2006 Community Involvement Training Conference

EPA Pesticide Factsheets

A dynamic training conference that brings together more than 450 people from EPA and the Agency’s partners and stakeholders who plan and implement environmental community involvement, partnership, stewardship, outreach, and education programs.

2013 Community Involvement Training Conference

EPA Pesticide Factsheets

A dynamic training conference that brings together more than 450 people from EPA and the Agency’s partners and stakeholders who plan and implement environmental community involvement, partnership, stewardship, outreach, and education programs.

2007 Community Involvement Training Conference

EPA Pesticide Factsheets

A dynamic training conference that brings together more than 450 people from EPA and the Agency’s partners and stakeholders who plan and implement environmental community involvement, partnership, stewardship, outreach, and education programs.

Wilderness education: The ultimate commitment to quality wilderness stewardship

Treesearch

Gregory F. Hansen; Tom Carlson

2007-01-01

The effective planning, implementation, and monitoring of a wilderness education program will ultimately produce measurable results that can be instrumental in achieving wilderness management goals and objectives. This paper will provide a simple step-by-step overview of how to develop and maintain a successful wilderness education program through planning,...

Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship.

PubMed

Messacar, Kevin; Parker, Sarah K; Todd, James K; Dominguez, Samuel R

2017-03-01

New rapid molecular diagnostic technologies for infectious diseases enable expedited accurate microbiological diagnoses. However, diagnostic stewardship and antimicrobial stewardship are necessary to ensure that these technologies conserve, rather than consume, additional health care resources and optimally affect patient care. Diagnostic stewardship is needed to implement appropriate tests for the clinical setting and to direct testing toward appropriate patients. Antimicrobial stewardship is needed to ensure prompt appropriate clinical action to translate faster diagnostic test results in the laboratory into improved outcomes at the bedside. This minireview outlines the roles of diagnostic stewardship and antimicrobial stewardship in the implementation of rapid molecular infectious disease diagnostics. Copyright © 2017 American Society for Microbiology.

Local Government Planning Tool to Calculate Institutional and Engineering Control Costs for Brownfield Properties

EPA Pesticide Factsheets

This cost calculator is designed as a guide for municipal or local governments to assist in calculating their expected costs of implementing and conducting long-term stewardship of institutional controls and engineering controls at brownfield properties.

Planning the Transition to Long-Term Stewardship for the River Corridor

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

Cearlock, C.S.; Lerch, J.A.; Sands, J.P.

2007-07-01

Long-term stewardship refers to all activities necessary to ensure protection of human health and the environment following completion of remediation, disposal, or stabilization of a site or a portion of a site. Efforts to establish the proposed approach and criteria to be met for long-term stewardship in the river corridor of the Hanford Site in Richland, Washington, are currently being established and a draft plan is expected to be completed in mid-2007 to facilitate planning for a smooth and seamless transition to long-term stewardship. Once the initial criteria have been established, supporting information will be gathered as the work proceeds.more » Near the end of cleanup actions under the River Corridor Closure Contract, these criteria will be finalized in a long-term stewardship plan that documents how the criteria have been met. In addition, the final long-term stewardship plan will also contain a proposed Finding of Suitability to Transfer in accordance with Comprehensive Environmental Response, Compensation, and Liability Act of 1980 Section 120(h) [1]. This final long-term stewardship plan will provide the foundation for post-River Corridor Closure Contract and management activities in the river corridor pending actual property transfer from the U.S. Department of Energy. (authors)« less

FY 2016 - Stockpile Stewardship and Management Plan

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

None

2015-03-01

This Department of Energy’s (DOE) National Nuclear Security Administration (NNSA) Fiscal Year Stockpile Stewardship and Management Plan (SSMP) is a key planning document for the nuclear security enterprise.

Implementation of a Mobile Clinical Decision Support Application to Augment Local Antimicrobial Stewardship.

PubMed

Hoff, Brian M; Ford, Diana C; Ince, Dilek; Ernst, Erika J; Livorsi, Daniel J; Heintz, Brett H; Masse, Vincent; Brownlee, Michael J; Ford, Bradley A

2018-01-01

Medical applications for mobile devices allow clinicians to leverage microbiological data and standardized guidelines to treat patients with infectious diseases. We report the implementation of a mobile clinical decision support (CDS) application to augment local antimicrobial stewardship. We detail the implementation of our mobile CDS application over 20 months. Application utilization data were collected and evaluated using descriptive statistics to quantify the impact of our implementation. Project initiation focused on engaging key stakeholders, developing a business case, and selecting a mobile platform. The preimplementation phase included content development, creation of a pathway for content approval within the hospital committee structure, engaging clinical leaders, and formatting the first version of the guide. Implementation involved a media campaign, staff education, and integration within the electronic medical record and hospital mobile devices. The postimplementation phase required ongoing quality improvement, revision of outdated content, and repeated staff education. The evaluation phase included a guide utilization analysis, reporting to hospital leadership, and sustainability and innovation planning. The mobile application was downloaded 3056 times and accessed 9259 times during the study period. The companion web viewer was accessed 8214 times. Successful implementation of a customizable mobile CDS tool enabled our team to expand beyond microbiological data to clinical diagnosis, treatment, and antimicrobial stewardship, broadening our influence on antimicrobial prescribing and incorporating utilization data to inspire new quality and safety initiatives. Further studies are needed to assess the impact on antimicrobial utilization, infection control measures, and patient care outcomes.

36 CFR 230.6 - Landowner forest stewardship plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., Tree Farm management plans, or similar plans meet or can be amended to meet Landowner Forest... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Landowner forest stewardship plan. 230.6 Section 230.6 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE...

36 CFR 230.6 - Landowner forest stewardship plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Tree Farm management plans, or similar plans meet or can be amended to meet Landowner Forest... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Landowner forest stewardship plan. 230.6 Section 230.6 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE...

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

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

Silvas, A. J.

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

Strategic Plan for Sustainable Energy Management and Environmental Stewardship for Los Angeles Unified School District

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

Walker, A.; Beattie, D.; Thomas, K.

2007-11-01

This Strategic Plan for Sustainable Energy Management and Environmental Stewardship states goals, measures progress toward goals and how actions are monitored to achieve continuous improvement for the Los Angeles Unified School District.

78 FR 12352 - Notice of Intent To Prepare an Environmental Impact Statement for the Wilderness Stewardship Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

... Park, Clallam, Grays Harbor, Jefferson and Mason County, WA AGENCY: National Park Service, Interior... Act of 1969 (Pub. L. 91-190) Olympic National Park is initiating the conservation planning and... Superintendent Sarah Creachbaum, Olympic National Park, Attn: Wilderness Stewardship Plan, 600 East Park Ave...

Implementation of a pharmacist-led antimicrobial management team in a community teaching hospital: use of pharmacy residents and pharmacy students in a prospective audit and feedback approach.

PubMed

Laible, Brad R; Nazir, Jawad; Assimacopoulos, Aris P; Schut, Jennifer

2010-12-01

Antimicrobial stewardship is an important process proven to combat antimicrobial resistance, improve patient outcomes, and reduce costs. The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) have provided guidelines for the provision of antimicrobial stewardship. According to these recommendations, antimicrobial stewardship teams should be multidisciplinary in nature, with core members consisting of an infectious disease physician and an infectious disease-trained clinical pharmacist. Due to limited resources, our institution chose to implement a pharmacist-led antimicrobial stewardship service on 1 medical/surgical ward, with the existing clinical pharmacist and 3 infectious disease physicians as core members. This clinical pharmacist was not trained in infectious disease specialty, and stewardship activities were only one part of his daily activities. Pharmacy residents and students were extensively utilized to assist in the stewardship process. Approximately two thirds of stewardship recommendations were accepted using primarily a prospective audit and feedback approach.

Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey.

PubMed

Chou, Ann F; Graber, Christopher J; Jones, Makoto; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Kelly, Allison; Glassman, Peter A

2016-06-01

BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.

7 CFR 1470.22 - Conservation stewardship plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., and (iii) Documenting the participant's conservation objectives to reach and exceed stewardship thresholds; (2) A plan map delineating enrolled land with associated acreage amounts; (3) In the case where a... participant's transition to or participation in the National Organic Program; (4) In the case where a...

77 FR 38267 - Information Collection; Role of Communities in Stewardship Contracting Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

...) Nature of roles played by the entities involved in developing agreement or contract plans, (c) Benefits... Collection; Role of Communities in Stewardship Contracting Projects AGENCY: Forest Service, USDA. ACTION... revision of a currently approved information collection, Role of Communities in Stewardship Contracting...

Antimicrobial Stewardship Barriers and Goals in Pediatric Oncology and Bone Marrow Transplantation: A Survey of Antimicrobial Stewardship Practitioners.

PubMed

Wolf, Joshua; Sun, Yilun; Tang, Li; Newland, Jason G; Gerber, Jeffrey S; Van Dyke, Christie J; Hymes, Saul R; Yu, Diana; Carias, Delia C; Bryant, Penelope A

2016-03-01

We undertook a cross-sectional survey of antimicrobial stewardship clinicians in North America and Australasia regarding practices, goals, and barriers to implementation of stewardship for pediatric oncology patients. Goals and barriers were similar regardless of clinician or institutional characteristics and geographic location. Strategies addressing these factors could help optimize antimicrobial use.

The Italian Hub of Population Biobanks as a Potential Tool for Improving Public Health Stewardship

PubMed Central

Napolitano, Mariarosaria; Santoro, Filippo; Belardelli, Filippo; Federici, Antonio

2013-01-01

In Italy, a country that is experiencing the decentralization of health services from central to regional level of government, the Minister of Health is proposing stewardship as a model of governance for the public health system. Stewardship favors efficiency in the policy decision-making process, based on reciprocal trust, and tends to be more ethical. The embryonic proposal to test stewardship in the field of population-based research was advanced during the launching conference Challenges and Opportunities of the Italian Hub of Population Biobanks (HIBP) held in 2012 in Rome. Resources collected by population biobanks (i.e., blood and its derivatives, and/or DNA isolated from any type of biological samples and relative associated data) have, in fact, a recognized scientific value for the investigation of links between genetics, health and life style, and epidemiological outcomes through population biobank-based studies, and are essential to planning effective and qualified interventions for public health. The current economic crisis requires a strong push to rationalize investment in health policies. In particular, population biobank-based studies require financial commitment, often of long duration, for the realization of their goals. Thus, innovative solutions to allow fast integration of scientific knowledge into political health strategy are required. During the conference in Rome, it was proposed to test the stewardship model by its application to the inter-relationship between population biobank-based studies and disease prevention. Stewardship minimizes barriers to innovation and uses information more effectively to better develop new strategies for prevention and/or treatment. In the months following the conference, the proposal was defined more clearly, and the HIBP network became a potential tool for testing and implementing this model in the Italian Public Health prevention system. PMID:23840926

Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital

PubMed Central

Niwa, T; Shinoda, Y; Suzuki, A; Ohmori, T; Yasuda, M; Ohta, H; Fukao, A; Kitaichi, K; Matsuura, K; Sugiyama, T; Murakami, N; Itoh, Y

2012-01-01

Background Antimicrobial stewardship has not always prevailed in a wide variety of medical institutions in Japan. Methods The infection control team was involved in the review of individual use of antibiotics in all inpatients (6348 and 6507 patients/year during the first and second annual interventions, respectively) receiving intravenous antibiotics, according to the published guidelines, consultation with physicians before prescription of antimicrobial agents and organisation of education programme on infection control for all medical staff. The outcomes of extensive implementation of antimicrobial stewardship were evaluated from the standpoint of antimicrobial use density, treatment duration, duration of hospital stay, occurrence of antimicrobial-resistant bacteria and medical expenses. Results Prolonged use of antibiotics over 2 weeks was significantly reduced after active implementation of antimicrobial stewardship (2.9% vs. 5.2%, p < 0.001). Significant reduction in the antimicrobial consumption was observed in the second-generation cephalosporins (p = 0.03), carbapenems (p = 0.003), aminoglycosides (p < 0.001), leading to a reduction in the cost of antibiotics by 11.7%. The appearance of methicillin-resistant Staphylococcus aureus and the proportion of Serratia marcescens to Gram-negative bacteria decreased significantly from 47.6% to 39.5% (p = 0.026) and from 3.7% to 2.0% (p = 0.026), respectively. Moreover, the mean hospital stay was shortened by 2.9 days after active implementation of antimicrobial stewardship. Conclusion Extensive implementation of antimicrobial stewardship led to a decrease in the inappropriate use of antibiotics, saving in medical expenses, reduction in the development of antimicrobial resistance and shortening of hospital stay. PMID:22846073

A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative.

