fertilization do not consistently increase R. frustrana damage levels and pupal weights as is commonly believed. However, tip moth suppression efforts in areas adjacent to our study may have partially reduced the potential impacts of R. frustrana on this experiment.« less

Hydrology of C-3 watershed, Seney National Wildlife Refuge, Michigan

USGS Publications Warehouse

Sweat, Michael J.

2001-01-01

Proposed changes to watershed management practices near C-3 Pool at Seney National Wildlife Refuge will affect surface-water flow patterns, ground-water levels, and possibly local plant communities. Data were collected between fall 1998 and spring 2000 to document existing conditions and to assess potential changes in hydrology that might occur as a consequence of modifications to water management practices in C-3 watershed.Minimum and maximum measured inflows and outflows for the study period are presented in light of proposed management changes to C-3 watershed. Streamflows ranged from 0 to 8.61 cubic meters per second. Low or zero flow was generally measured in late summer and early fall, and highest flows were measured during spring runoff and winter rain events. Ground-water levels varied by about a half meter, with levels closest to or above the land surface during spring runoff into the early summer, and with levels generally below land surface during late fall into early winter.A series of optional management practices that could conserve and restore habitat of the C-3 watershed is described. Modifications to the existing system of a drainage ditch and control structures are examined, as are the possibilities of reconnecting streams to their historical channels and the construction of additional or larger control structures to further manage the distribution of water in the watershed. The options considered could reduce erosion, restore presettlement streamflow conditions, and modify the ground-water gradient.

Advances in the Diagnosis and Management of Inflammatory Bowel Disease: Challenges and Uncertainties

PubMed Central

Mosli, Mahmoud; Al Beshir, Mohammad; Al-Judaibi, Bandar; Al-Ameel, Turki; Saleem, Abdulaziz; Bessissow, Talat; Ghosh, Subrata; Almadi, Majid

2014-01-01

Over the past two decades, several advances have been made in the management of patients with inflammatory bowel disease (IBD) from both evaluative and therapeutic perspectives. This review discusses the medical advancements that have recently been made as the standard of care for managing patients with ulcerative colitis (UC) and Crohn's Disease (CD) and to identify the challenges associated with implementing their use in clinical practice. A comprehensive literature search of the major databases (PubMed and Embase) was conducted for all recent scientific papers (1990–2013) giving the recent updates on the management of IBD and the data were extracted. The reported advancements in managing IBD range from diagnostic and evaluative tools, such as genetic tests, biochemical surrogate markers of activity, endoscopic techniques, and radiological modalities, to therapeutic advances, which encompass medical, endoscopic, and surgical interventions. There are limited studies addressing the cost-effectiveness and the impact that these advances have had on medical practice. The majority of the advances developed for managing IBD, while considered instrumental by some IBD experts in improving patient care, have questionable applications due to constraints of cost, lack of availability, and most importantly, insufficient evidence that supports their role in improving important long-term health-related outcomes. PMID:24705146

Twelve evidence-based principles for implementing self-management support in primary care.

PubMed

Battersby, Malcolm; Von Korff, Michael; Schaefer, Judith; Davis, Connie; Ludman, Evette; Greene, Sarah M; Parkerton, Melissa; Wagner, Edward H

2010-12-01

Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.

Optimizing best management practices to control anthropogenic sources of atmospheric phosphorus deposition to inland lakes.

PubMed

Weiss, Lee; Thé, Jesse; Winter, Jennifer; Gharabaghi, Bahram

2018-04-18

Excessive phosphorus loading to inland freshwater lakes around the globe has resulted in nuisance plant growth along the waterfronts, degraded habitat for cold water fisheries, and impaired beaches, marinas and waterfront property. The direct atmospheric deposition of phosphorus can be a significant contributing source to inland lakes. The atmospheric deposition monitoring program for Lake Simcoe, Ontario indicates roughly 20% of the annual total phosphorus load (2010-2014 period) is due to direct atmospheric deposition (both wet and dry deposition) on the lake. This novel study presents a first-time application of the Genetic Algorithm (GA) methodology to optimize the application of best management practices (BMPs) related to agriculture and mobile sources to achieve atmospheric phosphorus reduction targets and restore the ecological health of the lake. The novel methodology takes into account the spatial distribution of the emission sources in the airshed, the complex atmospheric long-range transport and deposition processes, cost and efficiency of the popular management practices and social constraints related to the adoption of BMPs. The optimization scenarios suggest that the optimal overall capital investment of approximately $2M, $4M, and $10M annually can achieve roughly 3, 4 and 5 tonnes reduction in atmospheric P load to the lake, respectively. The exponential trend indicates diminishing returns for the investment beyond roughly $3M per year and that focussing much of this investment in the upwind, nearshore area will significantly impact deposition to the lake. The optimization is based on a combination of the lowest-cost, most-beneficial and socially-acceptable management practices that develops a science-informed promotion of implementation/BMP adoption strategy. The geospatial aspect to the optimization (i.e. proximity and location with respect to the lake) will help land managers to encourage the use of these targeted best practices in areas that will most benefit from the phosphorus reduction approach.

Prevalence and Implementation of IAQ Programs in U.S. Schools

PubMed Central

Moglia, Dena; Smith, Alisa; MacIntosh, David L.; Somers, Jennifer L.

2006-01-01

In this study, we determined the extent to which U.S. schools are implementing indoor air quality (IAQ) programs. We administered a questionnaire on IAQ programs and practices to a representative sample of schools. Participants were asked to provide information on the use, administration, implementation, challenges, and benefits of the IAQ program in their school. We developed an IAQ Practice Index to determine the level of activity directed toward IAQ in schools. The index was computed based on responses to specific survey questions and was normalized to a range of 0 to 100. Each question was weighted qualitatively according to its contribution to strong IAQ management practices. Forty-two percent of schools in the United States have an IAQ management program, and there has been sustained growth from 1998 through 2002 in the number of schools that have such programs. Nearly half of those schools use the U.S. Environmental Protection Agency’s IAQ Tools for Schools program. The IAQ Practice Index scores varied widely for schools with an IAQ management program, suggesting that having a program is not equivalent to implementing effective IAQ policies and procedures. Respondents indicated that their IAQ programs led to improved workplace satisfaction, fewer asthma attacks, fewer visits to the school nurse, and lower absenteeism. When actively supported by the school administration, an IAQ program appears to be a valuable factor in improving the learning environment for U.S. schoolchildren. PMID:16393672

The RICORDO approach to semantic interoperability for biomedical data and models: strategy, standards and solutions

PubMed Central

2011-01-01

Background The practice and research of medicine generates considerable quantities of data and model resources (DMRs). Although in principle biomedical resources are re-usable, in practice few can currently be shared. In particular, the clinical communities in physiology and pharmacology research, as well as medical education, (i.e. PPME communities) are facing considerable operational and technical obstacles in sharing data and models. Findings We outline the efforts of the PPME communities to achieve automated semantic interoperability for clinical resource documentation in collaboration with the RICORDO project. Current community practices in resource documentation and knowledge management are overviewed. Furthermore, requirements and improvements sought by the PPME communities to current documentation practices are discussed. The RICORDO plan and effort in creating a representational framework and associated open software toolkit for the automated management of PPME metadata resources is also described. Conclusions RICORDO is providing the PPME community with tools to effect, share and reason over clinical resource annotations. This work is contributing to the semantic interoperability of DMRs through ontology-based annotation by (i) supporting more effective navigation and re-use of clinical DMRs, as well as (ii) sustaining interoperability operations based on the criterion of biological similarity. Operations facilitated by RICORDO will range from automated dataset matching to model merging and managing complex simulation workflows. In effect, RICORDO is contributing to community standards for resource sharing and interoperability. PMID:21878109

Prevalence and implementation of IAQ programs in U.S. schools.

PubMed

Moglia, Dena; Smith, Alisa; MacIntosh, David L; Somers, Jennifer L

2006-01-01

In this study, we determined the extent to which U.S. schools are implementing indoor air quality (IAQ) programs. We administered a questionnaire on IAQ programs and practices to a representative sample of schools. Participants were asked to provide information on the use, administration, implementation, challenges, and benefits of the IAQ program in their school. We developed an IAQ Practice Index to determine the level of activity directed toward IAQ in schools. The index was computed based on responses to specific survey questions and was normalized to a range of 0 to 100. Each question was weighted qualitatively according to its contribution to strong IAQ management practices. Forty-two percent of schools in the United States have an IAQ management program, and there has been sustained growth from 1998 through 2002 in the number of schools that have such programs. Nearly half of those schools use the U.S. Environmental Protection Agency's IAQ Tools for Schools program. The IAQ Practice Index scores varied widely for schools with an IAQ management program, suggesting that having a program is not equivalent to implementing effective IAQ policies and procedures. Respondents indicated that their IAQ programs led to improved workplace satisfaction, fewer asthma attacks, fewer visits to the school nurse, and lower absenteeism. When actively supported by the school administration, an IAQ program appears to be a valuable factor in improving the learning environment for U.S. schoolchildren.

Teaching residents practice-management knowledge and skills: an in vivo experience.

PubMed

Williams, Laurel Lyn

2009-01-01

This article explores the relevant data regarding teaching psychiatric residents practice management knowledge and skills. This article also introduces a unique program for teaching practice management to residents. A literature search was conducted through PubMed and Academic Psychiatry. Additionally residents involved in the training program for practice management were given an anonymous survey to complete. There were no randomized, controlled trials in the academic psychiatric field concerning the topic of practice management. The responses to the resident survey (n=10) indicated a modest improvement in residents' perception of receiving adequate training and exposure to practice management knowledge and skills. The available research suggests that many residents and faculty believe that practice management knowledge and skills are still not adequately addressed. The Baylor Clinic practice management program may be one possible solution for integrating the teaching of practice management knowledge and skills. More research on this topic is needed.

Using Social Network Analysis to Examine the Effect of Care Management Structure on Chronic Disease Management Communication Within Primary Care.

PubMed

Holtrop, Jodi Summers; Ruland, Sandra; Diaz, Stephanie; Morrato, Elaine H; Jones, Eric

2018-05-01

Care management and care managers are becoming increasingly prevalent in primary care medical practice as a means of improving population health and reducing unnecessary care. Care managers are often involved in chronic disease management and associated transitional care. In this study, we examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. We sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Individual written surveys were given to all practice members in the participating practices. Survey questions assessed demographics as well as practice culture, quality improvement, care management activities, and communication regarding chronic disease care. Using social network analysis and other statistical methods, we analyzed the communication dynamics related to chronic disease care for each practice. The structure of chronic disease communication varies greatly from practice to practice. Care managers who were embedded in the practice or co-located were more likely to be in the core of the communication network than were off-site care managers. These care managers also had higher in-degree centrality, indicating that they acted as a hub for communication with team members in many other roles. Social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. Structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.

Management of food allergy: a survey of Australian paediatricians.

PubMed

Morawetz, Deborah Y; Hiscock, Harriet; Allen, Katrina J; Davies, Sarah; Danchin, Margie H

2014-06-01

The prevalence of Immunoglobulin E (IgE)-mediated food allergy in the developed world is increasing, overwhelming tertiary allergy services. Alternative models of care are required. General paediatricians could provide this care but may require further training to do so. We aimed to determine Australian general paediatricians': (i) knowledge and management of IgE-mediated food allergy; (ii) access to and use of diagnostic services; and (iii) interest in further training. Members of the Australian Paediatric Research Network completed an online survey in 2011/12. A case study elicited paediatrician's knowledge of diagnostic history taking, testing and key management principles. Study-designed questions assessed paediatricians' current practice, access to allergy services and interest in further training. One hundred sixty-eight (43%) of 390 paediatricians responded; 93 paediatricians reported managing food allergy. Diagnostic and management practices varied widely. Paediatricians had high levels of agreement (>90%) for only three of 13 questions pertaining to diagnosis and management. Only 56 (61%) correctly identified that a diagnosis of IgE-mediated food allergy requires a history consistent with a clinical reaction and a positive specific serum IgE antibody or skin prick test result. Reported waiting times for tertiary allergy services ranged from 5.4 (private) to 10.6 months (public). Most (91%) paediatricians expressed interest in further training. General paediatricians would benefit from further training if they are to practice allergy care as their diagnosis and management is often inconsistent with international guidelines. Training could be delivered online to maximise reach and uptake. If effective, such a model could relieve some of the burden experienced by Australian tertiary allergy services. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

The potential of land management to decrease global warming from climate change

NASA Astrophysics Data System (ADS)

Mayer, A.; Hausfather, Z.; Jones, A. D.; Silver, W. L.

2016-12-01

Recent evidence suggests that negative emissions (i.e. sequestration) is critical to slow climate change (IPCC, 2013; Gasser et al, 2015). Agricultural (crop and grazing) lands have the potential to act as a significant carbon sink. These ecosystems cover a significant proportion of the global land surface, and are largely degraded with regard to soil carbon due to previous management practices (Bai et al, 2008). However, few studies have examined the required scale of land management interventions that would be required to make a significant contribution to a portfolio of efforts aimed at limiting anthropogenic influences on global mean temperature. To address this, we modelled the quantitative effect of a range of soil carbon sequestration rates on global temperature to 2100. Results showed that by assuming a baseline emissions scenario outlined in RCP 2.6, the sequestration of an additional 0.7 Pg C per year through improved agricultural land management practices would produce a reduction of 0.1 degrees C from predicted global temperatures by the year 2100. We also compiled previous estimates of global carbon sequestration potential of agricultural soils to compare with our theoretical prediction to determine whether carbon sequestration through existing land management practices has potential to significantly reduce global temperatures. Assuming long-term soil carbon uptake, the combined potential of agricultural land management-based mitigation approaches exceeded 0.25 degrees C warming reduction by the year 2100. However, results were highly sensitive to potential carbon saturation, defined as the maximum threshold for carbon storage in soil. Our results suggest that current land management technologies and available land area exist and could make a measureable impact on warming reduction. Results also highlighted potential carbon saturation as a key gap in knowledge.

A district survey of vaccine cold chain protection in general practitioners' surgeries.

PubMed

Finn, L; Crook, S

1999-01-01

Failure to ensure that vaccines are kept within a prescribed temperature range at all times can reduce their potency and cause primary vaccine failure. A postal survey of 103 general practices in a health district to assess vaccine handling and storage yielded 75 responses (73%). Poor practice was identified in receipt and storage of vaccines, temperature monitoring and control, management of vaccines during immunisation sessions, and disposal of partly used vaccines. The data suggest that the vaccine cold chain is not maintained with the degree of care necessary for safe practice. National guidelines need to be implemented conscientiously by all those involved with immunisation programmes if the effectiveness of vaccines is to be guaranteed.

Chronic morbidities after traumatic brain injury: an update for the advanced practice nurse.

PubMed

Bay, Esther H; Chartier, Kattlynn S

2014-06-01

Emerging data suggest that traumatic brain injury (TBI) is a disease process with considerable long-range morbidities requiring lifelong monitoring and treatment. Multiple chronic morbidities develop across the life span after TBI, including mental health disorders, headaches, seizures, and neuroendocrine imbalances as well as chronic diseases. Still, there has been limited focus on effective guides and strategies for helping persons with TBI meet their chronic health needs as they live with the consequences of TBI. The advanced practice nurse is well positioned to participate collaboratively in practices that promote health screening and chronic disease management after TBI to ameliorate distress and enhance quality of life as persons with TBI live with lifelong consequences.

Home remedy or hazard?: management and costs of paediatric steam inhalation therapy burn injuries.

PubMed

Al Himdani, Sarah; Javed, Muhammad Umair; Hughes, Juliana; Falconer, Olivia; Bidder, Christopher; Hemington-Gorse, Sarah; Nguyen, Dai

2016-03-01

Steam inhalation has long been considered a beneficial home remedy to treat children with viral respiratory tract infections, but there is no evidence to suggest a benefit and children are at risk of serious burn injuries. To determine the demographics, mechanism, management, and costs of steam inhalation therapy scalds to a regional burns centre in the UK, and to ascertain whether this practice is recommended by primary care providers. A retrospective study of all patients admitted to a regional burns centre in Swansea, Wales, with steam inhalation therapy scalds. Patients who attended the burns centre for steam inhalation therapy scalds between January 2010 and February 2015 were identified using the burns database and data on patient demographics, treatment, and costs incurred were recorded. In addition, an electronic survey was e-mailed to 150 local GPs to determine whether they recommended steam inhalation therapy to patients. Sixteen children attended the burns centre with steam inhalation scalds. The average age attending was 7.4 years (range 1-15 years) and, on average, three children per year were admitted. The most common indication was for the common cold (n = 9). The average size of the burns was 3.1% (range: 0.25-17.0%) of total body area. One child was managed surgically; the remainder were treated with dressings, although one patient required a stay in a high-dependency unit. The total cost of treatment for all patients was £37,133. All in all, 17 out of 21 GPs surveyed recommended steam inhalation to their patients; eight out of 19 GPs recommended it for children aged <5 years. Steam inhalation incurs a significant cost to patients and the healthcare system. Its practice continues to be recommended by GPs but children, due to their limited motor skills, curiosity, and poor awareness of danger, are at significant risk of burn injuries and this dangerous practice should no longer be recommended. © British Journal of General Practice 2016.

Managing protected areas under climate change: challenges and priorities.

PubMed

Rannow, Sven; Macgregor, Nicholas A; Albrecht, Juliane; Crick, Humphrey Q P; Förster, Michael; Heiland, Stefan; Janauer, Georg; Morecroft, Mike D; Neubert, Marco; Sarbu, Anca; Sienkiewicz, Jadwiga

2014-10-01

The implementation of adaptation actions in local conservation management is a new and complex task with multiple facets, influenced by factors differing from site to site. A transdisciplinary perspective is therefore required to identify and implement effective solutions. To address this, the International Conference on Managing Protected Areas under Climate Change brought together international scientists, conservation managers, and decision-makers to discuss current experiences with local adaptation of conservation management. This paper summarizes the main issues for implementing adaptation that emerged from the conference. These include a series of conclusions and recommendations on monitoring, sensitivity assessment, current and future management practices, and legal and policy aspects. A range of spatial and temporal scales must be considered in the implementation of climate-adapted management. The adaptation process must be area-specific and consider the ecosystem and the social and economic conditions within and beyond protected area boundaries. However, a strategic overview is also needed: management at each site should be informed by conservation priorities and likely impacts of climate change at regional or even wider scales. Acting across these levels will be a long and continuous process, requiring coordination with actors outside the "traditional" conservation sector. To achieve this, a range of research, communication, and policy/legal actions is required. We identify a series of important actions that need to be taken at different scales to enable managers of protected sites to adapt successfully to a changing climate.

Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials

PubMed Central

Straus, Sharon E.

2008-01-01

BACKGROUND Studies indicate a gap between evidence and clinical practice in osteoporosis management. Tools that facilitate clinical decision making at the point of care are promising strategies for closing these practice gaps. OBJECTIVE To systematically review the literature to identify and describe the effectiveness of tools that support clinical decision making in osteoporosis disease management. DATA SOURCES Medline, EMBASE, CINAHL, and EBM Reviews (CDSR, DARE, CCTR, and ACP J Club), and contact with experts in the field. REVIEW METHODS Randomized controlled trials (RCTs) in any language from 1966 to July 2006 investigating disease management interventions in patients at risk for osteoporosis. Outcomes included fractures and bone mineral density (BMD) testing. Two investigators independently assessed articles for relevance and study quality, and extracted data using standardized forms. RESULTS Of 1,246 citations that were screened for relevance, 13 RCTs met the inclusion criteria. Reported study quality was generally poor. Meta-analysis was not done because of methodological and clinical heterogeneity; 77% of studies included a reminder or education as a component of their intervention. Three studies of reminders plus education targeted to physicians and patients showed increased BMD testing (RR range 1.43 to 8.67) and osteoporosis medication use (RR range 1.60 to 8.67). A physician reminder plus a patient risk assessment strategy found reduced fractures [RR 0.58, 95% confidence interval (CI) 0.37 to 0.90] and increased osteoporosis therapy (RR 2.44, CI 1.43 to 4.17). CONCLUSION Multi-component tools that are targeted to physicians and patients may be effective for supporting clinical decision making in osteoporosis disease management. Electronic supplementary material The online version of this article (doi:10.1007/s11606-008-0812-9) contains supplementary material, which is available to authorized users. PMID:18836782

Assessing the appropriateness of information on childhood fever in thermometer package leaflets: a systematic audit of thermometers available in the UK.

PubMed

Hernandez, Jose; Nicholson, Brian D; Thompson, Matthew

2015-06-01

Thermometers are found in most parents' homes, but little is known about the quality and accuracy of the information they provide, nor its consistency with current guidelines for managing fever. To compare information included with commonly available thermometers with National Institute for Health and Care Excellence (NICE) guidance for management of feverish illness in children. Systematic thermometer sampling from UK retailers between February 2013 and May 2013. Information was extracted from device packaging and leaflets on details and type of thermometer, instructions for use, normal ranges, and fever thresholds cited. This was compared with key parental recommendations from the 2013 NICE guidance on feverish illness in children. Associations were explored between cost of device and level of information. There were 123 thermometers identified (ranging from £0.99 to £69.99), none of which made explicit reference to NICE guidance. Most (n = 81, 65.9%) recommended use at a body site consistent with NICE guidance, but only 17 (13.8%) defined fever using the correct threshold (≥38.0°C), and few (n = 12, 9.8%) included advice on fever management, of which four suggested actions not advised by NICE. There was no association between thermometer cost and provision of information consistent with NICE guidance. Parents and caregivers have access to a large number of thermometers, yet they lack evidence-based information about fever detection and management, and in some cases contain misleading information. This represents a missed opportunity to disseminate best practices from guidelines for management of fever in children, and thermometer manufacturers are urged to include information consistent with current guidance. © British Journal of General Practice 2015.

Solo or partnership.

PubMed

Urschel, H C

1995-11-01

Reassessment of the managed care environment and restructuring of our practice will be accomplished by transitional short-term actions while we institute our long-range plan. In the short term we must develop appropriate relationships with hospitals and medical groups that interrelate to our specialty, and develop a "love our enemy" philosophy. We must establish operating organizational units that will be competitive. Reassessment of our own practice, our unique skills, our inadequacies, our competition, and our performance through outcome studies is essential to retake positions weakened by loss of contract inclusion. Long-term strategy must develop insurance coverage in conjunction with our patients in such a way that the middleman is eliminated and the profit currently extracted by managed care is reinvested in patient care, research, and education. Whoever controls payment determines the quality of medicine and how it is delivered.

Participatory approach: from problem identification to setting strategies for increased productivity and sustainability in small scale irrigated agriculture

NASA Astrophysics Data System (ADS)

Habtu, Solomon; Ludi, Eva; Jamin, Jean Yves; Oates, Naomi; Fissahaye Yohannes, Degol

2014-05-01

Practicing various innovations pertinent to irrigated farming at local field scale is instrumental to increase productivity and yield for small holder farmers in Africa. However the translation of innovations from local scale to the scale of a jointly operated irrigation scheme is far from trivial. It requires insight on the drivers for adoption of local innovations within the wider farmer communities. Participatory methods are expected to improve not only the acceptance of locally developed innovations within the wider farmer communities, but to allow also an estimation to which extend changes will occur within the entire irrigation scheme. On such a base, more realistic scenarios of future water productivity within an irrigation scheme, which is operated by small holder farmers, can be estimated. Initial participatory problem and innovation appraisal was conducted in Gumselassa small scale irrigation scheme, Ethiopia, from Feb 27 to March 3, 2012 as part of the EAU4FOOD project funded by EC. The objective was to identify and appraise problems which hinder sustainable water management to enhance production and productivity and to identify future research strategies. Workshops were conducted both at local (Community of Practices) and regional (Learning Practice Alliance) level. At local levels, intensive collaboration with farmers using participatory methods produced problem trees and a "Photo Safari" documented a range of problems that negatively impact on productive irrigated farming. A range of participatory methods were also used to identify local innovations. At regional level a Learning Platform was established that includes a wide range of stakeholders (technical experts from various government ministries, policy makers, farmers, extension agents, researchers). This stakeholder group did a range of exercise as well to identify major problems related to irrigated smallholder farming and already identified innovations. Both groups identified similar problems to productive smallholder irrigation: soil nutrient depletion, salinization, disease and pest resulting from inefficient irrigation practices, infrastructure problems leading to a reduction of the size of the command area and decrease in reservoir volume. The major causes have been poor irrigation infrastructure, poor on-farm soil and water management, prevalence of various crop pests and diseases, lack of inputs and reservoir siltation. On-farm participatory research focusing on soil, crop and water management issues, including technical, institutional and managerial aspects, to identify best performing innovations while taking care of the environment was recommended. Currently, a range of interlinked activities are implemented a multiple scales, combining participatory and scientific approaches towards innovation development and up-scaling of promising technologies and institutional and managerial approaches from local to regional scales. ____________________________ Key words: Irrigation scheme, productivity, innovation, participatory method, Gumselassa, Ethiopia

Australian GPs' perceptions about child and adolescent overweight and obesity the Weight of Opinion study

PubMed Central

King, Lesley A; Loss, Julika HM; Wilkenfeld, Rachel L; Pagnini, Deanna L; Booth, Michael L; Booth, Susan L

2007-01-01

Background GPs can potentially play a significant role in assessing weight status, providing advice, and making referrals to address overweight and obesity and its consequences among children and adolescents. Aim To investigate the perceptions of GPs about overweight and obesity in children and adolescents, including the extent to which they perceive it as a concern, the factors they see as causal, what actions they consider might be needed, and their sense of responsibility and self-efficacy. Design of study A cross-sectional qualitative study of GPs' perceptions. Setting General practice and primary health care services in the state of New South Wales, Australia. Method Focus groups using a structured protocol were conducted with samples of GPs. Groups comprised a mix of male and female GPs from a range of cultural backgrounds and working in practices in low, medium and high socioeconomic areas. Data were recorded and transcribed. Content analysis was used to identify key themes. Results Many GPs are concerned about the increasing prevalence of childhood overweight and obesity. They are committed to dealing with the medical consequences, but are aware of the broad range of social causes. GPs perceived that parents are sensitive about this topic, making it difficult for them to raise the issue directly in clinical practice, unless they use lateral strategies. GPs were confident about providing advice, with some managing the problem independently, while others preferred to refer to specialised services. GPs perceived that there were significant barriers to patient compliance with advice. Conclusion Whereas some GPs manage patients' lifestyle change directly, including children's weight management, others prefer to refer. Programmes, service delivery systems, and resources to support both approaches are required. PMID:17263929

Cost and technical efficiency of physician practices: a stochastic frontier approach using panel data.

PubMed

Heimeshoff, Mareike; Schreyögg, Jonas; Kwietniewski, Lukas

2014-06-01

This is the first study to use stochastic frontier analysis to estimate both the technical and cost efficiency of physician practices. The analysis is based on panel data from 3,126 physician practices for the years 2006 through 2008. We specified the technical and cost frontiers as translog function, using the one-step approach of Battese and Coelli to detect factors that influence the efficiency of general practitioners and specialists. Variables that were not analyzed previously in this context (e.g., the degree of practice specialization) and a range of control variables such as a patients' case-mix were included in the estimation. Our results suggest that it is important to investigate both technical and cost efficiency, as results may depend on the type of efficiency analyzed. For example, the technical efficiency of group practices was significantly higher than that of solo practices, whereas the results for cost efficiency differed. This may be due to indivisibilities in expensive technical equipment, which can lead to different types of health care services being provided by different practice types (i.e., with group practices using more expensive inputs, leading to higher costs per case despite these practices being technically more efficient). Other practice characteristics such as participation in disease management programs show the same impact throughout both cost and technical efficiency: participation in disease management programs led to an increase in both, technical and cost efficiency, and may also have had positive effects on the quality of care. Future studies should take quality-related issues into account.

Factors influencing evidence-based practice in prosthetics and orthotics.

PubMed

Andrysek, Jan; Christensen, James; Dupuis, Annie

2011-03-01

The importance of evidence-based practice is being recognized across a broad range of healthcare disciplines as a means for improving patient outcomes and also efficiently managing healthcare resources. The objective of this work was to obtain information from clinicians about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Cross sectional survey. An internet survey was developed and distributed to 300 prosthetists and orthotists currently practicing in Canada. A principal component factor analysis of the survey results revealed ten primary factors affecting evidence-based practice. These include time constraints, workload and system demands, limited relevant evidence from research, and gaps in skills and knowledge required to perform evidence-based practice. Clinicians value research as a means of improving clinical practice, but they are faced with a number of practical barriers in performing evidence-based practice. This study provides empirical data about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Such data are essential in order to inform those involved in improving existing clinical practices, including educators, professional organizations, and governing bodies.

Results of an online questionnaire to survey calf management practices on dairy cattle breeding farms in Austria and to estimate differences in disease incidences depending on farm structure and management practices.