PubMed

Kelly, Allison A; Jones, Makoto M; Echevarria, Kelly L; Kralovic, Stephen M; Samore, Matthew H; Goetz, Matthew B; Madaras-Kelly, Karl J; Simbartl, Loretta A; Morreale, Anthony P; Neuhauser, Melinda M; Roselle, Gary A

2017-05-01

OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513-520.

Advancing antimicrobial stewardship: Summary of the 2015 CIDSC Report.

PubMed

Khan, F; Arthur, J; Maidment, L; Blue, D

2016-11-03

Antimicrobial resistance (AMR) is recognized as an important global public health concern that has a cross-cutting impact on human health, animal health, food and agriculture and the environment. The Communicable and Infectious Disease Steering Committee (CIDSC) of the Pan-Canadian Public Health Network (PHN) created a Task Group on Antimicrobial Stewardship to look at this issue from a Canadian perspective. To summarize the key findings of the Task Group Report that identified core components of antimicrobial stewardship programs, best practices, key challenges, gaps and recommendations to advance stewardship across jurisdictions. Search strategies were developed to identify scientific literature, grey literature and relevant websites on antimicrobial stewardship. The information was reviewed and based on this evidence, expert opinion and consensus-building, the Task Group identified core components, best practices, key challenges and gaps and developed recommendations to advance stewardship in Canada. The four components of a promising antimicrobial stewardship initiative were: leadership, interventions, monitoring/evaluation and future research. Best practices include a multi-sectoral/multipronged approach involving a wide range of stakeholders at the national, provincial/territorial, local and health care organizational levels. Key challenges and gaps identified were: the success and sustainability of stewardship undertakings require appropriate and sustained resourcing and expertise; there is limited evidence about how to effectively implement treatment guidance; and there is a challenge in ensuring accessibility, standardization and consistency of use among professionals. ​: Recommendations to the CIDSC about how to advance stewardship across jurisdictions included the following: institute a national infrastructure; develop best practices to implement stewardship programs; develop education and promote awareness; establish consistent evidence-based guidance, resources, tools and training; mandate the incorporation of stewardship education; develop audit and feedback tools; establish benchmarks and performance targets for stewardship; and conduct timely evaluation of stewardship programs. Findings of this report will inform a more systematic approach to addressing antimicrobial stewardship Canada-wide.

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

Garland, Sid; Brown, Sally; Sims, Lynn

Long-term stewardship is the set of activities necessary to return contaminated land to safe and beneficial use. The activities include physical and legal controls to prevent inappropriate exposure to contamination left in place at a site. It is the longest phase of the Department of Energy's Environmental Management Program and ensures the protection of human health and the environment for varied end uses. At the Department of Energy's Oak Ridge Reservation an automated program has been developed and implemented that tracks the multitude of long-term stewardship activities. The Oak Ridge Reservation is a large site that currently has over 50more » actions requiring long-term stewardship activities. The Oak Ridge Reservation consists primarily of three plant sites, and long-term stewardship will enable these sites to be leased to private entities (East Tennessee Technology Park), modernized for an evolving national security mission (Y-12 National Security Complex), and revitalized to continue multi-disciplinary research (Oak Ridge National Laboratory). The varied site end uses of the individual plant sites coupled with the multitude of controls required by leaving waste in place presents challenges. A single remedial action may include surveillance and maintenance activities, media monitoring, property record notices as well as physical controls such as fences and signs. Thus, the array of long-term stewardship activities is complex and intermingled (over 200 inspections each year at various frequencies are required currently) and requires an effective tracking program, termed the Land Use Manager. The Land Use Manager is a web-based data management application for use by personnel responsible for implementing, maintaining, and verifying engineering and land use controls on the Oak Ridge Reservation. The program is a data entry and tracking tool, as well as a notification tool. The status and performance of engineering and land use controls are checked annually for evaluation in the required Remediation Effectiveness Report, and the automated Land Use Manager collects, maintains, tracks, notifies, monitors, and manages the information necessary to perform this evaluation. Land Use Manager tracks site information including type of contamination, regulatory requirements, locates land use controls; provides information on inspections, certification, and reporting; and provides reports. Most data access features, e.g., view, print, query, and download, are available to all users; however, data input, updating, and editing are restricted to the personnel directly responsible for monitoring and inspection. The Land Use Manager application was developed for the Department of Energy Oak Ridge Office by URS - CH2M Oak Ridge LLC, Restoration Services Incorporated, and MIJARA Corporation to meet the specific needs of long-term stewardship tracking on the Oak Ridge Reservation. The successful implementation of long-term stewardship enables the future government and private activities being planned on the Oak Ridge Reservation to proceed. (authors)« less

Highlights of the national evaluation of the Forest Stewardship Planning Program

Treesearch

R.J. Moulton; J.D. Esseks

2001-01-01

In 1998 and 1999, a nationwide random sample of 1238 nonindustrial private (NIPF) landowners with approved multiple resource Forest Stewardship Plans were interviewed to determine if this program is meeting its Congressional mandate of promoting sustainable management of forest resources on NIPF ownerships. It was found that two-thirds of program participants had never...

Falcon: automated optimization method for arbitrary assessment criteria

DOEpatents

Yang, Tser-Yuan; Moses, Edward I.; Hartmann-Siantar, Christine

2001-01-01

FALCON is a method for automatic multivariable optimization for arbitrary assessment criteria that can be applied to numerous fields where outcome simulation is combined with optimization and assessment criteria. A specific implementation of FALCON is for automatic radiation therapy treatment planning. In this application, FALCON implements dose calculations into the planning process and optimizes available beam delivery modifier parameters to determine the treatment plan that best meets clinical decision-making criteria. FALCON is described in the context of the optimization of external-beam radiation therapy and intensity modulated radiation therapy (IMRT), but the concepts could also be applied to internal (brachytherapy) radiotherapy. The radiation beams could consist of photons or any charged or uncharged particles. The concept of optimizing source distributions can be applied to complex radiography (e.g. flash x-ray or proton) to improve the imaging capabilities of facilities proposed for science-based stockpile stewardship.

Development of an antimicrobial stewardship-based infectious diseases elective that incorporates human patient simulation technology.

PubMed

Falcione, Bonnie A; Meyer, Susan M

2014-10-15

To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs.

Environmental Management System Plan

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

Fox, Robert; Thorson, Patrick; Horst, Blair

2009-03-24

Executive Order 13423, Strengthening Federal Environmental, Energy, and Transportation Management establishes the policy that Federal agencies conduct their environmental, transportation, and energy-related activities in a manner that is environmentally, economically and fiscally sound, integrated, continually improving, efficient, and sustainable. The Department of Energy (DOE) has approved DOE Order 450.1A, Environmental Protection Program and DOE Order 430.2B, Departmental Energy, Renewable Energy and Transportation Management as the means of achieving the provisions of this Executive Order. DOE Order 450.1A mandates the development of Environmental Management Systems (EMS) to implement sustainable environmental stewardship practices that: (1) Protect the air, water, land, and othermore » natural and cultural resources potentially impacted by facility operations; (2) Meet or exceed applicable environmental, public health, and resource protection laws and regulations; and (3) Implement cost-effective business practices. In addition, the DOE Order 450.1A mandates that the EMS must be integrated with a facility's Integrated Safety Management System (ISMS) established pursuant to DOE P 450.4, 'Safety Management System Policy'. DOE Order 430.2B mandates an energy management program that considers energy use and renewable energy, water, new and renovated buildings, and vehicle fleet activities. The Order incorporates the provisions of the Energy Policy Act of 2005 and Energy Independence and Security Act of 2007. The Order also includes the DOE's Transformational Energy Action Management initiative, which assures compliance is achieved through an Executable Plan that is prepared and updated annually by Lawrence Berkeley National Laboratory (LBNL, Berkeley Lab, or the Laboratory) and then approved by the DOE Berkeley Site Office. At the time of this revision to the EMS plan, the 'FY2009 LBNL Sustainability Executable Plan' represented the most current Executable Plan. These DOE Orders and associated policies establish goals and sustainable stewardship practices that are protective of environmental, natural, and cultural resources, and take a life cycle approach that considers aspects such as: (1) Acquisition and use of environmentally preferable products; (2) Electronics stewardship; (3) Energy conservation, energy efficiency, and renewable energy; (4) Pollution prevention, with emphasis on toxic and hazardous chemical and material reduction; (5) Procurement of efficient energy and water consuming materials and equipment; (6) Recycling and reuse; (7) Sustainable and high-performance building design; (8) Transportation and fleet management; and (9) Water conservation. LBNL's approach to sustainable environmental stewardship required under Order 450.1A poses the challenge of implementing its EMS in a compliance-based, performance-based, and cost-effective manner. In other words, the EMS must deliver real and tangible business value at a minimal cost. The purpose of this plan is to describe Berkeley Lab's approach for achieving such an EMS, including an overview of the roles and responsibilities of key Laboratory parties. This approach begins with a broad-based environmental policy consistent with that stated in Chapter 11 of the LBNL Health and Safety Manual (PUB-3000). This policy states that Berkeley Lab is committed to the following: (1) Complying with applicable environmental, public health, and resource conservation laws and regulations. (2) Preventing pollution, minimizing waste, and conserving natural resources. (3) Correcting environmental hazards and cleaning up existing environmental problems, and (4) Continually improving the Laboratory's environmental performance while maintaining operational capability and sustaining the overall mission of the Laboratory. A continual cycle of planning, implementing, evaluating, and improving processes will be performed to achieve goals, objectives, and targets that will help LBNL carry out this policy. Each year, environmental aspects will be identified and their impacts to the environment will be evaluated. Objectives and targets will be developed (or updated) for each aspect that is determined to have a significant impact. Environmental Management Programs (EMPs) will be prepared (or updated) to document actions necessary for reducing certain environmental impacts. Each EMP will identify responsible parties and associated target deadlines for each action. Quarterly, environmental programs will be reviewed for compliance issues and effectiveness. Annually, an internal assessment will be performed to evaluate the progress of the EMS, and LBNL senior management will review the results. In addition, at least once every 3 years a third-party audit will be performed to validate that the EMS is being implemented according to plan.« less

Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions.

PubMed

Stenehjem, Edward; Hyun, David Y; Septimus, Ed; Yu, Kalvin C; Meyer, Marc; Raj, Deepa; Srinivasan, Arjun

2017-08-15

Antibiotic stewardship programs (ASPs) improve antibiotic prescribing. Seventy-three percent of US hospitals have <200 beds. Small hospitals (<200 beds) have similar rates of antibiotic prescribing compared to large hospitals, but the majority of small hospitals lack ASPs that satisfy the Centers for Disease Control and Prevention's core elements. All hospitals, regardless of size, are now required to have ASPs by The Joint Commission, and the Centers for Medicare and Medicaid Services has proposed a similar requirement. Very few studies have described the successful implementation of ASPs in small hospitals. We describe barriers commonly encountered in small hospitals when constructing an antibiotic stewardship team, obtaining appropriate metrics of antibiotic prescribing, implementing antibiotic stewardship interventions, obtaining financial resources, and utilizing the microbiology laboratory. We propose potential solutions that tailor stewardship activities to the needs of the facility and the resources typically available. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Listening to your audience: developing an educational tool to assist with recreation planning on private lands

Treesearch

J. Daniel van Dijk; Gary T. Green; Craig A. Miller

2009-01-01

The Georgia Forestry Commission in conjunction with the U.S. Forest Service instituted the Forest Stewardship Program (FSP) in 1991. A growing component of the FSP is recreation, which is the component least understood by stewardship planners. A survey was developed to better understand the needs of planners with regard to developing forest recreation plans, and the...

Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America

PubMed Central

Barlam, Tamar F.; Cosgrove, Sara E.; Abbo, Lilian M.; MacDougall, Conan; Schuetz, Audrey N.; Septimus, Edward J.; Srinivasan, Arjun; Dellit, Timothy H.; Falck-Ytter, Yngve T.; Fishman, Neil O.; Hamilton, Cindy W.; Jenkins, Timothy C.; Lipsett, Pamela A.; Malani, Preeti N.; May, Larissa S.; Moran, Gregory J.; Neuhauser, Melinda M.; Newland, Jason G.; Ohl, Christopher A.; Samore, Matthew H.; Seo, Susan K.; Trivedi, Kavita K.

2016-01-01

Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics. PMID:27080992

Analysing the Stewardship Function in Botswana’s Health System: Reflecting on the Past, Looking to the Future

PubMed Central

Seitio-Kgokgwe, Onalenna; Gauld, Robin DC; Hill, Philip C.; Barnett, Pauline

2016-01-01

Background: In many parts of the world, ongoing deficiencies in health systems compromise the delivery of health interventions. The World Health Organization (WHO) identified four functions that health systems need to perform to achieve their goals: Efforts to strengthen health systems focus on the way these functions are carried out. While a number of studies on health systems functions have been conducted, the stewardship function has received limited attention. In this article, we evaluate the extent to which the Botswana Ministry of Health (MoH) undertook its stewardship role. Methods: We used the WHO Health Systems Performance Assessment Frame (HSPAF) to guide analysis of the stewardship function of the Botswana’s MoH focusing on formulation of national health policies, exerting influence through health regulation, and coalition building. Data were abstracted from published and unpublished documents. We interviewed 54 key informants comprising staff of the MoH (N = 40) and stakeholder organizations (N = 14). Data from documents was analyzed through content analysis. Interviews were transcribed and analyzed through thematic analysis. Results: A lack of capacity for health policy development was identified. Significant policy gaps existed in some areas. Challenges were reported in policy implementation. While the MoH made efforts in developing various statutes that regulated different aspects of the health system, some gaps existed in the regulatory framework. Poor enforcement of legislation was a challenge. Although the MoH had a high number of stakeholders, the mechanisms for stakeholder engagement in the planning processes were weak. Conclusion: Problems in the exercise of the stewardship function posed challenges in ensuring accountability and limited the health system’s ability to benefit from its stakeholders. Ongoing efforts to establish a District Health System under control of the MoH, attempts to improve service delivery at a national level and political will to strengthen public-private engagement mechanisms are some of the prospects that can improve the MoH’s stewardship function. PMID:28005550

Antibiotic Stewardship: New Frontier, Familiar Journey.

PubMed

Martin, Caren McHenry

2017-05-01

Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts.

Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections

PubMed Central

Patel, Twisha S.; Kaakeh, Rola; Nagel, Jerod L.; Newton, Duane W.

2016-01-01

ABSTRACT Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million. PMID:27795335

7 CFR 1469.23 - Program payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM Contracts and Payments § 1469.23 Program payments. (a) Stewardship component of CSP payments. (1) The conservation stewardship plan... Agriculture Statistics Service (NASS) land rental data, and Conservation Reserve Program (CRP) rental rates...

Antibiotic stewardship through the EU project "ABS International".

PubMed

Allerberger, Franz; Frank, Annegret; Gareis, Roland

2008-01-01

The increasing problem of antimicrobial resistance requires implementation of antibiotic stewardship (ABS) programs. The project "ABS International--implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the European Union" was started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (antibiotic list, guides for antibiotic treatment and surgical prophylaxis, antibiotic-related organization) and valid process measures, as well as quality indicators for antibiotic use were developed. Specific ABS tools are being implemented in up to five healthcare facilities in each country. Although ABS International clearly focuses on healthcare institutions, future antimicrobial stewardship programs must also cover public education and antibiotic prescribing in primary care.

Improving patient care through implementation of an antimicrobial stewardship program.

PubMed

Palmer, Hannah R; Weston, Jaye; Gentry, Layne; Salazar, Miguel; Putney, Kimberly; Frost, Craig; Tipton, Joyce A; Cottreau, Jessica; Tam, Vincent H; Garey, Kevin W

2011-11-15

The implementation of an antimicrobial stewardship program at a health system is described. In 2008, the Center for Antimicrobial Stewardship and Epidemiology (CASE) was formed at St. Luke's Episcopal Hospital (SLEH) to improve the quality of care for patients as it related to antimicrobial therapy. The charter of CASE contained specific aims for improving patient care, furthering clinical research, and training the next generation of clinical infectious diseases pharmacists. The CASE team consists of at least two infectious diseases pharmacists and one physician (the medical director) who provide direct oversight for antimicrobial utilization within the hospital. The CASE medical director, an infectious diseases physician, is responsible for overseeing the activities of the center. With the oversight of the CASE advisory board, the medical director develops and implements the antimicrobial stewardship and management policies for SLEH. Another key innovative feature of CASE is its extensive involvement in training new infectious diseases pharmacists and conducting research. CASE uses a model in which a clinical scenario or problem is identified, a research project is undertaken to further elucidate the problem, and policy changes are made to improve patient outcomes. The CASE team is supported by a CASE advisory board, a CASE research collaborative including university faculty, and a dedicated training program for pharmacy fellows, residents, and students. Implementation of an antimicrobial stewardship program at a health system helped decrease the inappropriate use of antibiotics, improve patient care and outcomes, further clinical research, and increase training opportunities for future clinical infectious diseases pharmacists.

Advancing mission in the marketplace. Integrated strategic planning and budgeting helps a system remain accountable.

PubMed

Smessaert, A H

1992-10-01

In the late 1980s Holy Cross Health System (HCHS), South Bend, IN, began to implement a revised strategic planning and budgeting process to effectively link the system's mission with its day-to-day operations. Leaders wanted a process that would help system employees internalize and act on the four major elements articulated in the HCHS mission statement: fidelity, excellence, empowerment, and stewardship. Representatives from mission, strategic planning, and finance from the corporate office and subsidiaries examined planning and budgeting methods. From the beginning, HCHS leaders decided that the process should be implemented gradually, with each step focusing on refining methodology and improving mission integration. As the process evolved. HCHS developed a sequence in which planning preceded budgeting. The system also developed a variety of educational and collaborative initiatives to help system employees adapt to the organization's change of direction. One critical aspect of HCHS's ongoing education is an ethical reflection process that helps participants balance ethical considerations by viewing an issue from three perspectives: social vision, multiple responsibility, and self-interest.

Development of an Antimicrobial Stewardship-based Infectious Diseases Elective that Incorporates Human Patient Simulation Technology

PubMed Central

Meyer, Susan M.

2014-01-01

Objective. To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. Design. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Assessment. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. Conclusion. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs. PMID:25386016

7 CFR 1469.7 - Benchmark condition inventory and conservation stewardship plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Benchmark condition inventory and conservation...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General Provisions § 1469.7 Benchmark condition inventory and conservation stewardship...

Embedding Data Stewardship in Geoscience Australia

NASA Astrophysics Data System (ADS)

Bastrakova, I.; Fyfe, S.

2013-12-01

Ten years of technological innovation now enable vast amounts of data to be collected, managed, processed and shared. At the same time, organisations have witnessed government legislative and policy requirements for open access to public sector data, and a demand for flexibility in access to data by both machine-to-machine and human consumption. Geoscience Australia (GA) has adopted Data Stewardship as an organisation-wide initiative to improve the way we manage and share our data. The benefits to GA including: - Consolidated understanding of GA's data assets and their value to the Agency; - Recognition of the significant role of data custodianship and data management; - Well-defined governance, policies, standards, practices and accountabilities that promote the accessibility, quality and interoperability of GA's data; - Integration of disparate data sets into cohesive information products available online in real time and equally accessible to researchers, government, industry and the public. Although the theory behind data stewardship is well-defined and accepted and the benefits are generally well-understood, practical implementation requires an organisation to prepare for a long-term commitment of resources, both financial and human. Fundamentally this involves: 1. Raising awareness in the organisation of the need for data stewardship and the challenges this entails; 2. Establishing a data stewardship framework including a data governance office to set policy and drive organisational change; and 3. Embedding the functions and a culture of data stewardship into business as usual operations. GA holds a vast amount of data ranging from petabytes of Big Data to significant quantities of relatively small ';long tail' geoscientific observations and measurements. Over the past four years, GA has undertaken strategic activities that prepare us for Data Stewardship: - Organisation-wide audits of GA's data holdings and identification of custodians for each dataset; - Developing guiding Principles on how the Agency undertakes Science, Data Management and Cataloguing; - Developing a Data Classification Schema that aligns scientific requirements and business workflows with data architecture; - Creating the Scientific Data Stewardship Steering Committee, comprising champions from across the Agency to guide development and support implementation of Data Stewardship in GA; - Forming Scientific Data Communities of Practice of leading scientific experts to identify tandards and practices across their domain, and integrate data stewardship practices into scientific workflows; - Establishing the Data Governance and Services Section to provide ongoing capacity for the development, communication, coordination and governance of data stewardship policies, strategies, standards and practices. GA is now moving towards Data Stewardship as an operational capability and culture within the Agency. The challenges we face into the future include: - Maintaining continuous and enthusiastic engagement from the Agency executive; - Implementing long term cultural change at all levels within the organisation; - Formal recognition that data stewardship is a continuous operational BAU activity; - Incorporation of data custodianship and management activities in work programs and budgets; and - Cultivation and support of the data stewardship champions.

[Measurement of antimicrobial consumption using DDD per 100 bed-days versus DDD per 100 discharges after the implementation of an antimicrobial stewardship program].