PubMed

Klein-Jöbstl, Daniela; Arnholdt, Tim; Sturmlechner, Franz; Iwersen, Michael; Drillich, Marc

2015-08-19

Calf disease may result in great economic losses. To implement prevention strategies it is important to gain information on management and to point out risk factors. The objective of this internet based survey was to describe calf management practices on registered dairy breeding farms in Austria and to estimate differences in calf disease incidences depending on farm structure and management practices. A total of 1287 questionnaires were finally analysed (response rate 12.2 %). Herd characteristics and regional distribution of farms indicated that this survey gives a good overview on calf management practices on registered dairy farms in Austria. The median number of cows per farm was 20 (interquartile range 13-30). Significant differences regarding farm characteristics and calf management between small and large farms (≤20 vs >20 cows) were present. Only 2.8 % of farmers tested first colostrum quality by use of a hydrometer. Storing frozen colostrum was more prevalent on large farms (80.8 vs 64.2 %). On 85.1 % of the farms, whole milk, including waste milk, was fed to the calves. Milk replacer and waste milk were more often used on large farms. In accordance with similar studies from other countries, calf diarrhoea was indicated as the most prevalent disease. Multivariable logistic regression analysis revealed that herd size was associated with calf diarrhoea and calf respiratory tract disease, with higher risk of disease on large farms. Furthermore, feeding waste milk to the calves was associated with increasing calf diarrhoea incidence on farm. In the final model with calf respiratory tract disease as outcome, respondents from organic farms reported less often a respiratory tract disease incidence of over 10 % compared with conventional farms [odds ratio (OR) 0.40, 95 % confidence interval (CI) 0.21-0.75] and farmers that housed calves individually or in groups after birth significantly reported more often to have an incidence of respiratory tract disease >10 % compared with farms where all calves were housed individually (OR 2.28, 95 % CI 1.16-4.48). The results obtained in this study provide an overview on calf management on dairy breeding farms in Austria and may help to further point out areas to be improved on farm.

Recent advances in the management of bovine tuberculosis in free-ranging wildlife.

PubMed

O'Brien, Daniel J; Schmitt, Stephen M; Rudolph, Brent A; Nugent, Graham

2011-07-05

Established foci of Mycobacterium bovis (the causative agent of bovine tuberculosis [bTB]) in free-ranging wildlife are currently under various stages of management on three continents (Africa, Europe and North America) and in New Zealand. Other, as yet undiagnosed, foci seem likely to exist elsewhere. The complex roles that these wildlife foci play in the ecology of bTB remain among the greatest challenges facing bTB control globally. Conceptually, management of bTB in free-ranging wildlife can be thought of as progressing from the discovery of an outbreak through frequently overlapping stages of epidemiological characterization, initial control, simulation and forecasting, focused control, and verification of eradication. Surveillance in its various forms remains a critical component of assessment throughout. Since the Fourth International M. bovis Conference in 2005, research on management of bTB in free-ranging wildlife has encompassed such areas as the human dimensions of wildlife management, mitigation of bTB risks from wildlife on cattle farms, vaccine biology, and epidemiology, with a major contribution from simulation modeling. In order to advance the actual field management of bTB, however, research must be sufficiently grounded to aid development of practical, affordable and politically defensible management interventions which stand a reasonable chance of being implemented. The current management of two wildlife reservoirs of bTB, brushtail possums (Trichosurus vulpecula) in New Zealand, and white-tailed deer (Odocoileus virginianus) in Michigan, USA, serve as contrasting examples of different wildlife management strategies aimed at achieving a common goal. In New Zealand, the importance of agricultural export markets and the status of the possum as a non-native pest have facilitated direct, aggressive management of the disease reservoir, resulting in considerable progress towards bTB freedom since 1994. In Michigan, the relative importance of the hunting economy and of whitetails as a game animal have made such aggressive culling politically untenable. This has forced reliance upon publicly supported, and implemented, management tools, and so provided impetus to better understand social support for wildlife management policy, its limitations, and ways to employ it in disease control policy development. Copyright © 2011. Published by Elsevier B.V.

Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten Up randomised controlled trial.

PubMed

Jolly, Kate; Lewis, Amanda; Beach, Jane; Denley, John; Adab, Peymane; Deeks, Jonathan J; Daley, Amanda; Aveyard, Paul

2011-11-03

To assess the effectiveness of a range of weight management programmes in terms of weight loss. Eight arm randomised controlled trial. Primary care trust in Birmingham, England. 740 obese or overweight men and women with a comorbid disorder identified from general practice records. Weight loss programmes of 12 weeks' duration: Weight Watchers; Slimming World; Rosemary Conley; group based, dietetics led programme; general practice one to one counselling; pharmacy led one to one counselling; choice of any of the six programmes. The comparator group was provided with 12 vouchers enabling free entrance to a local leisure (fitness) centre. The primary outcome was weight loss at programme end (12 weeks). Secondary outcomes were weight loss at one year, self reported physical activity, and percentage weight loss at programme end and one year. Follow-up data were available for 658 (88.9%) participants at programme end and 522 (70.5%) at one year. All programmes achieved significant weight loss from baseline to programme end (range 1.37 kg (general practice) to 4.43 kg (Weight Watchers)), and all except general practice and pharmacy provision resulted in significant weight loss at one year. At one year, only the Weight Watchers group had significantly greater weight loss than did the comparator group (2.5 (95% confidence interval 0.8 to 4.2) kg greater loss,). The commercial programmes achieved significantly greater weight loss than did the primary care programmes at programme end (mean difference 2.3 (1.3 to 3.4) kg). The primary care programmes were the most costly to provide. Participants allocated to the choice arm did not have better outcomes than those randomly allocated to a programme. Commercially provided weight management services are more effective and cheaper than primary care based services led by specially trained staff, which are ineffective. Trial registration Current Controlled Trials ISRCTN25072883.

Effect of care management program structure on implementation: a normalization process theory analysis.

PubMed

Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A

2016-08-15

Care management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice. Data collection involved semi-structured interviews and observations conducted at 25 practices in five physician organizations in Michigan, USA. Practices were selected to reflect variation in physician organizations, type of care management program, and degree of normalization. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with NPT as a guiding framework. Seventy interviews and 25 observations were completed. Two key structures for care management organization emerged: practice-based care management where the care managers were embedded in the practice as part of the practice team; and centralized care management where the care managers worked independently of the practice work flow and was located outside the practice. There were differences in normalization of care management across practices. Practice-based care management was generally better normalized as compared to centralized care management. Differences in normalization were well explained by the NPT, and in particular the collective action construct. When care managers had multiple and flexible opportunities for communication (interactional workability), had the requisite knowledge, skills, and personal characteristics (skill set workability), and the organizational support and resources (contextual integration), a trusting professional relationship (relational integration) developed between practice providers and staff and the care manager. When any of these elements were missing, care management implementation appeared to be affected negatively. Although care management can introduce many new changes into delivery of clinical practice, implementing it successfully as a new complex intervention is possible. NPT can be helpful in explaining differences in implementing a new care management program with a view to addressing them during implementation planning.

A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: face validity and feasibility of implementation.

PubMed

Matthews, James; Hall, Amanda M; Hernon, Marian; Murray, Aileen; Jackson, Ben; Taylor, Ian; Toner, John; Guerin, Suzanne; Lonsdale, Chris; Hurley, Deirdre A

2015-07-05

Clinical practice guidelines for the treatment of low back pain suggest the inclusion of a biopsychosocial approach in which patient self-management is prioritized. While many physiotherapists recognise the importance of evidence-based practice, there is an evidence practice gap that may in part be due to the fact that promoting self-management necessitates change in clinical behaviours. Evidence suggests that a patient's motivation and maintenance of self-management behaviours can be positively influenced by the clinician's use of an autonomy supportive communication style. Therefore, the aim of this study was to develop and pilot-test the feasibility of a theoretically derived implementation intervention to support physiotherapists in using an evidence-based autonomy supportive communication style in practice for promoting patient self-management in clinical practice. A systematic process was used to develop the intervention and pilot-test its feasibility in primary care physiotherapy. The development steps included focus groups to identify barriers and enablers for implementation, the theoretical domains framework to classify determinants of change, a behaviour change technique taxonomy to select appropriate intervention components, and forming a testable theoretical model. Face validity and acceptability of the intervention was pilot-tested with two physiotherapists and monitoring their communication with patients over a three-month timeframe. Using the process described above, eight barriers and enablers for implementation were identified. To address these barriers and enablers, a number of intervention components were selected ranging from behaviour change techniques such as, goal-setting, self-monitoring and feedback to appropriate modes of intervention delivery (i.e. continued education meetings and audit and feedback focused coaching). Initial pilot-testing revealed the acceptability of the intervention to recipients and highlighted key areas for refinement prior to scaling up for a definitive trial. The development process utilised in this study ensured the intervention was theory-informed and evidence-based, with recipients signalling its relevance and benefit to their clinical practice. Future research should consider additional intervention strategies to address barriers of social support and those beyond the clinician level.

Herd management and social variables associated with bulk tank somatic cell count in dairy herds in the eastern United States.

PubMed

Schewe, R L; Kayitsinga, J; Contreras, G A; Odom, C; Coats, W A; Durst, P; Hovingh, E P; Martinez, R O; Mobley, R; Moore, S; Erskine, R J

2015-11-01

The ability to reduce somatic cell counts (SCC) and improve milk quality depends on the effective and consistent application of established mastitis control practices. The US dairy industry continues to rely more on nonfamily labor to perform critical tasks to maintain milk quality. Thus, it is important to understand dairy producer attitudes and beliefs relative to management practices, as well as employee performance, to advance milk quality within the changing structure of the dairy industry. To assess the adoption rate of mastitis control practices in United States dairy herds, as well as assess social variables, including attitudes toward employees relative to mastitis control, a survey was sent to 1,700 dairy farms in Michigan, Pennsylvania, and Florida in January and February of 2013. The survey included questions related to 7 major areas: sociodemographics and farm characteristics, milking proficiency, milking systems, cow environment, infected cow monitoring and treatment, farm labor, and attitudes toward mastitis and related antimicrobial use. The overall response rate was 41% (21% in Florida, 39% in Michigan, and 45% in Pennsylvania). Herd size ranged from 9 to 5,800 cows. Self-reported 3-mo geometric mean bulk tank SCC (BTSCC) for all states was 194,000 cells/mL. Multivariate analysis determined that proven mastitis control practices such as the use of internal teat sealants and blanket dry cow therapy, and not using water during udder preparation before milking, were associated with lower BTSCC. Additionally, farmer and manager beliefs and attitudes, including the perception of mastitis problems and the threshold of concern if BTSCC is above 300,000 cells/mL, were associated with BTSCC. Ensuring strict compliance with milking protocols, giving employees a financial or other penalty if BTSCC increased, and a perceived importance of reducing labor costs were negatively associated with BTSCC in farms with nonfamily employees. These findings highlight the need for a comprehensive approach to managing mastitis, one that includes the human dimensions of management to maintain the practice of scientifically validated mastitis control practices. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Point Prevalence of Chronic Wounds at a Tertiary Hospital in Nigeria.

PubMed

Iyun, Ayodele O; Ademola, Samuel A; Olawoye, Olayinka A; Michael, Afie I; Oluwatosin, Odunayo M

2016-02-01

Chronic wounds are a drain on resources both for the patient and health institution. Management of chronic wounds based on evidence-based practice requires baseline data for adequate planning. This study was carried out to determine the point prevalence of chronic wounds in a tertiary hospital (University College Hospital, Ibadan, Nigeria) and utilize this information for subsequent wound care planning. The study was carried out within a 1-month period and included all patients seen in the hospital with chronic wounds. The data obtained was entered into a designed form and was subsequently analyzed. There were 48 patients with 78 wounds representing approximately 11% of patients seen in the Department of Plastic, Reconstructive, and Aesthetic Surgery each month. Their ages ranged from 3 months to 80 years; the median age was 48 years. The male to female ratio was 1.6 to 1. The duration of the wounds ranged from 6 weeks to 780 weeks; the median duration of the wounds was 10 weeks. The area of the wounds ranged from 1 cm(2) -1,248 cm(2) (median 24 cm(2)). The most common chronic wounds were diabetic wounds, followed by pressure ulcers, postinfection ulcers, posttraumatic ulcers, burn wounds, malignant ulcers, and venous ulcers. The point prevalence data serves as a basis for wound care planning. This, in turn, should result in improved wound management grounded in evidence-based practices.

Cost of Transformation among Primary Care Practices Participating in a Medical Home Pilot.

PubMed

Martsolf, Grant R; Kandrack, Ryan; Gabbay, Robert A; Friedberg, Mark W

2016-07-01

Medical home initiatives encourage primary care practices to invest in new structural capabilities such as patient registries and information technology, but little is known about the costs of these investments. To estimate costs of transformation incurred by primary care practices participating in a medical home pilot. We interviewed practice leaders in order to identify changes practices had undertaken due to medical home transformation. Based on the principles of activity-based costing, we estimated the costs of additional personnel and other investments associated with these changes. The Pennsylvania Chronic Care Initiative (PACCI), a statewide multi-payer medical home pilot. Twelve practices that participated in the PACCI. One-time and ongoing yearly costs attributed to medical home transformation. Practices incurred median one-time transformation-associated costs of $30,991 per practice (range, $7694 to $117,810), equivalent to $9814 per clinician ($1497 to $57,476) and $8 per patient ($1 to $30). Median ongoing yearly costs associated with transformation were $147,573 per practice (range, $83,829 to $346,603), equivalent to $64,768 per clinician ($18,585 to $93,856) and $30 per patient ($8 to $136). Care management activities accounted for over 60% of practices' transformation-associated costs. Per-clinician and per-patient transformation costs were greater for small and independent practices than for large and system-affiliated practices. Error in interviewee recall could affect estimates. Transformation costs in other medical home interventions may be different. The costs of medical home transformation vary widely, creating potential financial challenges for primary care practices-especially those that are small and independent. Tailored subsidies from payers may help practices make these investments. Agency for Healthcare Research and Quality.

Avian Species Richness in Relation to Intensive Forest Management Practices in Early Seral Tree Plantations

PubMed Central

Jones, Jay E.; Kroll, Andrew J.; Giovanini, Jack; Duke, Steven D.; Ellis, Tana M.; Betts, Matthew G.