PubMed

Collado, Roberto; Losa, Juan Emilio; Álvaro, Elena Alba; Toro, Piedad; Moreno, Leonor; Pérez, Montserrat

2015-12-01

Monitoring antimicrobial consumption in hospitals is a necessary measure. The indicators commonly employed do not clearly reflect the antibiotic selection pressure. The objective of this study is to evaluate two different methods that analyze antimicrobial consumption based on DDD, per stay and per discharge, before and after the implementation an antimicrobial stewardship program. Comparative pre-post study of antimicrobial consumption with the implementation of an antimicrobial stewardship program using DDD per 100 bed-days and DDD per 100 discharges as indicators. Hospital bed days remained stable and discharges increased slightly along the period of study Antibiotic consumption in DDD per 100 bed-days decreased by 2.5% versus 3.8% when expressed as DDD per 100 discharges. Antifungal consumption decreased by more than 50%. When average hospital stay decreases, reductions in the consumption of antimicrobials with an antimicrobial stewardship program system occur at the expense of reducing the number of patients receiving treatment, while increases occur due to longer durations of treatment.

Stewardship as a Means to Create Organizational Reform: A View into Minnesota 4-H Youth Development

ERIC Educational Resources Information Center

Skuza, Jennifer A.; Freeman, Dorothy M.; Bremseth, Tamara J.; Doering, Shirley A.; Quinlan, Robert B.; Morreim, Patricia A.; Deidrick, James C.

2010-01-01

Minnesota 4-H Youth Development (MN 4-H) used stewardship as a means to create organizational reform to address the public use of the 4-H name and emblem in terms of risk management, real estate and equipment, and finances. A task force implemented a participatory process with colleagues and stakeholders to build and implement the reform effort.…

Antibiotic Stewardship Programs in U.S. Acute Care Hospitals: Findings From the 2014 National Healthcare Safety Network Annual Hospital Survey.

PubMed

Pollack, Lori A; van Santen, Katharina L; Weiner, Lindsey M; Dudeck, Margaret A; Edwards, Jonathan R; Srinivasan, Arjun

2016-08-15

The National Action Plan to Combat Antibiotic Resistant Bacteria calls for all US hospitals to improve antibiotic prescribing as a key prevention strategy for resistance and Clostridium difficile Antibiotic stewardship programs (ASPs) will be important in this effort but implementation is not well understood. We analyzed the 2014 National Healthcare Safety Network Annual Hospital Survey to describe ASPs in US acute care hospitals as defined by the Center for Disease Control and Prevention's (CDC) Core Elements for Hospital ASPs. Univariate analyses were used to assess stewardship infrastructure and practices by facility characteristics and a multivariate model determined factors associated with meeting all ASP core elements. Among 4184 US hospitals, 39% reported having an ASP that met all 7 core elements. Although hospitals with greater than 200 beds (59%) were more likely to have ASPs, 1 in 4 (25%) of hospitals with less than 50 beds reported achieving all 7 CDC-defined core elements of a comprehensive ASP. The percent of hospitals in each state that reported all seven elements ranged from 7% to 58%. In the multivariate model, written support (adjusted relative risk [RR] 7.2 [95% confidence interval [CI], 6.2-8.4]; P < .0001) or salary support (adjusted RR 1.5 [95% CI, 1.4-1.6]; P < .0001) were significantly associated with having a comprehensive ASP. Our findings show that ASP implementation varies across the United States and provide a baseline to monitor progress toward national goals. Comprehensive ASPs can be established in facilities of any size and hospital leadership support for antibiotic stewardship appears to drive the establishment of ASPs. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis.

PubMed

Baur, David; Gladstone, Beryl Primrose; Burkert, Francesco; Carrara, Elena; Foschi, Federico; Döbele, Stefanie; Tacconelli, Evelina

2017-09-01

Antibiotic stewardship programmes have been shown to reduce antibiotic use and hospital costs. We aimed to evaluate evidence of the effect of antibiotic stewardship on the incidence of infections and colonisation with antibiotic-resistant bacteria. For this systematic review and meta-analysis, we searched PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Web of Science for studies published from Jan 1, 1960, to May 31, 2016, that analysed the effect of antibiotic stewardship programmes on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infections in hospital inpatients. Two authors independently assessed the eligibility of trials and extracted data. Studies involving long-term care facilities were excluded. The main outcomes were incidence ratios (IRs) of target infections and colonisation per 1000 patient-days before and after implementation of antibiotic stewardship. Meta-analyses were done with random-effect models and heterogeneity was calculated with the I 2 method. We included 32 studies in the meta-analysis, comprising 9 056 241 patient-days and 159 estimates of IRs. Antibiotic stewardship programmes reduced the incidence of infections and colonisation with multidrug-resistant Gram-negative bacteria (51% reduction; IR 0·49, 95% CI 0·35-0·68; p<0·0001), extended-spectrum β-lactamase-producing Gram-negative bacteria (48%; 0·52, 0·27-0·98; p=0·0428), and meticillin-resistant Staphylococcus aureus (37%; 0·63, 0·45-0·88; p=0·0065), as well as the incidence of C difficile infections (32%; 0·68, 0·53-0·88; p=0·0029). Antibiotic stewardship programmes were more effective when implemented with infection control measures (IR 0·69, 0·54-0·88; p=0·0030), especially hand-hygiene interventions (0·34, 0·21-0·54; p<0·0001), than when implemented alone. Antibiotic stewardship did not affect the IRs of vancomycin-resistant enterococci and quinolone-resistant and aminoglycoside-resistant Gram-negative bacteria. Significant heterogeneity between studies was detected, which was partly explained by the type of interventions and co-resistance patterns of the target bacteria. Antibiotic stewardship programmes significantly reduce the incidence of infections and colonisation with antibiotic-resistant bacteria and C difficile infections in hospital inpatients. These results provide stakeholders and policy makers with evidence for implementation of antibiotic stewardship interventions to reduce the burden of infections from antibiotic-resistant bacteria. German Center for Infection Research. Copyright © 2017 Elsevier Ltd. All rights reserved.

77 FR 67394 - Gulf of Mexico (GOM), Outer Continental Shelf (OCS), Western Planning Area (WPA) Lease Sale 233...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

... baseline conditions and potential environmental effects of oil and natural gas leasing, exploration...://www.boem.gov/Environmental-Stewardship/Environmental-Assessment/NEPA/nepaprocess.aspx . Several.../Environmental-Stewardship/Environmental-Assessment/NEPA/nepaprocess.aspx . Comments: Federal, state, and local...

Integrated vector management: the Zambian experience.

PubMed

Chanda, Emmanuel; Masaninga, Fred; Coleman, Michael; Sikaala, Chadwick; Katebe, Cecilia; Macdonald, Michael; Baboo, Kumar S; Govere, John; Manga, Lucien

2008-08-27

The Zambian Malaria Control Programme with the Roll Back Malaria (RBM) partners have developed the current National Malaria Strategic Plan (NMSP 2006-2011) which focuses on prevention based on the Integrated Vector Management (IVM) strategy. The introduction and implementation of an IVM strategy was planned in accordance with the World Health Organization (WHO) steps towards IVM implementation namely Introduction Phase, Consolidation Phase and Expansion Phase. IVM has created commitment for Legal and Regulatory policy review, monitoring, Research and a strong stewardship by the chemical suppliers. It has also leveraged additional resources, improved inter-sectoral collaboration, capacity building and enhanced community participation which facilitated a steady scaling up in coverage and utilisation of key preventive interventions. Thus, markedly reducing malaria incidence and case fatalities in the country. Zambia has successfully introduced, consolidated and expanded IVM activities. Resulting in increased coverage and utilization of interventions and markedly reducing malaria-related morbidity and mortality while ensuring a better protection of the environment.

Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections.

PubMed

Patel, Twisha S; Kaakeh, Rola; Nagel, Jerod L; Newton, Duane W; Stevenson, James G

2017-01-01

Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million. Copyright © 2016 American Society for Microbiology.

Antimicrobial Stewardship Program Implementation of a Quality Improvement Intervention Using Real-Time Feedback and an Electronic Order Set for the Management of Staphylococcus aureus Bacteremia.

PubMed

Rosa, Rossana; Zavala, Bruno; Cain, Natalie; Anjan, Shweta; Aragon, Laura; Abbo, Lilian M

2018-03-01

Antimicrobial stewardship programs can optimize the management of Staphylococcus aureus bacteremia by integrating information technology and microbiology laboratory resources. This study describes our experience implementing an intervention consisting of real-time feedback and the use of an electronic order set for the management of S. aureus bacteremia. Infect Control Hosp Epidemiol 2018;39:346-349.

7 CFR 1450.208 - Eligible practices.

Code of Federal Regulations, 2013 CFR

2013-01-01

... practices specified in the conservation plan, forest stewardship plan, or equivalent plan that meet all standards needed to cost-effectively establish: (1) Annual crops; (2) Non-woody perennial crops; and (3...

7 CFR 1450.208 - Eligible practices.

Code of Federal Regulations, 2012 CFR

2012-01-01

... practices specified in the conservation plan, forest stewardship plan, or equivalent plan that meet all standards needed to cost-effectively establish: (1) Annual crops; (2) Non-woody perennial crops; and (3...

7 CFR 1450.208 - Eligible practices.

Code of Federal Regulations, 2014 CFR

2014-01-01

... practices specified in the conservation plan, forest stewardship plan, or equivalent plan that meet all standards needed to cost-effectively establish: (1) Annual crops; (2) Non-woody perennial crops; and (3...

7 CFR 1450.208 - Eligible practices.

Code of Federal Regulations, 2011 CFR

2011-01-01

... practices specified in the conservation plan, forest stewardship plan, or equivalent plan that meet all standards needed to cost-effectively establish: (1) Annual crops; (2) Non-woody perennial crops; and (3...

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

None

This Department of Energy’s (DOE) National Nuclear Security Administration (NNSA) Fiscal Year Stockpile Stewardship and Management Plan (SSMP) is a key planning document for the nuclear security enterprise.

Long-Term Outcomes of an Antimicrobial Stewardship Program Implemented in a Hospital with Low Baseline Antibiotic Use

PubMed Central

Jenkins, Timothy C.; Knepper, Bryan C.; Shihadeh, Katherine; Haas, Michelle K.; Sabel, Allison L.; Steele, Andrew W.; Wilson, Michael L.; Price, Connie S.; Burman, William J.; Mehler, Philip S.

2016-01-01

Objective To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use Design Quasi-experimental, interrupted-time series study Setting 525-bed public safety-net hospital Intervention Implementation of a formal ASP in July 2008 Methods We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008 – September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005 – June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset C. difficile infection, and other patient-centered measures. Results During the preintervention period, total antibacterial and antipseudomonal use were declining (−9.2 and −5.5 DOT/1000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (−3.7 and −2.2 DOT/1000 PD, respectively), resulting in a slope change of 5.5 DOT/1000 PD per quarter for total antibacterial use (P = .10) and 3.3 DOT/100 PD per quarter for antipseudomonal use (P = .01). Antibiotic expenditures declined markedly during the stewardship period (−$295.42/1000PD per quarter, p=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. Conclusion In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures; however, this study highlights limitations of commonly used stewardship outcome measures. PMID:25740560

Influence of financial incentive programs in sustaining wildlife values

Treesearch

Thomas J. Straka; Michael A. Kilgore; Michael G. Jacobson; John L. Greene; Steven E. Daniels

2007-01-01

Conservation incentive programs have substantial impacts on the nation’s forests and wildlife habitat. There are eight major conservation incentive programs. The Forest Stewardship Program (FSP) provides forest landowner assistance by focusing on resource management plans embodying multi-resource stewardship principles. The Forest Land Enhancement Program (FLEP) is the...

Strategies for improving antibiotic use in Qatar: a survey of pharmacists' perceptions and experiences.