2012-01-01

Background Managers of landscapes dedicated to forest commodity production require information about how practices influence biological diversity. Individual species and communities may be threatened if management practices truncate or simplify forest age classes that are essential for reproduction and survival. For instance, the degradation and loss of complex diverse forest in young age classes have been associated with declines in forest-associated Neotropical migrant bird populations in the Pacific Northwest, USA. These declines may be exacerbated by intensive forest management practices that reduce hardwood and broadleaf shrub cover in order to promote growth of economically valuable tree species in plantations. Methodology and Principal Findings We used a Bayesian hierarchical model to evaluate relationships between avian species richness and vegetation variables that reflect stand management intensity (primarily via herbicide application) on 212 tree plantations in the Coast Range, Oregon, USA. Specifically, we estimated the influence of broadleaf hardwood vegetation cover, which is reduced through herbicide applications, on bird species richness and individual species occupancy. Our model accounted for imperfect detection. We used average predictive comparisons to quantify the degree of association between vegetation variables and species richness. Both conifer and hardwood cover were positively associated with total species richness, suggesting that these components of forest stand composition may be important predictors of alpha diversity. Estimates of species richness were 35–80% lower when imperfect detection was ignored (depending on covariate values), a result that has critical implications for previous efforts that have examined relationships between forest composition and species richness. Conclusion and Significance Our results revealed that individual and community responses were positively associated with both conifer and hardwood cover. In our system, patterns of bird community assembly appear to be associated with stand management strategies that retain or increase hardwood vegetation while simultaneously regenerating the conifer cover in commercial tree plantations. PMID:22905249

Nuclear Physicists in Finance

NASA Astrophysics Data System (ADS)

Mattoni, Carlo

2017-01-01

The financial services industry presents an interesting alternative career path for nuclear physicists. Careers in finance typically offer intellectual challenge, a fast pace, high caliber colleagues, merit-based compensation with substantial upside, and an opportunity to deploy skills learned as a physicist. Physicists are employed at a wide range of financial institutions on both the ``buy side'' (hedge fund managers, private equity managers, mutual fund managers, etc.) and the ``sell side'' (investment banks and brokerages). Historically, physicists in finance were primarily ``quants'' tasked with applying stochastic calculus to determine the price of financial derivatives. With the maturation of the field of derivative pricing, physicists in finance today find work in a variety of roles ranging from quantification and management of risk to investment analysis to development of sophisticated software used to price, trade, and risk manage securities. Only a small subset of today's finance careers for physicists require the use of advanced math and practically none provide an opportunity to tinker with an apparatus, yet most nevertheless draw on important skills honed during the training of a nuclear physicist. Intellectually rigorous critical thinking, sophisticated problem solving, an attention to minute detail and an ability to create and test hypotheses based on incomplete information are key to both disciplines.

The role of management in an in vitro fertilization practice.

PubMed

Masler, Steve; Strickland, Robert R

2013-05-01

An in vitro fertilization (IVF) practice is an enterprise. Like any enterprise, it has management that plays a major role, forming the structure, framework, and components that make the practice viable. Management of an IVF practice consists of two key teams: the fertility team and the management team. Management activities of the teams fall into eight core areas: business operations, financial, human resources, information technology, organizational governance, risk management, patient care systems, and quality management. Shady Grove Fertility Centers and Huntington Reproductive Center are two examples of professionally managed large fertility practices, one managed mostly centrally and the other largely managed in a decentralized way. Management is what takes a physician's IVF practice and converts it to a professional enterprise. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical practice guideline on diagnosis and treatment of hyponatraemia.

PubMed

Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; Van Biesen, Wim; Nagler, Evi

2014-04-01

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

Clinical practice guideline on diagnosis and treatment of hyponatraemia.

PubMed

Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; Van Biesen, Wim; Nagler, Evi

2014-03-01

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

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

Code of Federal Regulations, 2010 CFR

2010-01-01

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

ChronoMedIt--a computational quality audit framework for better management of patients with chronic conditions.

PubMed

Mabotuwana, Thusitha; Warren, Jim

2010-02-01

Quality audit and feedback to general practice is an important aspect of successful chronic disease management. However, due to the complex temporal relationships associated with the nature of chronic illness, formulating clinically relevant queries within the context of a specific evaluation period is difficult. We abstracted requirements from a set of previously developed criteria to develop a generic criteria model that can be used to formulate queries related to chronic condition management. We implemented and verified the framework, ChronoMedIt, to execute clinical queries within the scope of the criteria model. Our criteria model consists of four broad classes of audit criteria - lapse in indicated therapy, no measurement recording, time to achieve target and measurement contraindicating therapy. Using these criteria classes as a guide, ChronoMedIt has been implemented as an extensible framework. ChronoMedIt can produce criteria reports and has an integrated prescription and measurement timeline visualisation tool. We illustrate the use of the framework by identifying patients on suboptimal therapy based on a range of pre-determined audit criteria using production electronic medical record data from two general medical practices for 607 and 679 patients with hypertension. As the most prominent result, we find that 59% (out of 607) and 34% (out of 679) of patients with hypertension had at least one episode of >30day lapse in their antihypertensive therapy over a 12-month evaluation period. ChronoMedIt can reliably execute a wide range of clinically useful queries to identify patients whose chronic condition management can be improved.

Water storage equity and safety assurance policy to mitigate potential 'dual-extreme cumulative threats' in agricultural catchments

NASA Astrophysics Data System (ADS)

Pisaniello, John D.; Tingey-Holyoak, Joanne L.

2017-02-01

Farm dams that are not managed properly at the individual level can create water storage equity and safety threats to downstream communities and the environment that aggregate at the catchment level: a potential 'dual-extreme cumulative' problem. The paper provides indicative evidence and develops understanding of this novel phenomenon and associated policy needs within the Australian setting comprising dual hydrologic extremes of floods and droughts, further exacerbated by climate change. This is achieved through comparative case studies involving surveys of both dam owner perceptions and dam management practices in four States representing a complete range of integrated policy approaches from weak to strong. Survey results find most farmers do not believe dam maintenance is important, will undertake spillway blocking and do not plan for emergencies. These results are supported by physical on-site findings of farmers neglecting dams and blocking or under-designing spillways, in turn storing more water than they are entitled and creating unsafe dams at both the individual and cumulative levels. From detailed cross-case comparative assessment against policy context, it emerges that on-farm perceptions and practices form a range of 'acceptability' of dam management that directly reflects policy strength and integration in each setting. The paper advances the international small dams policy, agricultural water management and hydrology literatures, evidencing the need for effective integrated policy to mitigate dual extreme cumulative threats. Importantly, guidance is provided to jurisdictions internationally with high inter-annual rainfall variation on how best to design integrated policy that can achieve both water storage equity and safety in agricultural catchments.

An Examination of the Application of Professional Reliance To Management of Karst Resources In British Columbia (Canada)

NASA Astrophysics Data System (ADS)

Ramsey, Carolyn L.; Griffiths, Paul A.

2010-05-01

British Columbia (BC), Canada's most ecologically diverse province, is home to some of the nation's finest karst resources. Many of these are in forested settings, and are often associated with special/unique natural attributes ranging from geomorphology to hydrology, biology and ecology. Karst management in BC forests was shaped initially by concerns for caves and their recreation management, but as of 1997 there was a significant shift to an ecosystem approach to management of karst and cave resources. This new management approach was supported in due course by standards and guidelines for karst assessment and management. The approach also recognized the inherently multidisciplinary nature of this type of work and the frequent need to engage professionals with specialized knowledge of karst, and its natural and cultural resource values. In 2004, the BC Government introduced the Forest and Range Practices Act, a new results-based regulatory framework for forest practices. Government orders made pursuant to regulations under the Act identify categories of karst terrain and associated resource features that must be protected from the potentially damaging effects of roadbuilding and road maintenance, timber harvesting, and silviculture activities. In support of a general shift toward more results-based regulation and "freedom to manage" forest resources, it was argued that the forestry sector and its professionals are qualified, and competent enough, to formulate strategies for protecting and managing forest resources (including karst) without as much government oversight. As a result, forest tenure holders and their professionals are now responsible for assessing protected categories of karst resource features and developing and applying appropriate forest practices for them. Where knowledge beyond the area of forest professionals' expertise is required, the knowledge gaps are to be addressed by hiring suitably qualified professional consultants for advice and judgment - a concept termed "professional reliance". Forest tenure holders are responsible for determining when specialized expertise or judgment of qualified resource professionals is required and for assessing the professional qualifications of any consultants they hire. However, there is mounting cause for concern about the quality of karst resource work being conducted in BC. Sidestepping or disregarding the principles of professional reliance has lead to substandard karst field assessments and poor "results" for karst resource features. In this paper, we examine some of the professional reliance failures and conclude that persons engaged to conduct karst resource work in BC have seldom met the minimum qualifications suggested by government. Published standards and guidelines for conducting karst assessments, as well as the published best practices for managing karst landscapes and features in BC exist but these are often overlooked, misapplied or ignored. We offer a more precise definition of the title "Qualified Karst Resource Professional" as well as an expanded checklist of criteria that can be used to evaluate professional qualifications and competency.

Forest Health in North America: Some Perspectives on Actual and Potential Roles of Climate and Air Pollution

Treesearch

S. McLaughlin; K. Percy

1999-01-01

The perceived health of forest ecosystems over large temporal and spatial scales can be strongly influenced by the frames of reference chosen to evaluate both forest condition and the functional integrity of sustaining forest processes. North American forests are diverse in range, species composition, past disturbance history, and current management practices....

Aspen indicator species in lichen communities in the Bear River range of Idaho and Utah

Treesearch

Paul C. Rogers; Roger Rosentreter; Ronald J. Ryel

2007-01-01

Aspen are thought to be declining in this region due to a combination of fire suppression, grazing and wildlife management practices, and potentially cool/wet climates of the past century which favor advancing conifer succession. Many scientists are concerned that aspen's related species may also be losing habitat, thereby threatening the long-term local and...

Factors influencing epiphytic lichen communities in aspen-associated forests of the Bear River Range, Idaho and Utah

Treesearch

Paul C. Rogers

2007-01-01

In western North America, quaking aspen (Populus tremuloides Michx.) is the most common hardwood in montane landscapes. Fire suppression, grazing, wildlife management practices, and climate patterns of the past century are some of the threats to aspen coverage in this region. Researchers are concerned that aspen-dependent species may be losing...

What's at Risk? The Proliferation of Risk across Child and Youth Policy in England

ERIC Educational Resources Information Center

Turnbull, Gavin; Spence, Jean

2011-01-01

The concept of risk has found increasing prominence in social policy, human services management and front-line practice in recent years. This is particularly the case in relation to children and young people, who, in the UK, have been subject to a range of interventions based on the identification of population-based risk factors. Through the…

Land-use change and new houses on forestland: contrasting trends over 30 years in Oregon and Washington

Treesearch

Andrew N. Gray; Joel L. Thompson; Gary J. Lettman

2015-01-01

Conversion of forest, range, and agricultural resource lands to residential and commercial uses affects the available land base, management practices on remaining resource lands, habitat quality, and ecosystem services. The Forest Inventory and Analysis program (FIA) mandate includes monitoring changes in the land area in forest use, and this has proved valuable for...

Modeling Firing Range Best Management Practices with TREECS (trademark)

DTIC Science & Technology

2013-06-01

is reduced. Phytoremediation can also be considered a source treatment BMP when plants uptake and transform the MC into other chemical forms that are...the amendment, and the local soil conditions. Phytoremediation includes phytoextraction, phytostabilization, and phytotransformation...model can then be run as usual while taking into account the phytoremediation of the MC. Phytotransformation is being implemented as an option in

Vegetation monitoring to detect and predict vegetation change: Connecting historical and future shrub/steppe data in Yellowstone National Park

Treesearch

Geneva Chong; David Barnett; Benjamin Chemel; Roy Renkin; Pamela Sikkink

2011-01-01

A 2002 National Research Council (NRC) evaluation of ungulate management practices in Yellowstone specifically concluded that previous (1957 to present) vegetation monitoring efforts were insufficient to determine whether climate or ungulates were more influential on shrub/steppe dynamics on the northern ungulate winter range. The NRC further recommended that the...

Influence of reproduction cutting methods on structure, growth and regeneration of longleaf pine forests in flatwoods and uplands

Treesearch

Dale G. Brockway; Kenneth W. Outcalt

2017-01-01

Though longleaf pine (Pinus palustris Mill.) forests have been primarily managed with even-aged methods, interest is increasing in uneven-aged systems, as a means of achieving a wider range of stewardship goals. Selection silviculture has been practiced on a limited scale in longleaf pine, but difficulty with using traditional approaches and...

Wildland Fire Use - Challenges Associated With Program Management Across Multiple Ownerships and Land Use Situations

Treesearch

Thomas Zimmerman; Michael Frary; Shelly Crook; Brett Fay; Patricia Koppenol; Richard Lasko

2006-01-01

The application and use of wildland fire for a range of beneficial ecological objectives is rapidly expanding across landscapes supporting diverse vegetative complexes and subject to multiple societal uses. Wildland fire use originated in wilderness and has become a proven practice successful in meeting ecological needs. The use of wildland fire in non-wilderness is...

Rehabilitating slash pile burn scars in upper montane forests of the Colorado Front Range

Treesearch

Paula J. Fornwalt; Charles C. Rhoades

2011-01-01

Slash pile burning is widely conducted by land managers to dispose of unwanted woody fuels, yet this practice typically has undesirable ecological impacts. Simple rehabilitation treatments may be effective at ameliorating some of the negative impacts of pile burning on plants and soils. Here, we investigated: (1) the impacts of slash pile burning on soil nitrogen and...

Changes in forest structure since 1860 in ponderosa pine dominated forests in the Colorado and Wyoming Front Range, USA

Treesearch

Mike A. Battaglia; Benjamin Gannon; Peter M. Brown; Paula J. Fornwalt; Antony S. Cheng; Laurie S. Huckaby

2018-01-01

Management practices since the late 19th century, including fire exclusion and harvesting, have altered the structure of ponderosa pine (Pinus ponderosa Douglas ex P. Lawson & C. Lawson) dominated forests across the western United States. These structural changes have the potential to contribute to uncharacteristic wildfire behavior and effects. Locally-...

A coordinated teaching program for future dairy practitioners at the university of Wisconsin-Madison, School of Veterinary Medicine.

PubMed

Cook, Nigel B; Eisele, Christian O; Klos, Rachel F; Bennett, Thomas B; McGuirk, Sheila M; Goodger, William J; Oetzel, Garrett R; Nordlund, Kenneth V

2004-01-01

The University of Wisconsin School of Veterinary Medicine (UW-SVM) has implemented a variety of strategies to optimize teaching in dairy herd medicine. These include the provision of opportunities for dairy cow handling and management using a dairy teaching herd for veterinary students throughout the four-year curriculum, exposure for all students in their final year to a substantial first-opinion dairy case load using a private practice-based ambulatory clinic rotation, and, finally, the teaching of dairy herd health management and problem solving in a group of four final-year elective production medicine clinical rotations. On average, since 1986, 32.6% of each graduating class attended at least one elective production medicine rotation, with a range from 19.0% to 43.4%. For those University of Wisconsin students who could be traced, 65% were still actively involved in some aspect of dairy practice, representing a range of between seven and 17 students per year since the start of the program. The advantages and disadvantages of operating a "regional center of excellence" for training students from out-of-state institutions are discussed.

Collation and comparison of multi-practice audit data: prevalence and treatment of known diabetes mellitus.

PubMed Central

Khunti, K; Goyder, E; Baker, R

1999-01-01

BACKGROUND: Different methods have been used to determine the prevalence and treatment of diabetes. Despite the large number of studies, previous estimations of prevalence and treatment have been carried out on relatively small numbers of patients, and then in only a few practices in single geographical regions. AIM: To investigate the feasibility of collating data from multi-practice audits organized by primary care audit groups in order to estimate the prevalence and treatment of patients with known diabetes, and to discuss the methodological issues and reasons for variation. METHOD: A postal questionnaire survey of all primary care audit groups in England and Wales that had conducted a multi-practice audit of diabetes between 1993-1995. Prevalence rates and patterns of diabetic care were compared with other community-based surveys of known diabetes from 1986-1996 identified on MEDLINE. RESULTS: Twenty-five (43%) audit groups supplied data from multi-practice audits of diabetes. Seven (28%) multi-practice audits involving 259 practices fulfilled the inclusion criteria for prevalence estimation. The overall prevalence of diabetes based on a population of 1,475,512 patients was 1.46% (range between audit groups = 1.18% to 1.66%; chi 2 = 308; df = 6; P < 0.0001). Male to female ratio was 1.15:1. Treatment of diabetes could be ascertained for 10 (40%) audit groups comprising 319 practices. Of these, 23.4% (range = 16.5%-27.4%) were controlled by diet, 48.5% (range = 43.6%-55.8%) were prescribed oral hypoglycaemic drugs, and 28.2% (range = 25.0%-32.4%) were treated with insulin. There were significant variations between audit groups in treatment pattern (chi 2 = 250; df = 18; P < 0.0001). CONCLUSION: Prevalence and treatment rates of diabetes and other chronic diseases can be assessed and compared using data from multi-practice audits. Collation of audit data could improve the precision of quantitative estimates of health status in populations. A standard method of data recording and collection may provide a new approach that could considerably improve our ability to monitor disease and its management. PMID:10736888

A Web-based system for the intelligent management of diabetic patients.

PubMed

Riva, A; Bellazzi, R; Stefanelli, M

1997-01-01

We describe the design and implementation of a distributed computer-based system for the management of insulin-dependent diabetes mellitus. The goal of the system is to support the normal activities of the physicians and patients involved in the care of diabetes by providing them with a set of automated services ranging from data collection and transmission to data analysis and decision support. The system is highly integrated with current practices in the management of diabetes, and it uses Internet technology to achieve high availability and ease of use. In particular, the user interaction takes place through dynamically generated World Wide Web pages, so that all the system's functions share an intuitive graphic user interface.

Assessment and Monitoring of Nutrient Management in Irrigated Agriculture for Groundwater Quality Protection

NASA Astrophysics Data System (ADS)

Harter, T.; Davis, R.; Smart, D. R.; Brown, P. H.; Dzurella, K.; Bell, A.; Kourakos, G.

2017-12-01

Nutrient fluxes to groundwater have been subject to regulatory assessment and control only in a limited number of countries, including those in the European Union, where the Water Framework Directive requires member countries to manage groundwater basis toward achieving "good status", and California, where irrigated lands will be subject to permitting, stringent nutrient monitoring requirements, and development of practices that are protective of groundwater. However, research activities to rigorously assess agricultural practices for their impact on groundwater have been limited and instead focused on surface water protection. For groundwater-related assessment of agricultural practices, a wide range of modeling tools has been employed: vulnerability studies, nitrogen mass balance assessments, crop-soil-system models, and various statistical tools. These tools are predominantly used to identify high risk regions, practices, or crops. Here we present the development of a field site for rigorous in-situ evaluation of water and nutrient management practices in an irrigated agricultural setting. Integrating groundwater monitoring into agricultural practice assessment requires large research plots (on the order of 10s to 100s of hectares) and multi-year research time-frames - much larger than typical agricultural field research plots. Almonds are among the most common crops in California with intensive use of nitrogen fertilizer and were selected for their high water quality improvement potential. Availability of an orchard site with relatively vulnerable groundwater conditions (sandy soils, water table depth less than 10 m) was also important in site selection. Initial results show that shallow groundwater concentrations are commensurate with nitrogen leaching estimates obtained by considering historical, long-term field nitrogen mass balance and groundwater dynamics.

Quality measures for the management of hydrocephalus: concepts, simulations, and preliminary field-testing.

PubMed

Barton, Spencer E; Campbell, Jeffrey W; Piatt, Joseph H

2013-04-01

The authors define and examine the properties of 2 new, practice-based quality measures for the management of hydrocephalus. The Surgical Activity Rate (SAR) is defined as the number of definitive operations for the treatment of hydrocephalus performed in a neurosurgical practice over the course of a year, divided by the number of patients with hydrocephalus seen in follow-up during that year. The Revision Quotient (RQ) is defined as the number of definitive revision operations performed in a neurosurgical practice in the course of a year, divided by the number of definitive initial operations during that year for patients with newly diagnosed hydrocephalus. Using published actuarial shunt survival data, the authors conducted Monte Carlo simulations of a pediatric neurosurgical practice to illustrate the properties and interpretations of the SAR and RQ. They used data from the Kids' Inpatient Database (KID) for 2009 to calculate RQs for hospitals accounting for more than 10 admissions coded for initial CSF shunt insertions. During the initial growth phase of a simulated neurosurgical practice, the SAR approached its steady-state value much earlier than the RQ. Both measures were sensitive to doubling or halving of monthly failure rates. In the 2009 KID, 117 hospitals reported more than 10 initial shunt insertions. The weighted mean (± standard deviation) RQ for these hospitals was 1.79 ± 0.69. Among hospitals performing 50 or more initial shunt insertions, the RQ ranged between 0.71 and 3.65. The SAR and RQ have attractive qualitative features as practice-based quality measures. The RQ, at least, exhibits clinically meaningful interhospital variation as applied to CSF shunt surgery. The SAR and RQ merit prospective field-testing as measures of quality in the management of childhood hydrocephalus.

Managing mechanistic and organic structure in health care organizations.

PubMed

Olden, Peter C

2012-01-01

Managers at all levels in a health care organization must organize work to achieve the organization's mission and goals. This requires managers to decide the organization structure, which involves dividing the work among jobs and departments and then coordinating them all toward the common purpose. Organization structure, which is reflected in an organization chart, may range on a continuum from very mechanistic to very organic. Managers must decide how mechanistic versus how organic to make the entire organization and each of its departments. To do this, managers should carefully consider 5 factors for the organization and for each individual department: external environment, goals, work production, size, and culture. Some factors may push toward more mechanistic structure, whereas others may push in the opposite direction toward more organic structure. Practical advice can help managers at all levels design appropriate structure for their departments and organization.

Convergence of potential net ecosystem production among contrasting C3 grasslands

PubMed Central

Peichl, Matthias; Sonnentag, Oliver; Wohlfahrt, Georg; Flanagan, Lawrence B.; Baldocchi, Dennis D.; Kiely, Gerard; Galvagno, Marta; Gianelle, Damiano; Marcolla, Barbara; Pio, Casimiro; Migliavacca, Mirco; Jones, Michael B.; Saunders, Matthew

2013-01-01

Metabolic theory and body size dependent constraints on biomass production and decomposition suggest that differences in the intrinsic potential net ecosystem production (NEPPOT) should be small among contrasting C3 grasslands and therefore unable to explain the wide range in the annual apparent net ecosystem production (NEPAPP) reported by previous studies. We estimated NEPPOT for nine C3 grasslands under contrasting climate and management regimes using multi-year eddy covariance data. NEPPOT converged within a narrow range suggesting little difference in the net carbon dioxide uptake capacity across C3 grasslands. Our results indicate a unique feature of C3 grasslands compared to other terrestrial ecosystems and suggest a state of stability in NEPPOT due to tightly coupled production and respiration processes. Consequently, the annual NEPAPP of C3 grasslands is primarily a function of seasonal and short-term environmental and management constraints, and therefore especially susceptible to changes in future climate patterns and associated adaptation of management practices. PMID:23346985

Practical salinity management for leachate irrigation to poplar trees.

PubMed

Smesrud, Jason K; Duvendack, George D; Obereiner, James M; Jordahl, James L; Madison, Mark F

2012-01-01

Landfill leachate can be beneficially reused for irrigation of fiber crops with appropriate attention to nutrient and salinity management. The Riverbend Landfill in Western Oregon has been effectively practicing irrigation of landfill leachate to poplar trees since 1993. Over that time, the site has been adaptively managed to control salinity impacts to the tree crop while beneficially utilizing the applied water and nutrients during each growing season. Representative leachate irrigation water has ranged in concentration of total dissolved solids from 777 to 6,940 mg/L, chloride from 180 to 1,760 mg/L and boron from 3.2 to 7.3 mg/L. Annual leachate irrigation applications have also ranged between 102 and 812 mm/yr. Important conclusions from this site have included: 1) Appropriate tree clone selection and tree stand spacing, thinning, and harvest rotations are critical to maintaining a productive tree stand that is resilient and resistant to salt stress. The most effective combinations have included clones DN-34, OP-367, 184-411, 49-177, and 15-29 planted at spacing of 3.7-m x 1.8-m to 3.7-m x 3.7-m; 2) Leaf tissue boron levels are closely correlated to soil boron levels and can be managed with leaching. When leaf tissue boron levels exceed 200 to 250 mg/kg, signs of salt stress may emerge and should be monitored closely; 3) Salinity from leachate irrigation can be managed to sustain a healthy tree crop by controlling mass loading rates and providing appropriate irrigation blending if necessary. Providing freshwater irrigation following each leachate irrigation and targeting freshwater irrigation as 30 percent of total irrigation water applied has successfully controlled salt impacts to vegetation; and 4) Drip irrigation generally requires more careful attention to long-term soil salinity management than spray irrigation. Moving drip irrigation tubes periodically to prevent the formation of highly saline zones within the soil profile is important. In this paper, a fifteen year record of monitoring and operational data are presented that can be used by others in managing irrigation of saline water to poplar trees. When salinity is carefully managed, tree systems can help to provide sustainable leachate management solutions for landfills.

Reverse quality management: developing evidence-based best practices in health emergency management.

PubMed

Lynch, Tim; Cox, Paul

2006-01-01

The British Columbia Ministry of Health's Framework for Core Functions in Public Health was the catalyst that inspired this review of best practices in health emergency management. The fieldwork was conducted in the fall of 2005 between hurricane Katrina and the South Asia earthquake. These tragedies, shown on 24/7 television news channels, provided an eyewitness account of disaster management, or lack of it, in our global village world. It is not enough to just have best practices in place. There has to be a governance structure that can be held accountable. This review of best practices lists actions in support of an emergency preparedness culture at the management, executive, and corporate/governance levels of the organization. The methodology adopted a future quality management approach of the emergency management process to identify the corresponding performance indictors that correlated with practices or sets of practices. Identifying best practice performance indictors needed to conduct a future quality management audit is described as reverse quality management. Best practices cannot be assessed as stand-alone criteria; they are influenced by organizational culture. The defining of best practices was influenced by doubt about defining a practice it is hoped will never be performed, medical staff involvement, leadership, and an appreciation of the resources required and how they need to be managed. Best practice benchmarks are seen as being related more to "measures" of performance defined locally and agreed on by 2 or more parties rather than to achieving industrial standards. Relating practices to performance indicators and then to benchmarks resulted in the development of a Health Emergency Management Best Practices Matrix that lists specific practice in the different phases of emergency management.

The practices, challenges and recommendations of South African audiologists regarding managing children with auditory processing disorders

PubMed Central

Govender, Samantha; Khan, Nasim

2016-01-01

Audiologists managing children with auditory processing disorders (APD) encounter challenges that include conflicting definitions, several classification profiles, problems with differential diagnosis and a lack of standardised guidelines. The heterogeneity of the disorder and its concomitant childhood disorders makes diagnosis difficult. Linguistic and cultural issues are additional challenges faced by South African audiologists. The study aimed to describe the practices, challenges and recommendations of South African audiologists managing children with APD. A quantitative, non-experimental descriptive survey was used to obtain data from 156 audiologists registered with the Health Professions of South Africa. Findings revealed that 67% screened for APD, 42% assessed while 43% provided intervention. A variety of screening and assessment procedures were being administered, with no standard test battery identified. A range of intervention strategies being used are discussed. When the relationship between the number of years of experience and the audiologists’ level of preparedness to practice in the field of APD was compared, a statistically significant difference (p = 0.049) was seen in that participants with more than 10 years of experience were more prepared to practice in this area. Those participants having qualified as speech-language therapists and audiologists were significantly more prepared (p = 0.03) to practice than the audiologists who comprised the sample. Challenges experienced by the participants included the lack of linguistically and culturally appropriate screening and assessment tools and limited normative data. Recommendations included reviewing the undergraduate audiology training programmes, reinstituting the South African APD Taskforce, developing linguistically and culturally appropriate normative data, creating awareness among educators and involving them in the multidisciplinary team. PMID:27380913

Gender differences in practice patterns for diagnosis and treatment of dental caries: Findings from The Dental PBRN

PubMed Central

Riley, Joseph L.; Gordan, Valeria V.; Rouisse, Kathleen M.; McClelland, Jocelyn; Gilbert, Gregg H.