PubMed

Pawluk, Shane; Black, Emily; El-Awaisi, Alla

2015-02-01

The objectives of this study were to identify antimicrobial stewardship activities in Qatar, identify pharmacist involvement in activities and summarize perceived barriers for implementation of antimicrobial stewardship programs (ASPs). A cross-sectional survey was developed based on study objectives and completed by pharmacists in Qatar. Most hospital settings have implemented components of ASP. Lack of infectious disease specialists and training of healthcare providers was the most common barrier to implementation or expansion of ASP identified in the hospital and community settings respectively. Pharmacists report some components of ASP have been implemented; however, barriers must be overcome to further expand ASPs. © 2014 Royal Pharmaceutical Society.

Assessment of Undergraduate Students' Environmental Stewardship Reasoning and Knowledge

ERIC Educational Resources Information Center

Hartman, Christie-Joy Brodrick; DeMars, Christine E.; Griscom, Heather Peckham; Butner, Harold Martin

2017-01-01

Purpose: The purpose of this paper is to present a public university's design and implementation of an assessment approach that measures the change in undergraduate students' environmental stewardship reasoning and knowledge abilities over time. Design/methodology/approach: In support of a university's strategic emphasis on environmental…

Implementing AACN's recommendations for environmental sustainability in colleges of nursing: from concept to impact.

PubMed

Butterfield, Patricia; Schenk, Elizabeth; Eide, Phyllis; Hahn, Laura; Postma, Julie; Fitzgerald, Cynthia; Oneal, Gail

2014-01-01

In 2011, the American Association of Colleges of Nursing (AACN) released a guidance report titled Toward an Environmentally Sustainable Academic Enterprise: An AACN Guide for Nursing Education. The report was developed in response to a vivid slide presentation at an AACN meeting depicting the deleterious public and environmental health effects of global industrialization. Following the presentation, AACN members capitalized on the opportunity to provide national leadership to U.S. colleges of nursing in regard to environmental sustainability and stewardship. This article summarizes key features of the AACN plan and outlines one college's multifaceted implementation plan. The goal of the implementation plan was to translate the AACN recommendations from concept into college-specific actions. Specific steps taken by the college included the following: (a) increasing student and faculty awareness, (b) greening business operations, (c) increased participation in media events, (d) leveraging the impact of national sustainability initiatives, and (e) enhancing curricula at the undergraduate and graduate levels. Through this work, the college achieved not only a higher standard of sustainability within its own walls but also a richer appreciation of the importance of educating nurses as future stewards in an environmentally sustainable health care system. © 2014.

The concept of stewardship in health policy.

PubMed Central

Saltman, R. B.; Ferroussier-Davis, O.

2000-01-01

There is widespread agreement that both the configuration and the application of state authority in the health sector should be realigned in the interest of achieving agreed policy objectives. The desired outcome is frequently characterized as a search for good governance serving the public interest. The present paper examines the proposal in The World Health Report 2000 that the concept of stewardship offers the appropriate basis for reconfiguration. We trace the development of stewardship from its initial religious formulation to more recent ecological and sociological permutations. Consideration is given to the potential of stewardship for encouraging state decision-making that is both normatively based and economically efficient. Various dilemmas that could impede or preclude such a shift in state behaviour are examined. We conclude that the concept of stewardship holds substantial promise if adequately developed and effectively implemented. PMID:10916910

Initiatives and resources to promote antimicrobial stewardship.

PubMed

Paño-Pardo, José Ramón; Campos, José; Natera Kindelán, Clara; Ramos, Antonio

2013-09-01

The development of an antimicrobial stewardship program (ASP) requires institutional support. However, obtaining sufficient institutional support is often a complex task that requires convincing the hospital's managers of the benefits of these programs. Additionally, in the design and implementation of an ASP, antimicrobial stewardship (AS) leaders need tools for diverse purposes, such as measuring antimicrobial consumption, education and training and designing protocols. In this review we provide useful information for AS promoters to facilitate the task of designing and implementing an ASP. First, we summarize information about various institutions that promote AS and include evidence that supports the need for and benefits of these programs. Then, several campaigns promoting AS are described. Finally, online resources for professionals dealing with AS are briefly summarized. Copyright © 2013 Elsevier España, S.L. All rights reserved.

7 CFR 1450.213 - Levels and rates for establishment payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... establishing non-woody perennial crops and woody perennial crops specified in the conservation plan, forest stewardship plan, or equivalent plan. (b) The average cost of performing a practice may be determined by CCC...

Evaluating the forest stewardship program through a national survey of participants

Treesearch

J.D. Esseks; R.J. Moulton

2000-01-01

This paper reports findings from a national survey of 1,231 participants in the Forest Stewardship Program (FSP) of USDA's Forest Service. Launched in 1991, the FSP provides technical assistance through state forestry agencies to help landowners develop management plans for their non-industrial forestland. The survey allowed us to address five main evaluative...

The Critical Role of Stewardship in Fund Raising: The Coaches vs. Cancer Campaign.

ERIC Educational Resources Information Center

Worley, Debra A.; Little, Jennifer K.

2002-01-01

Examines the critical role of stewardship in the process of fund raising. Uses the Coaches vs. Cancer campaign to illustrate the limitations of the public relations ROPE (research, objectives, planning, and evaluation) model in explaining fund raising success, and supports K.S. Kelly's contention that addition of a fifth step to the model, the…

Wilderness stewardship challenges in the uKhahlamba Drakensberg Park World Heritage Site

Treesearch

Sonja Krüger

2007-01-01

The location of the uKhahlamba Drakensberg Park wilderness areas along an international border and within a World Heritage Site and Transfrontier Conservation Area, provides unique opportunities and challenges for the stewardship of these areas. Although the wilderness areas were proclaimed more than 30 years ago, wilderness-specific planning, management and monitoring...

Local Government Implementation of Long-Term Stewardship at Two DOE Facilities

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

John Pendergrass; Roman Czebiniak; Kelly Mott

2003-08-13

The Department of Energy (DOE) is responsible for cleaning up the radioactive and chemical contamination that resulted from the production of nuclear weapons. At more than one hundred sites throughout the country DOE will leave some contamination in place after the cleanup is complete. In order to protect human health and the environment from the remaining contamination DOE, U.S. Environmental Protection Agency (EPA), state environmental regulatory agencies, local governments, citizens and other entities will need to undertake long-term stewardship of such sites. Long-term stewardship includes a wide range of actions needed to protect human health in the environment for asmore » long as the risk from the contamination remains above acceptable levels, such as barriers, caps, and other engineering controls and land use controls, signs, notices, records, and other institutional controls. In this report the Environmental Law Institute (ELI) and the Energy Communities Alliance (ECA) examine how local governments, state environmental agencies, and real property professionals implement long-term stewardship at two DOE facilities, Losa Alamos National Laboratory and Oak Ridge Reservation.« less

Advanced Simulation and Computing Fiscal Year 2016 Implementation Plan, Version 0

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

McCoy, M.; Archer, B.; Hendrickson, B.

2015-08-27

The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The purpose of this IP is to outline key work requirements to be performed and to control individualmore » work activities within the scope of work. Contractors may not deviate from this plan without a revised WA or subsequent IP.« less

BROOKHAVEN NATIONAL LABORATORY WILDLIFE MANAGEMENT PLAN.

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

NAIDU,J.R.

2002-10-22

The purpose of the Wildlife Management Plan (WMP) is to promote stewardship of the natural resources found at the Brookhaven National Laboratory (BNL), and to integrate their protection with pursuit of the Laboratory's mission.

36 CFR 230.41 - Eligibility requirements for cost-share assistance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... management plans such as Tree Farm management plans, Forest Stewardship management plans, or similar plans... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Eligibility requirements for cost-share assistance. 230.41 Section 230.41 Parks, Forests, and Public Property FOREST SERVICE...

36 CFR 230.41 - Eligibility requirements for cost-share assistance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... management plans such as Tree Farm management plans, Forest Stewardship management plans, or similar plans... 36 Parks, Forests, and Public Property 2 2013-07-01 2013-07-01 false Eligibility requirements for cost-share assistance. 230.41 Section 230.41 Parks, Forests, and Public Property FOREST SERVICE...

36 CFR 230.41 - Eligibility requirements for cost-share assistance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... management plans such as Tree Farm management plans, Forest Stewardship management plans, or similar plans... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Eligibility requirements for cost-share assistance. 230.41 Section 230.41 Parks, Forests, and Public Property FOREST SERVICE...

36 CFR 230.41 - Eligibility requirements for cost-share assistance.

Code of Federal Regulations, 2012 CFR

2012-07-01

... management plans such as Tree Farm management plans, Forest Stewardship management plans, or similar plans... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Eligibility requirements for cost-share assistance. 230.41 Section 230.41 Parks, Forests, and Public Property FOREST SERVICE...

Effective antibiotic stewardship in spinal cord injury: Challenges and a way forward.

PubMed

Skelton, Felicia; Suda, Katie; Evans, Charlesnika; Trautner, Barbara

2018-01-11

Context Antibiotic stewardship, defined as a multidisciplinary program to reduce the misuse of antibiotics, and in turn, antibiotic resistance, is a high priority. Persons with spinal cord injury/disorder (SCI/D) are vulnerable to receiving multiple courses of antibiotics over their lifetime given frequent healthcare exposure, and have high rates of bacterial infection with multi-drug resistant organisms. Additional challenges to evaluating appropriate use of antibiotics in this population include bacterial colonization in the urine and the differences in the presenting signs and symptoms of infection. Therefore, Veterans Health Administration (VHA) facilities with SCI/D centers need effective antibiotic stewardship programs. Results We analyzed the results of a 2012 VHA-wide survey evaluating available antibiotic stewardship resources, and compared the resources present at facilities with SCI/D (n=23) versus non-SCI/D facilities (n=107). VHA facilities with SCI/D centers are more likely to have components of an antibiotic stewardship program that have led to reduced antibiotic use in previous studies. They are also more likely to have personnel with infectious diseases training. Conclusion VHA facilities with SCI/D centers have the resources needed for antibiotic stewardship. The next step will be to determine how to implement effective antibiotic stewardship tailored for this patient care setting.

Place-Conscious Capacity-Building: A Systemic Model for the Revitalisation and Renewal of Rural Schools and Communities through University-Based Regional Stewardship

ERIC Educational Resources Information Center

Johnson, Jerry; Thompson, Aaron; Naugle, Kim

2009-01-01

This paper sets forth a model of regional stewardship developed and implemented at a post-compulsory institution serving rural communities in central Appalachia, a region that is among the most impoverished in the United States. The model, termed place-conscious capacity-building, emphasises culturally-responsive methodologies and the strategic…

[What is the perception of the 10-point plan of the German Federal Ministry of Health against multidrug-resistant pathogens and measures of antibiotic stewardship? : An interdisciplinary analysis among German clinicians and development of a decision tool for urologists].