2011-01-01

Objectives A number of articles have addressed gender differences in the productivity of dentists, but little is known about differences in practice patterns for caries management. This study compared the use of a comprehensive range of specific diagnostic methods, preventive agents, and restorative decision making for caries management between male and female dentists who were members of The Dental Practice-Based Research Network(DPBRN). Methods This study surveyed general dentists who were members of DPBRN and who practiced within the United States. The survey asked about dentist, practice, and patient characteristics, as well as prevention, assessment, and treatment of dental caries. Differences in years since dental school graduation, practice model, full/part-time status, and practice owner/employee were adjusted in the statistical models, before making conclusions about gender differences. Results Three hundred ninety-three male (84%) and seventy-three female (16%) dentists participated. Female dentists recommended at-home fluoride to a significantly larger proportion of their patients, whereas males had a preference for using in-office fluoride treatments with pediatric patients. Female dentists also choose to restore interproximal lesions at a significantly later stage of development, preferring to use preventive therapy more often at earlier stages of dental caries. There were few differences in diagnostic methods, time spent on or charges for restorative dentistry, and busyness of their practices. Conclusion DPBRN female dentists differ from their male counterparts in some aspects of the prevention, assessment, and treatment of dental caries, even with significant covariates taken into account. Practice patterns of female dentists suggest a greater caries preventive treatment philosophy. PMID:21454850

High performance HRM: NHS employee perspectives.

PubMed

Hyde, Paula; Sparrow, Paul; Boaden, Ruth; Harris, Claire

2013-01-01

The purpose of this paper is to examine National Health Service (NHS) employee perspectives of how high performance human resource (HR) practices contribute to their performance. The paper draws on an extensive qualitative study of the NHS. A novel two-part method was used; the first part used focus group data from managers to identify high-performance HR practices specific to the NHS. Employees then conducted a card-sort exercise where they were asked how or whether the practices related to each other and how each practice affected their work. In total, 11 high performance HR practices relevant to the NHS were identified. Also identified were four reactions to a range of HR practices, which the authors developed into a typology according to anticipated beneficiaries (personal gain, organisation gain, both gain and no-one gains). Employees were able to form their own patterns (mental models) of performance contribution for a range of HR practices (60 interviewees produced 91 groupings). These groupings indicated three bundles particular to the NHS (professional development, employee contribution and NHS deal). These mental models indicate employee perceptions about how health services are organised and delivered in the NHS and illustrate the extant mental models of health care workers. As health services are rearranged and financial pressures begin to bite, these mental models will affect employee reactions to changes both positively and negatively. The novel method allows for identification of mental models that explain how NHS workers understand service delivery. It also delineates the complex and varied relationships between HR practices and individual performance.

KSC-04pd1656

NASA Image and Video Library

2004-08-05

KENNEDY SPACE CENTER, FLA. - At the ribbon cutting for the Enhanced Firing Range on Schwartz Rd. at Kennedy Space Center, Center Director Jim Kennedy practices firing on the new range. NASA’s Federal Law Enforcement Training Academy’s firing range has been upgraded to include a “rifle-grade” shoot house, a portable, tactical “shoot-back” trailer for cover and concealment drills, automated running targets and a new classroom facility. They are added to the existing three firearms ranges, “pistol-grade” shoot house, obstacle course and rappel tower. NASA’s Security Management and Safeguards Office funded the enhancements in order to improve ability to train the KSC security force and to support local, state and federal law enforcement agencies in Homeland Security.

Reflective practice: a framework for case manager development.

PubMed

Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia

2011-01-01

The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

Obesity: Risk factors, complications, and strategies for sustainable long-term weight management.

PubMed

Fruh, Sharon M

2017-10-01

The aims of this article are to review the effects of obesity on health and well-being and the evidence indicating they can be ameliorated by weight loss, and consider weight-management strategies that may help patients achieve and maintain weight loss. Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as "obesity," "overweight," "weight loss," "comorbidity," "diabetes," cardiovascular," "cancer," "depression," "management," and "intervention." Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%-10% range, and above, can significantly improve health-related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal-setting and increased consultation frequency can greatly improve the success of weight-management programs. Nurse practitioners have key roles in establishing weight-loss targets, providing motivation and support, and implementing weight-loss programs. With their in-depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight-management strategies deployed in clinical practice. ©2017 American Association of Nurse Practitioners.

Modified stretched exponential model of computer system resources management limitations-The case of cache memory

NASA Astrophysics Data System (ADS)

Strzałka, Dominik; Dymora, Paweł; Mazurek, Mirosław

2018-02-01

In this paper we present some preliminary results in the field of computer systems management with relation to Tsallis thermostatistics and the ubiquitous problem of hardware limited resources. In the case of systems with non-deterministic behaviour, management of their resources is a key point that guarantees theirs acceptable performance and proper working. This is very wide problem that stands for many challenges in financial, transport, water and food, health, etc. areas. We focus on computer systems with attention paid to cache memory and propose to use an analytical model that is able to connect non-extensive entropy formalism, long-range dependencies, management of system resources and queuing theory. Obtained analytical results are related to the practical experiment showing interesting and valuable results.

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.

Integrative management of commercialized wild mushroom: a case study of Thelephora ganbajun in Yunnan, southwest China.

PubMed

He, Jun; Zhou, Zhimei; Yang, Huixian; Xu, Jianchu

2011-07-01

The management of wild mushroom is interdisciplinary in nature, whereby the biophysical considerations have to be incorporated into the context of a wide range of social, economic and political concerns. However, to date, little documentation exists illustrating an interdisciplinary approach to management of wild mushrooms. Moreover, the empirical case studies necessary for developing applicable and practical methods are even more rare. This paper adopted an interdisciplinary approach combining participatory methods to improve the habitat management of Thelephora ganbajun, an endemic and one of the most economically valuable mushroom species in Southwest China. The paper documents an empirical case of how an interdisciplinary approach facilitated the development of a scientific basis for policy and management practice, and built the local capacity to create, adopt and sustain the new rules and techniques of mushroom management. With this integrative perspective, a sustainable management strategy was developed, which was found not only technically feasible for farmers, but also acceptable to the government from an ecological and policy-related perspective. More importantly, this approach has greatly contributed to raising the income of farmers. The paper highlights how the integration of biophysical and socioeconomic factors and different knowledge systems provided a holistic perspective to problem diagnosis and resolution, which helped to cope with conventional scientific dilemmas. Finally, it concludes that the success of this interdisciplinary approach is significant in the context of policy decentralization and reform for incorporating indigenous knowledge and local participation in forest management.

Integrative Management of Commercialized Wild Mushroom: A Case Study of Thelephora ganbajun in Yunnan, Southwest China

NASA Astrophysics Data System (ADS)

He, Jun; Zhou, Zhimei; Yang, Huixian; Xu, Jianchu

2011-07-01

The management of wild mushroom is interdisciplinary in nature, whereby the biophysical considerations have to be incorporated into the context of a wide range of social, economic and political concerns. However, to date, little documentation exists illustrating an interdisciplinary approach to management of wild mushrooms. Moreover, the empirical case studies necessary for developing applicable and practical methods are even more rare. This paper adopted an interdisciplinary approach combining participatory methods to improve the habitat management of Thelephora ganbajun, an endemic and one of the most economically valuable mushroom species in Southwest China. The paper documents an empirical case of how an interdisciplinary approach facilitated the development of a scientific basis for policy and management practice, and built the local capacity to create, adopt and sustain the new rules and techniques of mushroom management. With this integrative perspective, a sustainable management strategy was developed, which was found not only technically feasible for farmers, but also acceptable to the government from an ecological and policy-related perspective. More importantly, this approach has greatly contributed to raising the income of farmers. The paper highlights how the integration of biophysical and socioeconomic factors and different knowledge systems provided a holistic perspective to problem diagnosis and resolution, which helped to cope with conventional scientific dilemmas. Finally, it concludes that the success of this interdisciplinary approach is significant in the context of policy decentralization and reform for incorporating indigenous knowledge and local participation in forest management.

Healthcare Quality Indicators for Physiotherapy Management in Hip and Knee Osteoarthritis and Rheumatoid Arthritis: A Delphi Study.

PubMed

Peter, W F; Hurkmans, E J; van der Wees, P J; Hendriks, E J M; van Bodegom-Vos, L; Vliet Vlieland, T P M

2016-12-01

The aim of the present study was to develop healthcare quality indicators (HCQIs) for the physiotherapy (PT) management of patients with hip or knee osteoarthritis (HKOA) or rheumatoid arthritis (RA) in the Netherlands. Two multidisciplinary expert panels, including patients, were instituted. A draft HCQI set was derived from recommendations included in two existing Dutch PT guidelines for HKOA and RA. The panels suggested additional topics, after which a Delphi procedure was performed. All propositions were scored for their potential to represent good-quality PT care (score range 0-9). Based on predefined rules, the Delphi panel HCQIs were discussed and selected. Lastly, every indicator was rephrased, resulting in its output consisting of a numerator and denominator, to facilitate comparisons within and among practices. After two Delphi rounds, two final sets of 17 HCQI - one for HKOA and one for RA - were composed, both containing 16 process indicators (regarding initial assessment, treatment and evaluation) and one outcome indicator. Two sets of HCQIs for PT management in HKOA and RA were developed for measuring the quality of PT care in daily clinical practice. Each indicator was formulated in a measurable way. Future research should focus on the feasibility of both indicator sets for daily clinical practice. Copyright © 2016 John Wiley & Sons, Ltd.

Guidelines for the symptomatic management of fever in children: systematic review of the literature and quality appraisal with AGREE II.

PubMed

Chiappini, Elena; Bortone, Barbara; Galli, Luisa; de Martino, Maurizio

2017-07-31

Several societies have produced and disseminated clinical practice guidelines (CPGs) for the symptomatic management of fever in children. However, to date, the quality of such guidelines has not been appraised. To identify and evaluate guidelines for the symptomatic management of fever in children. The research was conducted using PubMed, guideline websites, and Google (January 2010 to July 2016). The quality of the CPGs was independently assessed by two assessors using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, and specific recommendations in guidelines were summarised and evaluated. Domain scores were considered of sufficient quality when >60% and of good quality when >80%. Seven guidelines were retrieved. The median score for the scope and purpose domain was 85.3% (range 66.6-100%). The median score for the stakeholder involvement domain was 57.5% (range 33.3-83.3%) and four guidelines scored >60%. The median score for the rigour of development domain was 52.0% (range 14.6-98.9%), and only three guidelines scored >60%. The median score for the clarity of presentation domain was 80.9% (range 50.0-94.4%). The median score for the applicability domain was 39.3% (8.3-100%). Only one guideline scored >60%. The median score for the editorial independence domain was 48.84% (0-91.6%); only three guidelines scored >60%. Most guidelines were recommended for use even if with modification, especially in the methodology, the applicability and the editorial independence domains. Our results could help improve reporting of future guidelines, and affect the selection and use of guidelines in clinical practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Management of patients under 18years of age by adult intensive care unit professionals: Level of training, workload, and specific challenges].

PubMed

Brossier, D; Villedieu, F; Letouzé, N; Pinto Da Costa, N; Jokic, M

2017-03-01

In routine practice, intensive care physicians rarely have to manage children under 18years of age, particularly those under 15. This study's objectives were to assess the quality of training in pediatrics of adult intensive care teams, to document the workload generated by care of pediatric patients, and to identify the difficulties encountered in managing minors as patients. A survey was administered in Lower Normandy from 4 April 2012 to 1 September 2012. Physicians, residents, nurses, and nurses' aides practicing in one of the nine intensive care units of Lower Normandy were asked to complete an electronic or paper format questionnaire. This questionnaire assessed their level of pediatric training, the workload management of pediatric patients entailed, and the challenges posed by these patients. One hundred and nine questionnaires were returned (by 26 attending physicians, 18 residents, 38 nurses, and 27 nurses' aides). Eighty-three of the respondents (76%) had no experience in a pediatric unit of any kind. Forty-two percent thought that the pediatric age range lies between 3months and 15years of age. However, more than 50% of respondents would like the upper limit to be 16years or even older. Ninety-three respondents (85%) estimated having some exposure to pediatric patients in their routine practice, but this activity remained quite low. Seventy-three (67%) reported difficulties with the management of these young patients. This survey provides current information regarding the level of training of adult intensive care unit professionals and their concerns about managing patients under 18years of age, both in terms of workload and specific challenges. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Five principles for the practice of knowledge exchange in environmental management.

PubMed

Reed, M S; Stringer, L C; Fazey, I; Evely, A C; Kruijsen, J H J

2014-12-15

This paper outlines five principles for effective practice of knowledge exchange, which when applied, have the potential to significantly enhance the impact of environmental management research, policy and practice. The paper is based on an empirical analysis of interviews with 32 researchers and stakeholders across 13 environmental management research projects, each of which included elements of knowledge co-creation and sharing in their design. The projects focused on a range of upland and catchment management issues across the UK, and included Research Council, Government and NGO funded projects. Preliminary findings were discussed with knowledge exchange professionals and academic experts to ensure the emerging principles were as broadly applicable as possible across multiple disciplines. The principles suggest that: knowledge exchange needs to be designed into research; the needs of likely research users and other stakeholders should be systematically represented in the research where possible; and long-term relationships must be built on trust and two-way dialogue between researchers and stakeholders in order to ensure effective co-generation of new knowledge. We found that the delivery of tangible benefits early on in the research process helps to ensure continued motivation and engagement of likely research users. Knowledge exchange is a flexible process that must be monitored, reflected on and continuously refined, and where possible, steps should be taken to ensure a legacy of ongoing knowledge exchange beyond initial research funding. The principles have been used to inform the design of knowledge exchange and stakeholder engagement guidelines for two international research programmes. They are able to assist researchers, decision-makers and other stakeholders working in contrasting environmental management settings to work together to co-produce new knowledge, and more effectively share and apply existing knowledge to manage environmental change. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Current state of herbicides in herbicide-resistant crops.

PubMed

Green, Jerry M

2014-09-01

Current herbicide and herbicide trait practices are changing in response to the rapid spread of glyphosate-resistant weeds. Growers urgently needed glyphosate when glyphosate-resistant crops became available because weeds were becoming widely resistant to most commonly used selective herbicides, making weed management too complex and time consuming for large farm operations. Glyphosate made weed management easy and efficient by controlling all emerged weeds at a wide range of application timings. However, the intensive use of glyphosate over wide areas and concomitant decline in the use of other herbicides led eventually to the widespread evolution of weeds resistant to glyphosate. Today, weeds that are resistant to glyphosate and other herbicide types are threatening current crop production practices. Unfortunately, all commercial herbicide modes of action are over 20 years old and have resistant weed problems. The severity of the problem has prompted the renewal of efforts to discover new weed management technologies. One technology will be a new generation of crops with resistance to glyphosate, glufosinate and other existing herbicide modes of action. Other technologies will include new chemical, biological, cultural and mechanical methods for weed management. From the onset of commercialization, growers must now preserve the utility of new technologies by integrating their use with other weed management technologies in diverse and sustainable systems. © 2014 Society of Chemical Industry.

Practice management for academic dermatology departments.

PubMed

Eaglstein, W H

2000-09-01

Practice management in the academic medical center (AMC) is different than in other environments. Practice is only a part of the practitioner's mission within an AMC. Practice revenue will be subject to a tax or overhead by both the school and the department. Contract and practice guidelines cannot be tailored to the needs of the dermatology practice, because contracts and guidelines are negotiated globally for all of the practices within the AMC. Personnel, on which the practice depends, may report to hospitals and clinics rather than to the practice's management. Even control of the practice's manager may be diluted by a dual or "dotted line" reporting relationship between the department manager and the school practice manager. Although more constraints exist within the AMC, there are some strategic and operational choices that affect a practice's success. Among these are: (1) selection of services offered; (2) creation of satellites; (3) stimulation of faculty effort; (4) enhancement of faculty billing knowledge; and (5) creation of a "tie" between staff and the practice.

Nurse managers describe their practice environments.

PubMed

Warshawsky, Nora E; Lake, Sharon W; Brandford, Arica

2013-01-01

Hospital work environments that support the professional practice of nurses are critical to patient safety. Nurse managers are responsible for creating these professional practice environments for staff nurses, yet little is known about the environments needed to support nurse managers. Domains of nurse managers' practice environment have recently been defined. This is a secondary analysis of 2 cross-sectional studies of organizational characteristics that influence nurse manager practice. Content analysis of the free text comments from 127 nurse managers was used to illustrate the 8 domains of nurse managers' practice environments. Nurse managers valued time spent with their staff; therefore, workloads must permit meaningful interaction. Directors demonstrated trust when they empowered nurse managers to make decisions. Administrative leaders should build patient safety cultures on the basis of shared accountability and mutual respect among the health care team. The expectations of nurse managers have greatly expanded in the volume and complexity of direct reports, patient care areas, and job functions. The nurse managers in this analysis reported characteristics of their practice environments that limit their role effectiveness and may negatively impact organizational performance. Further research is needed to understand the effects of nurse managers' practice environments on staff and patient outcomes.

Loneliness at the Top: Ten Ways Medical Practice Administrators Can Manage the Isolation of Leadership.

PubMed

Hills, Laura

2016-01-01

Medical practice.managers spend their days surrounded by people, so the last thing they may expect to feel is lonely. Yet for many, being the manager of a medical practice can lead to feelings of isolation from the rest of the staff, and loneliness. This article explores the many reasons that managing a medical practice can be a lonely business. It considers the risks when a practice manager's loneliness goes unchecked, both to the individual and to the practice. It suggests 10 effective and healthy strategies for preventing and managing the leadership loneliness that medical practice managers sometimes experience. Next, this article argues that acceptance is the first step in overcoming loneliness in the workplace. It offers guidance for medical practice managers who wish to help lonely members of their teams. It describes the benefits of having a confidant to help support the medical practice manager, and the characteristics of an ideal confidant. Finally, this article suggests a strategy for combatting loneliness by interacting with the staff more frequently.

Accounting for overdispersion when determining primary care outliers for the identification of chronic kidney disease: learning from the National Chronic Kidney Disease Audit.

PubMed

Kim, Lois G; Caplin, Ben; Cleary, Faye; Hull, Sally A; Griffith, Kathryn; Wheeler, David C; Nitsch, Dorothea

2017-04-01

Early diagnosis of chronic kidney disease (CKD) facilitates best management in primary care. Testing coverage of those at risk and translation into subsequent diagnostic coding will impact on observed CKD prevalence. Using initial data from 915 general practitioner (GP) practices taking part in a UK national audit, we seek to apply appropriate methods to identify outlying practices in terms of CKD stages 3-5 prevalence and diagnostic coding. We estimate expected numbers of CKD stages 3-5 cases in each practice, adjusted for key practice characteristics, and further inflate the control limits to account for overdispersion related to unobserved factors (including unobserved risk factors for CKD, and between-practice differences in coding and testing). GP practice prevalence of coded CKD stages 3-5 ranges from 0.04 to 7.8%. Practices differ considerably in coding of CKD in individuals where CKD is indicated following testing (ranging from 0 to 97% of those with and glomerular filtration rate  <60 mL/min/1.73 m 2 ). After adjusting for risk factors and overdispersion, the number of  'extreme' practices is reduced from 29 to 2.6% for the low-coded CKD prevalence outcome, from 21 to 1% for high-uncoded CKD stage and from 22 to 2.4% for low total (coded and uncoded) CKD prevalence. Thirty-one practices are identified as outliers for at least one of these outcomes. These can then be categorized into practices needing to address testing, coding or data storage/transfer issues. GP practice prevalence of coded CKD shows wide variation. Accounting for overdispersion is crucial in providing useful information about outlying practices for CKD prevalence. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Cost accounting helps ensure group practice profitability.

PubMed

Conrad, K A; Nagle, C B; Wunar, R J

1996-11-01

Physician practice managers are faced with the challenge of developing overall practice budgets, identifying strategies for the practice, and negotiating profitable managed care contracts. To accomplish these objectives, they need to understand and manage the costs associated with practice operations. Practices that have used cost accounting methodologies to identify their operational costs in greater detail and have developed methods to effectively manage their costs are likely to be more attractive partners to health plans and better positioned to thrive under managed care.

Cerulean Warbler Technical Group: Coordinating international research and conservation

USGS Publications Warehouse

Dawson, D.K.; Wigley, T.B.; Keyser, P.D.

2012-01-01

Effective conservation for species of concern requires interchange and collaboration among conservationists and stakeholders. The Cerulean Warbler Technical Group (CWTG) is a consortium of biologists and managers from government agencies, non-governmental organizations, academia, and industry, who are dedicated to finding pro-active, science-based solutions for conservation of the Cerulean Warbler (Setophaga cerulea). Formed in the United States in 2001, CWTG’s scope soon broadened to address the species’ ecology and conservation on both the breeding and non-breeding ranges, in partnership with biologists from South and Central America. In 2004, CWTG launched the Cerulean Warbler Conservation Initiative, a set of activities aimed at addressing information and conservation needs for the species. These include (1) studies in the core breeding range to assess Cerulean Warbler response to forest management practices and to identify mined lands that could be reforested to benefit the species, (2) ecological and demographic studies on the winter range, and (3) surveys of Cerulean Warbler distribution on the breeding and winter ranges and during migration. A rangewide conservation action plan has been completed, along with a more detailed conservation plan for the non-breeding range. CWTG and partners now move forward with on-the-ground conservation, while still addressing unmet information needs.

Couple/family therapy for posttraumatic stress disorder: review to facilitate interpretation of VA/DOD Clinical Practice Guideline.

PubMed

Monson, Candice M; Macdonald, Alexandra; Brown-Bowers, Amy

2012-01-01

A well-documented association exists among Veterans' posttraumatic stress disorder (PTSD) symptoms, family relationship problems, and mental health problems in partners and children of Veterans. This article reviews the recommendations regarding couple/family therapy offered in the newest version of the Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress. We then provide a heuristic for clinicians, researchers, and policy makers to consider when incorporating couple/family interventions into Veterans' mental health services. The range of research that has been conducted on couple/family therapy for Veterans with PTSD is reviewed using this heuristic, and suggestions for clinical practice are offered.

Utilizing a 'systems' approach to improve the management of waste from healthcare facilities: best practice case studies from England and Wales.

PubMed

Tudor, Terry L; Woolridge, Anne C; Bates, Margaret P; Phillips, Paul S; Butler, Sharon; Jones, Keith

2008-06-01

Changes in environmental legislation and standards governing healthcare waste, such as the Hazardous Waste Regulations are expected to have a significant impact on healthcare waste quantities and costs in England and Wales. This paper presents findings from two award winning case study organizations, the Cardiff and Vale NHS Trust and the Cornwall NHS Trust on 'systems' they have employed for minimizing waste. The results suggest the need for the development and implementation of a holistic range of systems in order to develop best practice, including waste minimization strategies, key performance indicators, and staff training and awareness. The implications for the sharing of best practice from the two case studies are also discussed.

Assessing the whole person: case managers take a holistic approach to physical and mental health.

PubMed

Carter, Jolynne Jo; Zawalski, Sandra; Sminkey, Patrice V; Christopherson, Bruce

2015-01-01

Given the prevalence of mental health issues, particularly depressive disorders, in the U.S. population, professional case managers should increase their sensitivity to and awareness of mental illnesses, as well as their impact on physical health. Throughout the case management process, case managers frequently observe behaviors and symptoms such as those associated with depressive disorders. Case managers need to have, at a minimum, a working knowledge of mental and behavioral health issues and be familiar with basic screening tools. This will enable them to become more attuned to symptoms and behaviors that indicate that the individual should be further assessed and diagnosed by a physician. Across the case management spectrum, including acute care, accountable care organizations, patient-centered medical homes, physician practices, clinics, occupational health clinics, workers' compensation, and other settings in which case managers work with individuals (clients who receive case management services) and their families/support systems. With more than one quarter of the U.S. population affected by a depressive disorder, professional case managers who practice holistically bring together the mental and physical aspects of health. This is particularly important in a health care system and among payer sources that continue to divide the two. Case managers elevate their practice by demonstrating a greater understanding of the interconnectedness of mental and physical health and can positively influence the transdisciplinary care team to take a person-centered approach to address all health issues, in pursuit of the individual's health goals. Professional case managers must increase their understanding of mental health, becoming more aware of "red flags" that may necessitate a further evaluation and assessment by a mental health professional. They should also hone their communication skills, particularly the use of motivational interviewing techniques, to encourage individuals to discuss their feelings, worries, fears, and anxiety, as well as any potential symptoms of depression, which may range from mild to severe. Without judgment or bias, the case manager, as the advocate, can provide the information, support, or other services needed to address mental health issues, to support and further the individual's health goals.

Transfer of knowledge and skills: some implications for nursing and nurse education.

PubMed

Lauder, W; Reynolds, W; Angus, N

1999-08-01

The construct of transfer has enormous importance to nursing as it begins to highlight potential problems in the transfer of knowledge and skills from the campus to the clinical area, from one part of the clinical area to another (e.g. surgical to medical), and from community to the clinical area. Thus, any adequate conceptualization of transfer must account for problems of practice-practice transfer as well as theory-practice transfer. These potential problems are the concern of educators, students and managers who have a responsibility for agency nurses and bank nurses who may find themselves in different specialities on a regular basis. Transfer has relevance to a whole raft of other issues ranging from the application of theories to nursing practice, through to the validity of claims that courses which develop intellectual skills prepare nurses for lifelong learning.

A Leadership Education and Development Program for Clinical Nurses.

PubMed

Fitzpatrick, Joyce J; Modic, Mary Beth; Van Dyk, Jennifer; Hancock, K Kelly

2016-11-01

The Leadership Education and Development (LEAD) Program was designed to transform care at the bedside by empowering clinical nurses as leaders. The heart of LEAD was enhancing communication skills of clinical nurses with clinical colleagues and, most importantly, patients and families. Key concepts of leadership/management were included: personal awareness, personal leadership skills/abilities, leading change, leading others individually and in teams, enhancing the patient/provider experience, and the leadership role in outcomes management. A quantitative, longitudinal, survey design was used with 2 cohorts. The program consisted of six 4-hour sessions for 3 to 6 months. Leadership practices were measured before program implementation, at the end of the program, and 3 months after program completion. There were significant increases in leadership practices sustained 3 months after program completion. A range of other outcome measures was included. There is a need for additional leadership development programs for clinical nurses.

StressHacker: Towards Practical Stress Monitoring in the Wild with Smartwatches.

PubMed

Hao, Tian; Walter, Kimberly N; Ball, Marion J; Chang, Hung-Yang; Sun, Si; Zhu, Xinxin

2017-01-01

In modern life, the nonstop and pervasive stress tends to keep us on long-lasting high alert, which over time, could lead to a broad range of health problems from depression, metabolic disorders to heart diseases. However, there is a stunning lack of practical tools for effective stress management that can help people navigate through their daily stress. This paper presents the feasibility evaluation of StressHacker, a smartwatch-based system designed to continuously and passively monitor one's stress level using bio-signals obtained from the on-board sensors. With the proliferation of smartwatches, StressHacker is highly accessible and suited for daily use. Our preliminary evaluation is based on 300 hours of data collected in a real-life setting (12 subjects, 29 days). The result suggests that StressHacker is capable of reliably capturing daily stress dynamics (precision = 86.1%, recall = 91.2%), thus with great potential to enable seamless and personalized stress management.

A Review of Hypothesized Determinants Associated with Bighorn Sheep (Ovis canadensis) Die-Offs

PubMed Central

Miller, David S.; Hoberg, Eric; Weiser, Glen; Aune, Keith; Atkinson, Mark; Kimberling, Cleon

2012-01-01

Multiple determinants have been hypothesized to cause or favor disease outbreaks among free-ranging bighorn sheep (Ovis canadensis) populations. This paper considered direct and indirect causes of mortality, as well as potential interactions among proposed environmental, host, and agent determinants of disease. A clear, invariant relationship between a single agent and field outbreaks has not yet been documented, in part due to methodological limitations and practical challenges associated with developing rigorous study designs. Therefore, although there is a need to develop predictive models for outbreaks and validated mitigation strategies, uncertainty remains as to whether outbreaks are due to endemic or recently introduced agents. Consequently, absence of established and universal explanations for outbreaks contributes to conflict among wildlife and livestock stakeholders over land use and management practices. This example illustrates the challenge of developing comprehensive models for understanding and managing wildlife diseases in complex biological and sociological environments. PMID:22567546

Livestock grazing and the desert tortoise in the Mojave Desert

USGS Publications Warehouse

Oldemeyer, John L.

1994-01-01

A large part of the Mojave Desert is not in pristine condition, and some current conditions can be related to past grazing-management practices. No information could be found on densities of the desert tortoise (Gopherus agassizii) or on vegetative conditions of areas that had not been grazed to allow managers a comparison of range conditions with data on tortoises. Experimental information to assess the effect of livestock grazing on tortoises is lacking, and researchers have not yet examined whether the forage that remains after grazing is sufficient to meet the nutritional needs of desert tortoises.

What can Europeans learn from Americans?

PubMed Central

Enthoven, Alain C.