PubMed

May, M; Vetterlein, M W; Wagenlehner, F M; Brookman-May, S D; Gilfrich, C; Fritsche, H-M; Spachmann, P J; Burger, M; Schostak, M; Lebentrau, S

2017-10-01

Due to increasing antibiotic resistances, relevant treatment problems are currently emerging in clinical practice. In March 2015, the German Federal Ministry of Health (BMG) published a 10-point plan designed to combat this development. Furthermore, the first German guideline on antibiotic stewardship (ABS) was implemented in 2013 and instructs physicians of different specialties about several treatment considerations. Evidence is scarce on how such concepts (10-point plan/BMG, ABS) are perceived among clinicians. Within the MR2 study (Multiinstitutional Reconnaissance of practice with MultiResistant bacteria - a survey focusing on German hospitals), a questionnaire including 4 + 35 items was sent to 18 German hospitals between August and October 2015, surveying internists, gynecologists, general surgeons, and urologists. Using multivariate logistic regression models (MLRM), the impact of medical specialty and further criteria on the endpoints (1) awareness of the 10-point plan/BMG and (2) knowledge of ABS measures were assessed. Fulfillment of endpoints was predefined when average or full knowledge was reported (reference: poor to no knowledge). Overall response rate was 43% (456/1061) for fully evaluable questionnaires. Only 63.0 and 53.6% of urologists and nonurologists (internists, gynecologists, and general surgeons), respectively, attended training courses regarding multidrug-resistance or antibiotic prescribing in the 12 months prior to the study (P = 0.045). The endpoints average and full knowledge regarding 10-point plan/BMG and ABS measures were fulfilled in only 31.4 and 32.8%, respectively. In MLRM, clinicians with at least one previous training course (reference: no training course) were 2.5- and 3.8-fold more likely to meet respective endpoint criteria (all P < 0.001). Medical specialty (urologists vs. nonurologists) did not significantly impact the endpoints in both MLRM. The 10-point plan/BMG and ABS programs should be implemented into clinical practice, but awareness and knowledge of both is insufficient. Thus, it stands to reason that the actual realization of such measures is inadequate and continuous training towards rational prescription of antibiotics is necessary, regardless of medical specialty.

Idaho National Laboratory Site Pollution Prevention Plan

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

E. D. Sellers

2007-03-01

It is the policy of the Department of Energy (DOE) that pollution prevention and sustainable environmental stewardship will be integrated into DOE operations as a good business practice to reduce environmental hazards, protect environmental resources, avoid pollution control costs, and improve operational efficiency and mission sustainability. In furtherance of this policy, DOE established five strategic, performance-based Pollution Prevention (P2) and Sustainable Environmental Stewardship goals and included them as an attachment to DOE O 450.1, Environmental Protection Program. These goals and accompanying strategies are to be implemented by DOE sites through the integration of Pollution Prevention into each site's Environmental Managementmore » System (EMS). This document presents a P2 and Sustainability Program and corresponding plan pursuant to DOE Order 450.1 and DOE O 435.1, Radioactive Waste Management. This plan is also required by the state of Idaho, pursuant to the Resource Conservation and Recovery Act (RCRA) partial permit. The objective of this document is to describe the Idaho National Laboratory (INL) Site P2 and Sustainability Program. The purpose of the program is to decrease the environmental footprint of the INL Site while providing enhanced support of its mission. The success of the program is dependent on financial and management support. The signatures on the previous page indicate INL, ICP, and AMWTP Contractor management support and dedication to the program. P2 requirements have been integrated into working procedures to ensure an effective EMS as part of an Integrated Safety Management System (ISMS). This plan focuses on programmatic functions which include environmentally preferable procurement, sustainable design, P2 and Sustainability awareness, waste generation and reduction, source reduction and recycling, energy management, and pollution prevention opportunity assessments. The INL Site P2 and Sustainability Program is administratively managed by the INL Site P2 Coordinator. Development and maintenance of this overall INL Site plan is ultimately the responsibility of DOE-ID. This plan is applicable to all INL Site contractors except those at the Naval Reactors Facility.« less

76 FR 64327 - Office of Oceanic and Atmospheric Research Draft Strategic Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-18

... science integrity. Ultimately, this plan provides the framework that OAR will use to deliver significant benefits to society while working to advance NOAA's mission of science, service, and stewardship. Dated...

The NCAR Digital Asset Services Hub (DASH): Implementing Unified Data Discovery and Access

NASA Astrophysics Data System (ADS)

Stott, D.; Worley, S. J.; Hou, C. Y.; Nienhouse, E.

2017-12-01

The National Center for Atmospheric Research (NCAR) Directorate created the Data Stewardship Engineering Team (DSET) to plan and implement an integrated single entry point for uniform digital asset discovery and access across the organization in order to improve the efficiency of access, reduce the costs, and establish the foundation for interoperability with other federated systems. This effort supports new policies included in federal funding mandates, NSF data management requirements, and journal citation recommendations. An inventory during the early planning stage identified diverse asset types across the organization that included publications, datasets, metadata, models, images, and software tools and code. The NCAR Digital Asset Services Hub (DASH) is being developed and phased in this year to improve the quality of users' experiences in finding and using these assets. DASH serves to provide engagement, training, search, and support through the following four nodes (see figure). DASH MetadataDASH provides resources for creating and cataloging metadata to the NCAR Dialect, a subset of ISO 19115. NMDEdit, an editor based on a European open source application, has been configured for manual entry of NCAR metadata. CKAN, an open source data portal platform, harvests these XML records (along with records output directly from databases) from a Web Accessible Folder (WAF) on GitHub for validation. DASH SearchThe NCAR Dialect metadata drives cross-organization search and discovery through CKAN, which provides the display interface of search results. DASH search will establish interoperability by facilitating metadata sharing with other federated systems. DASH ConsultingThe DASH Data Curation & Stewardship Coordinator assists with Data Management (DM) Plan preparation and advises on Digital Object Identifiers. The coordinator arranges training sessions on the DASH metadata tools and DM planning, and provides one-on-one assistance as requested. DASH RepositoryA repository is under development for NCAR datasets currently not in existing lab-managed archives. The DASH repository will be under NCAR governance and meet Trustworthy Repositories Audit & Certification (TRAC) requirements. This poster will highlight the processes, lessons learned, and current status of the DASH effort at NCAR.

The Federal Forest Stewardship Program and its implications for sustainable forestry on private forest ownerships in the United States

Treesearch

Robert J. Moulton; J. Dixon Esseks

2002-01-01

A 72 percent response rate was achieved in 1998 and 1999 national survey of 1,238 participants in the USDA Forest Service's Forest Stewardship Program, under which 130,000 individual multiple resource plans encompassing 16.5 million acres (6.5 million ha) of privately owned forest lands in the United States had been completed. Objectives were to determine if the...

US DOE Perspectives on Advisory Board Effectiveness - 13539

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

Adler, David

2013-07-01

Federal missions on the Oak Ridge Reservation began with the Manhattan Project, and continues today with major facilities supporting the Nation's Science and National Security missions. While most of the land area on the Oak Ridge Reservation is free of environmental impacts from these activities, significant legacy contamination is associated with specific facilities and past waste management areas. In 1989, the Oak Ridge Reservation (ORR) was placed on National Priorities List, and DOE established its Office of Environmental Management that same year. Three years later, in 1992, the Federal Facility Agreement for the reservation was signed. Three years afterward, themore » Oak Ridge Site Specific Advisory Board was established to augment ongoing public involvement activities related to Oak Ridge Reservation cleanup activities. One of the early and most impactful decisions the board made was to organize the End Use Working Group. This broad-based group of board members, DOE representatives, and members of the public was formed in 1997 to study future uses for contaminated areas of the reservation. The group was instrumental in building consensus in the Oak Ridge community regarding the long-term end state of reservation lands. The group's recommendations were a fundamental input into Record's of Decision subsequently developed to establish cleanup requirements across the ORR, and they continue to influence decisions being made today. In developing its recommendations on end states, the End Use Working Group came to the realization that long-term stewardship of contaminated areas of the reservation would be necessary, in some cases in perpetuity. It was from this concept that the Oak Ridge SSAB's 15-year involvement in stewardship would begin. A stewardship committee formed by the End Use Working Group wrote Volume 1 of the Stakeholder Report on Stewardship. This document-and its companion Volume 2, which was written a year later-form a crucial foundation for stewardship planning in Oak Ridge and have been referenced around the DOE complex as other sites consider stewardship planning. From these two broad-based initiatives, the board's focus has evolved to increasingly hone in on more specific, project-based recommendations and initiatives. The Oak Ridge Reservation Site Specific Advisory Board has been a highly effective forum for soliciting community input on Oak Ridge Reservation cleanup. Experience in Oak Ridge indicates that the utility of Board recommendations is far higher when the Board is asked to focus on broad programmatic issues, and less useful when the Board attempts to provide advice and recommendations on matters related to technical or project management issues. In Oak Ridge the Board has helped shape the program on many levels including definition of end-state cleanup objectives, budget development, program sequencing, waste management, and decisions concerning preservation of history related to missions implemented on the Oak Ridge Reservation. (authors)« less

Remote Antimicrobial Stewardship in Community Hospitals

PubMed Central

Wood, Zachary H.; Nicolsen, Nicole C.; Allen, Nichole; Cook, Paul P.

2015-01-01

Antimicrobial stewardship has become standard practice at university medical centers, but the practice is more difficult to implement in remote community hospitals that lack infectious diseases trained practitioners. Starting in 2011, six community hospitals within the Vidant Health system began an antimicrobial stewardship program utilizing pharmacists who reviewed charts remotely from Vidant Medical Center. Pharmacists made recommendations within the electronic medical record (EMR) to streamline, discontinue, or switch antimicrobial agents. Totals of charts reviewed, recommendations made, recommendations accepted, and categories of intervention were recorded. Linear regression was utilized to measure changes in antimicrobial use over time. For the four larger hospitals, recommendations for changes were made in an average of 45 charts per month per hospital and physician acceptance of the pharmacists’ recommendations varied between 83% and 88%. There was no significant decrease in total antimicrobial use, but much of the use was outside of the stewardship program’s review. Quinolone use decreased by more than 50% in two of the four larger hospitals. Remote antimicrobial stewardship utilizing an EMR is feasible in community hospitals and is generally received favorably by physicians. As more community hospitals adopt EMRs, there is an opportunity to expand antimicrobial stewardship beyond the academic medical center. PMID:27025642

NIF Operations Management Plan, August 2011

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

Van Wonterghem, Bruno M.

Lawrence Livermore National Laboratory’s (LLNL) National Ignition Facility (NIF) is a key component of the National Nuclear Security Administration’s (NNSA) Stockpile Stewardship Program, whose purpose is to maintain the safety, reliability, and effectiveness of our nation’s nuclear stockpile without underground nuclear testing. The NIF is crucial to the Stockpile Stewardship Program because it is the only facility that can create the conditions of extreme temperature and pressure—conditions that exist only in stars or in exploding nuclear weapons—that are relevant to understanding how our modern nuclear weapons operate. As such, the NIF’s primary mission is to attain fusion ignition in themore » laboratory. Fusion ignition not only supports Stockpile Stewardship needs, but also provides the basis for future decisions about fusion’s potential as a long-term energy source. Additionally, NIF provides scientists with access to high-energy-density regimes that can yield new insight and understanding in the areas of astrophysics, hydrodynamics, material properties, plasma physics, and radiative properties. The use of the NIF to support the Stockpile Stewardship Program and the advancement of basic high-energy-density science understanding is planned and managed through program-level execution plans and NIF directorate-level management teams. An example of a plan is the National Ignition Campaign Execution Plan. The NIF Operations Management Plan provides an overview of the NIF Operations organization and describes how the NIF is supported by the LLNL infrastructure and how it is safely and responsibly managed and operated. Detailed information on NIF management of the organization is found in a series of supporting plans, policies, and procedures. A list of related acronyms can be found in Appendix A of this document. The purpose of this document is to provide a roadmap of how the NIF Operations organization functions. It provides a guide to understanding the requirements, document flow down, organizational vision and mission, performance metrics, and interrelationship of the NIF Operations organization with other directorate and laboratory organizations. This document also provides a listing of roles and responsibilities, core processes, procedures, authority matrices, change control boards, and other information necessary for successfully functioning in the NIF Operations organization. This document, the NIF Shot Operations Plan, and the NIF Maintenance Plan together represent the primary documents satisfying our Conduct of Operations compliance requirement.« less

Energy Systems Integration Facility (ESIF) Facility Stewardship Plan: Revision 2.1

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

Torres, Juan; Anderson, Art

The U.S. Department of Energy (DOE), Office of Energy Efficiency and Renewable Energy (EERE), has established the Energy Systems Integration Facility (ESIF) on the campus of the National Renewable Energy Laboratory (NREL) and has designated it as a DOE user facility. This 182,500-ft2 research facility provides state-of-the-art laboratory and support infrastructure to optimize the design and performance of electrical, thermal, fuel, and information technologies and systems at scale. This Facility Stewardship Plan provides DOE and other decision makers with information about the existing and expected capabilities of the ESIF and the expected performance metrics to be applied to ESIF operations.more » This plan is a living document that will be updated and refined throughout the lifetime of the facility.« less

A review of antimicrobial stewardship training in medical education

PubMed Central

Silverberg, Sarah L.; Zannella, Vanessa E.; Countryman, Drew; Ayala, Ana Patricia; Lenton, Erica; Friesen, Farah

2017-01-01

Objectives We reviewed the published literature on antimicrobial stewardship training in undergraduate and postgraduate medical education to determine which interventions have been implemented, the extent to which they have been evaluated, and to understand which are most effective. Methods We searched Ovid MEDLINE and EMBASE from inception to December 2016. Four thousand three hundred eighty-five (4385) articles were identified and underwent title and abstract review. Only those articles that addressed antimicrobial stewardship interventions for medical trainees were included in the final review. We employed Kirkpatrick’s four levels of evaluation (reaction, learning, behaviour, results) to categorize intervention evaluations. Results Our review included 48 articles. The types of intervention varied widely amongst studies worldwide. Didactic teaching was used heavily in all settings, while student-specific feedback was used primarily in the postgraduate setting. The high-level evaluation was sparse, with 22.9% reporting a Kirkpatrick Level 3 evaluation; seventeen reported no evaluation. All but one article reported positive results from the intervention. No articles evaluated the impact of an intervention on undergraduate trainees’ prescribing behaviour after graduation. Conclusions This study enhances our understanding of the extent of antimicrobial stewardship in the context of medical education. While our study demonstrates that medical schools are implementing antimicrobial stewardship interventions, rigorous evaluation of programs to determine whether such efforts are effective is lacking. We encourage more robust evaluation to establish effective, evidence-based approaches to training prescribers in light of the global challenge of antimicrobial resistance.  PMID:29035872

Y-12 Site Sustainability Plan

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

Spencer, Charles G

2012-12-01

The accomplishments to date and the long-range planning of the Y-12 Energy Management and Sustainability and Stewardship programs support the U.S. Department of Energy (DOE) and the National Nuclear Security Administration (NNSA) vision for a commitment to energy effi ciency and sustainability and to achievement of the Guiding Principles. Specifi cally, the Y-12 vision is to support the Environment, Safety and Health Policy and the DOE Strategic Sustainability Performance Plan, while promoting overall sustainability and reduction of greenhouse gas emissions. The mission of the Y-12 Energy Management program is to incorporate energy-effi cient technologies site-wide and to position Y-12 tomore » meet NNSA energy requirement needs through 2025 and beyond. The plan addresses greenhouse gases, buildings, fleet management, water use, pollution prevention, waste reduction, sustainable acquisition, electronic stewardship and data centers, site innovation and government-wide support.« less

A cost-effectiveness analysis of two different antimicrobial stewardship programs.

PubMed

Okumura, Lucas Miyake; Riveros, Bruno Salgado; Gomes-da-Silva, Monica Maria; Veroneze, Izelandia

2016-01-01

There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardship programs and had 30-day mortality as main outcome. Selected costs included: workload, cost of defined daily doses, length of stay, laboratory and imaging resources used to diagnose infections. Data were analyzed by deterministic and probabilistic sensitivity analysis to assess model's robustness, tornado diagram and Cost-Effectiveness Acceptability Curve. Bundled Strategy was more expensive (Cost difference US$ 2119.70), however, it was more efficient (US$ 27,549.15 vs 29,011.46). Deterministic and probabilistic sensitivity analysis suggested that critical variables did not alter final Incremental Cost-Effectiveness Ratio. Bundled Strategy had higher probabilities of being cost-effective, which was endorsed by cost-effectiveness acceptability curve. As health systems claim for efficient technologies, this study conclude that Bundled Antimicrobial Stewardship Program was more cost-effective, which means that stewardship strategies with such characteristics would be of special interest in a societal and clinical perspective. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

Long-term outcomes of an antimicrobial stewardship program implemented in a hospital with low baseline antibiotic use.

PubMed

Jenkins, Timothy C; Knepper, Bryan C; Shihadeh, Katherine; Haas, Michelle K; Sabel, Allison L; Steele, Andrew W; Wilson, Michael L; Price, Connie S; Burman, William J; Mehler, Philip S

2015-06-01

To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use. Quasi-experimental, interrupted time-series study. Public safety net hospital with 525 beds. Implementation of a formal ASP in July 2008. We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008-September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005-June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1,000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset Clostridium difficile infection, and other patient-centered measures. During the preintervention period, total antibacterial and antipseudomonal use were declining (-9.2 and -5.5 DOT/1,000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (-3.7 and -2.2 DOT/1,000 PD, respectively), resulting in a slope change of 5.5 DOT/1,000 PD per quarter for total antibacterial use (P=.10) and 3.3 DOT/1,000 PD per quarter for antipseudomonal use (P=.01). Antibiotic expenditures declined markedly during the stewardship period (-$295.42/1,000 PD per quarter, P=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures. Common ASP outcome measures have limitations.

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit.

PubMed

Nzegwu, Nneka I; Rychalsky, Michelle R; Nallu, Loren A; Song, Xuemei; Deng, Yanhong; Natusch, Amber M; Baltimore, Robert S; Paci, George R; Bizzarro, Matthew J

2017-10-01

OBJECTIVE To evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP). DESIGN Quasi-experimental, interrupted time-series study. SETTING A 54-bed, level IV NICU in a regional academic and tertiary referral center. PATIENTS AND PARTICIPANTS All neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion. INTERVENTION Implementation of a NICU-specific ASP beginning July 2012. METHODS We convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance. RESULTS Antibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P=.669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P=.037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P<.0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time. CONCLUSIONS Implementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices. Infect Control Hosp Epidemiol 2017;38:1137-1143.

Development of a resource planning index for Washington's February 2010 scenic and recreational highways.

DOT National Transportation Integrated Search

2010-02-01

Washington State Department of Transportation Local Programs Division requested the creation of a : Resource Planning Index (or Index) for use in benchmarking and tracking the stewardship : performance of investments associated with Washington...

Strategies and challenges of antimicrobial stewardship in long-term care facilities.

PubMed

Dyar, O J; Pagani, L; Pulcini, C

2015-01-01

As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

76 FR 19683 - Conservation Program Recipient Reporting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-08

... regulation that has application or plan due dates after October 1, 2010. The Watershed Operations and Flood Prevention Program, Emergency Watersheds Protection Program, Healthy Forests Reserve Program, Agricultural Management Assistance Program, and the Conservation Stewardship Program have application or plan due dates...

Impact of an Antimicrobial Stewardship Program on Antibiotic Use at a Nonfreestanding Children's Hospital.

PubMed

Turner, R Brigg; Valcarlos, Elena; Loeffler, Ann M; Gilbert, Michael; Chan, Dominic

2017-09-01

Pediatric stewardship programs have been successful at reducing unnecessary antibiotic use. Data from nonfreestanding children's hospitals are currently limited. This study is an analysis of antibiotic use after implementation of an antimicrobial stewardship program at a community nonfreestanding children's hospital. In April 2013, an antimicrobial stewardship program that consisted of physician-group engagement and pharmacist prospective auditing and feedback was initiated. We compared antibiotic use in the preintervention period (April 2012 to March 2013) with that in the postintervention period (April 2013 to March 2015) in all units except the neonatal intensive care unit and the emergency department. In addition, drug-acquisition costs, antibiotic-specific use, death, length of stay, and case-mix index were examined. Antibiotic use decreased by 16.8% (95% confidence interval, 18.0% to -9.2%; P < .001) in the postintervention period. Vancomycin use decreased by 38% (P = .001), whereas antipseudomonal β-lactam use was unaltered. Drug-acquisition cost savings were estimated to be $67 000/year over the 2-year postintervention period. Lengths of stay and mortality rates were unchanged in the postintervention period after adjusting for case-mix index. Implementation of a simple stewardship initiative with limited resources at a community nonfreestanding children's hospital effectively reduced antibiotic use without an overt negative impact on overall clinical outcomes. The results of this study suggest that nonfreestanding children's hospitals can achieve substantial reductions in antibiotic use despite limited resources. © The Author 2016. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Earth Stewardship: An initiative by the Ecological Society of America to foster engagement to sustain Planet Earth

USGS Publications Warehouse

Chapin, F. Stuart; Pickett, S.T.A.; Power, Mary E.; Collins, Scott L.; Baron, Jill S.; Inouye, David W.; Turner, Monica G.

2017-01-01

The Ecological Society of America (ESA) has responded to the growing commitment among ecologists to make their science relevant to society through a series of concerted efforts, including the Sustainable Biosphere Initiative (1991), scientific assessment of ecosystem management (1996), ESA’s vision for the future (2003), Rapid Response Teams that respond to environmental crises (2005), and the Earth Stewardship Initiative (2009). During the past 25 years, ESA launched five new journals, largely reflecting the expansion of scholarship linking ecology with broader societal issues. The goal of the Earth Stewardship Initiative is to raise awareness and to explore ways for ecologists and other scientists to contribute more effectively to the sustainability of our planet. This has occurred through four approaches: (1) articulation of the stewardship concept in ESA publications and Website, (2) selection of meeting themes and symposia, (3) engagement of ESA sections in implementing the initiative, and (4) outreach beyond ecology through collaborations and demonstration projects. Collaborations include societies and groups of Earth and social scientists, practitioners and policy makers, religious and business leaders, federal agencies, and artists and writers. The Earth Stewardship Initiative is a work in progress, so next steps likely include continued nurturing of these emerging collaborations, advancing the development of sustainability and stewardship theory, improving communication of stewardship science, and identifying opportunities for scientists and civil society to take actions that move the Earth toward a more sustainable trajectory.

Forest Stewardship Committee

Science.gov Websites

Conservation Education Timber Management Wildland Fire & Aviation Burn Permits Firewise Alaska Brochure (PDF) Fire Management Plans Fire Assignments Annual Fire Statistics Fire Terms Glossary Incident Business Management Grants Become an Alaska Firewise Community Community Wildland Fire Protection Plans

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

Erhart, Steven C.; Spencer, Charles G.