1989-01-01

In a wide-ranging look at many aspects of health care financing and delivery, the concepts of glasnost and perestroika are used as a framework for presenting ideas from the American system that may have value for European health care planners. These include more uniform approaches to data collection and cost reporting, patient outcome studies, evaluation of service and access standards, publication of information, quality assurance review, decentralization and independent institutions, prepaid group practice, demonstrations and experiments, and managed competition. Suggestions are offered for making health care systems on both sides of the Atlantic more manageable, efficient, and responsive. PMID:10313435

Fire effects in southwestern forests: Proceedings of the Second La Mesa Fire symposium

USGS Publications Warehouse

Allen, Craig D.

1996-01-01

In 1977, the La Mesa Fire burned across 15,444 acres of ponderosa pine forests on the adjoining lands of Bandelier National Monument, the Santa Fe National Forest, and Los Alamos National Laboratory. Following this event, several fire effects studies were initiated. The 16 papers herein document longer-term knowledge gained about the ecological effects of the fire and about Southwestern fire ecology in general. The presentations are also designed to give resource managers practical information for managing fire in local landscapes. Studies presented range from fire histories and avifauna to geomorphology and arthropods.

How family members manage risk around functional decline: the autonomy management process in households facing dementia.

PubMed

Berry, Brandon; Apesoa-Varano, Ester Carolina; Gomez, Yarin

2015-04-01

Most dementia research investigates the social context of declining ability through studies of decision-making around medical treatment and end-of-life care. This study seeks to fill an important gap in research about how family members manage the risks of functional decline at home. Drawing on three waves of in-depth interviewing in 2012-2014, it investigates how family members in US households manage decline in an affected individual's natural range of daily activities over time. The findings show that early on in the study period affected individuals were perceived to have awareness of their decline and routinely drew on family members for support. Support transformed when family members detected that the individual's deficit awareness had diminished, creating a corresponding increase in risk of self-harm around everyday activities. With a loss of confidence in the individual's ability to regulate his or her own activities to avoid these risks, family members employed unilateral practices to manage the individual's autonomy around his or her activity involvements. These practices typically involved various deceits and ruses to discourage elders from engaging in activities perceived as potentially dangerous. The study concludes by discussing the implications that the social context of interpretive work around awareness and risk plays an important role in how families perceive an elder's functional ability and manage his or her activity involvements. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence.

PubMed

Hanekom, Susan D; Brooks, Dina; Denehy, Linda; Fagevik-Olsén, Monika; Hardcastle, Timothy C; Manie, Shamila; Louw, Quinette

2012-02-06

Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal. The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n=5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR)<0.5-were collated into the algorithm. The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential. An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.

How family members manage risk around functional decline: The autonomy management process in households facing dementia

PubMed Central

Berry, Brandon; Apesoa-Varano, Ester Carolina; Gomez, Yarin

2015-01-01

Most dementia research investigates the social context of declining ability through studies of decision-making around medical treatment and end-of-life care. This study seeks to fill an important gap in research about how family members manage the risks of functional decline at home. Drawing on three waves of retrospective interviewing in 2012–2014, it investigates how family members in US households manage decline in an affected individual’s natural range of daily activities over time. The findings show that early on in the study period affected individuals were perceived to have awareness of their decline and routinely drew on family members for support. Support transformed when family members detected that the individual’s deficit awareness had diminished, creating a corresponding increase in risk of self-harm around everyday activities. With a loss of confidence in the individual’s ability to regulate his or her own activities to avoid these risks, family members employed unilateral practices to manage the individual’s autonomy around his or her activity involvements. These practices typically involved various deceits and ruses to discourage elders from engaging in activities perceived as potentially dangerous. The study concludes by discussing the implications that the social context of interpretive work around awareness and risk plays an important role in how families perceive an elder’s functional ability and manage his or her activity involvements. PMID:25697634

Solid Waste Management Practices in the Eastern Province of Saudi Arabia

NASA Astrophysics Data System (ADS)

Khan, Hasin U.; Husain, Tahir; Khan, Suhail M.

1987-11-01

Solid waste management practices in the Eastern Province of Saudi Arabia are reviewed. The officials of various municipalities and agencies responsible for collecting and disposing of municipal waste were interviewed. The refuse generation rate found is in the range of 1.61 2.72 kg per capita per day. The refuse composition data indicate a high percentage of glass, metals, and wood. For storage purposes, 0.2-m3 barrels are used in residential areas and 0.75 to 1.50 m3-capacity containers are used in commerical areas. The present solid-waste collection system is labor-intensive, and a significant part of the budget is spent on collection and haul operations. The unit collection and haul cost is much higher than the unit disposal cost of refuse. The direct haul of refuse is the common practice, and the use of transfer stations has not yet been considered. It is also observed that the disposal methods used at these sites are not in line with modern techniques for refuse disposal. Landfilling and combined burning and landfilling are the common disposal methods at all the sites.

Public participation in watershed management: International practices for inclusiveness

NASA Astrophysics Data System (ADS)

Perkins, Patricia E. (Ellie)

This paper outlines a number of examples from around the world of participatory processes for watershed decision-making, and discusses how they work, why they are important, their social and ecological potential, and the practical details of how to start, expand and develop them. Because of long-standing power differentials in all societies along gender, class and ethnic lines, equitable public participation requires the recognition that different members of society have different kinds of relationships with the environment in general, and with water in particular. From a range of political perspectives, inclusive participatory governance processes have many benefits. The author has recently completed a 5 year project linking universities and NGOs in Brazil and Canada to develop methods of broadening public engagement in local watershed management committees, with a special focus on gender and marginalized communities. The innovative environmental education and multi-lingual international public engagement practices of the Centre for Socio-Environmental Knowledge and Care of the La Plata Basin (which spans Brazil, Argentina, Uruguay, Paraguay and Bolivia) are also discussed in this paper.

Evidence-based practice in Behçet’s disease: identifying areas of unmet need for 2014

PubMed Central

2014-01-01

Background Behçet’s Disease (BD) is characterized by a relapsing-remitting course, with symptoms of varying severity across almost all organ systems. There is a diverse array of therapeutic options with no universally accepted treatment regime, and it is thus important that clinical practice is evidence-based. We reviewed all currently available literature describing management of BD, and investigated whether evidence-based practice is possible for all disease manifestations, and assessed the range of therapeutic options tested. Methods We conducted an internet search of all literature describing management of BD up to August 2013, including pharmacological and non-pharmacological interventions. We recorded treatment options investigated and disease manifestations reported as primary and secondary study outcomes. Quality of data was assessed according to the Scottish Intercollegiate Guideline Network (SIGN) hierarchy of evidence. Results Whilst there is much literature describing treatment of ocular and mucocutaneous disease, there is little to guide management of rheumatoid, cardiovascular and neurological disease. This broadly reflects the prevalence of disease manifestations of BD, but not the severity. Biologic therapies are the most commonly investigated intervention. The proportion of SIGN-1 graded studies is declining, and there are no SIGN-1 graded studies investigating neurological or gastrointestinal manifestations of BD. Conclusions This is the first study to investigate trends in published literature for management of BD over time. It identifies neurological, cardiovascular and gastro-intestinal disease as particular areas of unmet need and suggests that overall quality of evidence is declining. Future research should be designed to address these areas of insufficiency to facilitate evidence-based practice in BD. PMID:24475935

The activities of a dietitian-led gastroenterology clinic using extended scope of practice.

PubMed

Ryan, Dominique; Pelly, Fiona; Purcell, Elizabeth

2016-10-21

Extending the scope of practice of allied health professionals has been a strategy adopted in the United Kingdom to address issues within the health system. Australia's health system is currently undermined by similar issues, heightening government interest in adopting the extended scope health care model. The aim of the current study was to describe the activities and outcomes of a dietitian-led gastroenterology clinic which operated under an extended scope of practice model in an outpatient gastroenterology department at a tertiary hospital in regional Queensland, Australia, and to assess patient satisfaction with the initiative. A descriptive, cross-sectional case series undertaken over 50 clinics involving 82 category 2 and 3 patients with suspected/confirmed coeliac disease or inflammatory bowel disease; low haemoglobin; gastroesophageal reflux disease, or; malnutrition. Data was analysed using Microsoft Excel 2010, and presented as descriptive statistics. Sixty out of 82 selected patients (median age 51 years) attended an initial appointment with the dietitian. Twenty-four review appointments were attended. Average waiting period for an initial appointment was 148 days (range 31-308 days). A total of 149 management strategies were provided, and 94 (63 %) of these involved the dietitian utilising extended scope of practice. The dietitian managed 47 (78 %) patients without need for gastroenterologist referral, and 25 (42 %) were discharged after dietetic management. Patients reported high levels of satisfaction with the clinic. Seventy-eight percent of category 2 and 3 patients referred to the gastroenterologist could be managed exclusively in the dietitian-led clinic. This extended scope model of care could potentially benefit the efficiency and acceptability of Australia's public health system.

Teachers' Reported Use of Instructional and Behavior Management Practices for Students with Behavior Problems: Relationship to Role and Level of Training in ADHD

ERIC Educational Resources Information Center

Martinussen, Rhonda; Tannock, Rosemary; Chaban, Peter

2011-01-01

The present study examined general and special education teachers' self-reported level of in-service training in attention-deficit hyperactivity disorder (ADHD), a common childhood mental health disorder, and the relationship between teachers' level of training in ADHD and their reported use of a range of recommended instructional and behavior…

Implement balanced scorecard to translate strategic plan into actionable objectives.

PubMed

2004-09-01

Faced with challenges ranging from declining reimbursement to staff shortages, health care organizations--integrated delivery systems, physician group practices, disease management providers, and others--increasingly are turning to general business models to map out step-by-step action plans for performance measurement and process improvement. Creating a "balanced scorecard" is an obvious starting point for assessing and improving clinical and financial performance.

Influence of selection systems and shelterwood methods on understory plant communities of longleaf pine forests in flatwoods and uplands

Treesearch

Dale G. Brockway; Kenneth W. Outcalt

2015-01-01

Although longleaf pine (Pinus palustris Mill.) forests have mostly been managed with even-aged methods, interest has been rising in uneven-aged systems, as a means of achieving a broader range of stewardship objectives. Selection silviculture has been practiced on a limited scale in longleaf pine, but difficulty of using traditional approaches and...

Proportional basal area method for implementing selection silviculture systems in longleaf pine forests

Treesearch

Dale G. Brockway; Edward F. Loewenstein; Kenneth W. Outcalt

2014-01-01

Proportional basal area (Pro-B) was developed as an accurate, easy-to-use method for making uneven-aged silviculture a practical management option. Following less than 3 h of training, forest staff from a range of professional backgrounds used Pro-B in an operational-scale field study to apply single-tree selection and group selection systems in longleaf pine (Pinus...

Interviewing Parents for Qualitative Research Studies: Using an ABCD Model to Manage the Sensitivities and Issues

ERIC Educational Resources Information Center

Price, Jayne; Nicholl, Honor

2013-01-01

Parenting a child with complex health/palliative care needs is wide ranging. Family-centred practices place parents at the heart of the ongoing care of these children, and therefore it makes sense that their views and experiences should be central to research within the field. Despite this assertion, little guidance exists as to how best to…

Enhancing the strategic management of practice learning through the introduction of the role of Learning Environment Manager.

PubMed

Congdon, Graham; Baker, Tracey; Cheesman, Amanda

2013-03-01

This paper describes a process evaluation project designed to enhance the strategic management of practice learning within a large Hospital in the North of England. The aim of the project was to introduce the role of the Learning Environment Manager with dedicated responsibility for practice learning of undergraduate student nurses within the Hospital's 49 practice-settings. Whilst aspects of this role were already evident in several of these settings, the project sought to locate and standardise responsibilities related to the organisation and management of learning and teaching in practice explicitly within the existing staffing structure of each practice-setting. Focus group interviews were used to explore significant aspects of the project with key stakeholder groups comprising Learning Environment Managers, the Hospital Clinical Educator, Hospital Department Managers, Ward Managers, Mentors, University Link Lecturers and undergraduate Student Nurses. Interview data were analysed using thematic content analysis. The findings of the project suggest that the Learning Environment Manager role affords providers of practice learning with a robust approach to establish organisation-wide benchmarks that standardise the strategic management of practice learning in collaboration with partner Universities. The role incorporated many operational activities previously undertaken by the Hospital Clinical Educator, thus enabling the Hospital Clinical Educator to make a more strategic contribution to the on-going quality monitoring and enhancement of practice learning across the Hospital. The Learning Environment Manager role was found to provide mentors with high levels of support which in turn helped to promote consistent, positive and holistic practice learning experiences for undergraduate student nurses across the Hospital. Importantly, the role offers a potent catalyst for nurses in practice to regain responsibility for practice learning and re-establish the value of practice teaching. Copyright © 2012 Elsevier Ltd. All rights reserved.

Observed intra-cluster correlation coefficients in a cluster survey sample of patient encounters in general practice in Australia

PubMed Central

Knox, Stephanie A; Chondros, Patty

2004-01-01

Background Cluster sample study designs are cost effective, however cluster samples violate the simple random sample assumption of independence of observations. Failure to account for the intra-cluster correlation of observations when sampling through clusters may lead to an under-powered study. Researchers therefore need estimates of intra-cluster correlation for a range of outcomes to calculate sample size. We report intra-cluster correlation coefficients observed within a large-scale cross-sectional study of general practice in Australia, where the general practitioner (GP) was the primary sampling unit and the patient encounter was the unit of inference. Methods Each year the Bettering the Evaluation and Care of Health (BEACH) study recruits a random sample of approximately 1,000 GPs across Australia. Each GP completes details of 100 consecutive patient encounters. Intra-cluster correlation coefficients were estimated for patient demographics, morbidity managed and treatments received. Intra-cluster correlation coefficients were estimated for descriptive outcomes and for associations between outcomes and predictors and were compared across two independent samples of GPs drawn three years apart. Results Between April 1999 and March 2000, a random sample of 1,047 Australian general practitioners recorded details of 104,700 patient encounters. Intra-cluster correlation coefficients for patient demographics ranged from 0.055 for patient sex to 0.451 for language spoken at home. Intra-cluster correlations for morbidity variables ranged from 0.005 for the management of eye problems to 0.059 for management of psychological problems. Intra-cluster correlation for the association between two variables was smaller than the descriptive intra-cluster correlation of each variable. When compared with the April 2002 to March 2003 sample (1,008 GPs) the estimated intra-cluster correlation coefficients were found to be consistent across samples. Conclusions The demonstrated precision and reliability of the estimated intra-cluster correlations indicate that these coefficients will be useful for calculating sample sizes in future general practice surveys that use the GP as the primary sampling unit. PMID:15613248