The accomplishments to date and the long-range planning of the Y-12 Energy Management and Sustainability and Stewardship programs support the U.S. Department of Energy (DOE) and the National Nuclear Security Administration (NNSA) vision for a commitment to energy effi ciency and sustainability and to achievement of the Guiding Principles. Specifi cally, the Y-12 vision is to support the Environment, Safety and Health Policy and the DOE Strategic Sustainability Performance Plan (SSPP), while promoting overall sustainability and reduction of greenhouse gas (GHG) emissions. The mission of the Y-12 Energy Management program is to incorporate energy-efficient technologies site-wide and to position Y-12more » to meet NNSA energy requirement needs through 2025 and beyond. This plan addresses: Greenhouse Gas Reduction and Comprehensive Greenhouse Gas Inventory; Buildings, ESPC Initiative Schedule, and Regional and Local Planning; Fleet Management; Water Use Efficiency and Management; Pollution Prevention and Waste Reduction; Sustainable Acquisition; Electronic Stewardship and Data Centers; Renewable Energy; Climate Change; and Budget and Funding.« less

Nevada Test Site Resource Management Plan

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

NONE

1998-12-01

The Nevada Test Site (NTS) Resource Management Plan (RMP) describes the NTS Stewardship Mission and how its accomplishment will preserve the resources of the ecoregion while accomplishing the objectives of the mission. The NTS Stewardship Mission is to manage the land and facilities at the NTS as a unique and valuable national resource. The RMP has defined goals for twelve resource areas based on the principles of ecosystem management. These goals were established using an interdisciplinary team of DOE/NV resource specialists with input from surrounding land managers, private parties, and representatives of Native American governments. The overall goal of themore » RMP is to facilitate improved NTS land use management decisions within the Great Basin and Mojave Desert ecoregions.« less

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program

PubMed Central

Reed, Erica E.; Stevenson, Kurt B.; West, Jessica E.; Bauer, Karri A.; Goff, Debra A.

2013-01-01

In an era of increasing antimicrobial resistance and few antimicrobials in the developmental pipeline, many institutions have developed antimicrobial stewardship programs (ASPs) to help implement evidence-based (EB) strategies for ensuring appropriate utilization of these agents. EB strategies for accomplishing this include formulary restriction with prior authorization. Potential limitations to this particular strategy include delays in therapy, prescriber pushback, and unintended increases in use of un-restricted antimicrobials; however, our ASP found that implementing prior authorization for select antimicrobials along with making a significant effort to educate clinicians on criteria for use ensured more appropriate prescribing of these agents, hopefully helping to preserve their utility for years to come. PMID:23154323

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program.

PubMed

Reed, Erica E; Stevenson, Kurt B; West, Jessica E; Bauer, Karri A; Goff, Debra A

2013-02-15

In an era of increasing antimicrobial resistance and few antimicrobials in the developmental pipeline, many institutions have developed antimicrobial stewardship programs (ASPs) to help implement evidence-based (EB) strategies for ensuring appropriate utilization of these agents. EB strategies for accomplishing this include formulary restriction with prior authorization. Potential limitations to this particular strategy include delays in therapy, prescriber pushback, and unintended increases in use of un-restricted antimicrobials; however, our ASP found that implementing prior authorization for select antimicrobials along with making a significant effort to educate clinicians on criteria for use ensured more appropriate prescribing of these agents, hopefully helping to preserve their utility for years to come.

Impact of an Antimicrobial Stewardship Care Bundle to Improve the Management of Patients with Suspected or Confirmed Urinary Tract Infection.

PubMed

Collins, Curtis D; Kabara, Jared J; Michienzi, Sarah M; Malani, Anurag N

2016-12-01

Implementation of an antimicrobial stewardship program bundle for urinary tract infections among 92 patients led to a higher rate of discontinuation of therapy for asymptomatic bacteriuria (52.4% vs 12.5%; P =.004), more appropriate durations of therapy (88.7% vs 63.6%; P =.001), and significantly higher overall bundle compliance (75% vs 38.2%; P < .001). Infect Control Hosp Epidemiol 2016;1499-1501.

Antimicrobial stewardship in long term care facilities: what is effective?

PubMed

Nicolle, Lindsay E

2014-02-12

Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection - limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection - were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities.

Characteristics of Pediatric Antimicrobial Stewardship Programs: Current Status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative

PubMed Central

McPherson, Christopher; Lee, Brian R.; Terrill, Cindy; Hersh, Adam L.; Gerber, Jeffrey S.; Kronman, Matthew P.; Newland, Jason G.

2018-01-01

In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP) have been rapidly implemented in the United States (US). This study examines the prevalence of the Centers for Disease Control and Prevention’s (CDC) seven core elements of a successful ASP within a large subset of US Children’s Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94%) had established ASPs and 41 hospitals (79%) included all seven core elements. Physician accountability (87%) and a dedicated ASP pharmacist or drug expert (88%) were present in the vast majority of hospitals. However, substantial variability existed in the financial support allotted to these positions. This variability did not predict program actions, tracking, reporting, and education. When compared with previous surveys, these results document a dramatic increase in the prevalence and resources of pediatric stewardship programs, although continued expansion is warranted. Further research is required to understand the feasibility of various core stewardship activities and the impact on patient outcomes in the setting of finite resources. PMID:29370071

Characteristics of Pediatric Antimicrobial Stewardship Programs: Current Status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative.

PubMed

McPherson, Christopher; Lee, Brian R; Terrill, Cindy; Hersh, Adam L; Gerber, Jeffrey S; Kronman, Matthew P; Newland, Jason G

2018-01-25

In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP) have been rapidly implemented in the United States (US). This study examines the prevalence of the Centers for Disease Control and Prevention's (CDC) seven core elements of a successful ASP within a large subset of US Children's Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94%) had established ASPs and 41 hospitals (79%) included all seven core elements. Physician accountability (87%) and a dedicated ASP pharmacist or drug expert (88%) were present in the vast majority of hospitals. However, substantial variability existed in the financial support allotted to these positions. This variability did not predict program actions, tracking, reporting, and education. When compared with previous surveys, these results document a dramatic increase in the prevalence and resources of pediatric stewardship programs, although continued expansion is warranted. Further research is required to understand the feasibility of various core stewardship activities and the impact on patient outcomes in the setting of finite resources.

Government stewardship of the for-profit private health sector in Afghanistan

PubMed Central

Sayedi, Omarzaman; Irani, Laili; Archer, Lauren C.; Sears, Kathleen; Sharma, Suneeta

2017-01-01

Abstract Background: Since 2003, Afghanistan's largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals. Aim: We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance. Methods: We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations. We carried out a series of key informant/participant interviews, organizational capacity assessments and analyses of hospital standards checklists. Using a literature review of health systems strengthening, we proposed an Afghan-specific definition of six key stewardship functions to assess progress towards MoPH stewardship objectives. Results: The MoPH and its partners have achieved positive results in strengthening its private sector stewardship functions especially in generating actionable intelligence and establishing strategic policy directions, administrative structures and a legal and regulatory framework. Progress has also been made on improving accountability and transparency, building partnerships and applying minimum required standards to private hospitals. Procedural and operational issues still need resolution and the MoPH is establishing mechanisms for resolving them. Conclusions: The MoPH stewardship initiative is notable for its achievements to date under challenging circumstances. Its success is due to the focus on developing a solid policy framework and building institutions and systems aimed at ensuring higher quality private services, and a rational long-term and sustainable role for the private sector. Although the MoPH stewardship initiative is still at an early stage, the evidence suggests that enhanced stewardship functions in the MoPH are leading to a more efficient and effective for-profit private sector. These successful early efforts offer high-leverage potential to rapidly scale up going forward. PMID:27683341

Government stewardship of the for-profit private health sector in Afghanistan.

PubMed

Cross, Harry E; Sayedi, Omarzaman; Irani, Laili; Archer, Lauren C; Sears, Kathleen; Sharma, Suneeta

2017-04-01

Since 2003, Afghanistan's largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals. We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance. We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations. We carried out a series of key informant/participant interviews, organizational capacity assessments and analyses of hospital standards checklists. Using a literature review of health systems strengthening, we proposed an Afghan-specific definition of six key stewardship functions to assess progress towards MoPH stewardship objectives. The MoPH and its partners have achieved positive results in strengthening its private sector stewardship functions especially in generating actionable intelligence and establishing strategic policy directions, administrative structures and a legal and regulatory framework. Progress has also been made on improving accountability and transparency, building partnerships and applying minimum required standards to private hospitals. Procedural and operational issues still need resolution and the MoPH is establishing mechanisms for resolving them. The MoPH stewardship initiative is notable for its achievements to date under challenging circumstances. Its success is due to the focus on developing a solid policy framework and building institutions and systems aimed at ensuring higher quality private services, and a rational long-term and sustainable role for the private sector. Although the MoPH stewardship initiative is still at an early stage, the evidence suggests that enhanced stewardship functions in the MoPH are leading to a more efficient and effective for-profit private sector. These successful early efforts offer high-leverage potential to rapidly scale up going forward. © VC The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Forests and People

Treesearch

Robin E. Hoffman; Mark J. Twery; Laura M. Alban; Ralph D. Nyland

1999-01-01

Establishing long-term plans for your forested property is a positive first step toward good forest stewardship. An appropriate management plan considers your needs and desires and helps you achieve them.Conversations with forest landowners have revealed some interesting stories about their likes and dislikes in the forest. Seeing big, healthy trees,...

Association of Inpatient Antimicrobial Utilization Measures with Antimicrobial Stewardship Activities and Facility Characteristics of Veterans Affairs Medical Centers.

PubMed

Graber, Christopher J; Jones, Makoto M; Chou, Ann F; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew H; Glassman, Peter A

2017-05-01

Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. To determine associations between ASPs and facility characteristics, and inpatient antimicrobial utilization measures in the Veterans Affairs (VA) system in 2012. In 2012, VA administered a survey on antimicrobial stewardship practices to designated ASP contacts at VA acute care hospitals. From the survey, we identified 34 variables across 3 domains (evidence, organizational context, and facilitation) that were assessed using multivariable least absolute shrinkage and selection operator regression against 4 antimicrobial utilization measures from 2012: aggregate acute care antimicrobial use, antimicrobial use in patients with non-infectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and double anaerobic coverage. All 130 VA facilities with acute care services. Variables associated with at least 3 favorable changes in antimicrobial utilization included presence of postgraduate physician/pharmacy training programs, number of antimicrobial-specific order sets, frequency of systematic de-escalation review, presence of pharmacists and/or infectious diseases (ID) attendings on acute care ward teams, and formal ID training of the lead ASP pharmacist. Variables associated with 2 unfavorable measures included bed size, the level of engagement with VA Antimicrobial Stewardship Task Force online resources, and utilization of antimicrobial stop orders. Formalization of ASP processes and presence of pharmacy and ID expertise are associated with favorable utilization. Systematic de-escalation review and order set establishment may be high-yield interventions. Journal of Hospital Medicine 2017;12:301-309. © 2017 Society of Hospital Medicine

Global Antimicrobial Stewardship: A Closer Look at the Formidable Implementation Challenges

PubMed Central

Tiong, John J. L.; Loo, Jason S. E.; Mai, Chun-Wai

2016-01-01

Antimicrobial stewardship (AMS) has been touted as one of the key strategies required in tackling worldwide escalation of antibiotic resistance. Although AMS has optimized antibiotic usage and reduced the incidence of resistance development in some regions, its full global potential has been curtailed by various AMS-impeding factors. This article seeks to highlight in a detailed perspective, the key challenges that hamper global AMS endeavors, some of which include the paucity of effective implementation strategies that cater for the challenging settings of developing nations, the slow response of governments, uncoordinated AMS activities as well as implementation fragmentation across different sectors and countries. The authors of this article call upon all stakeholders to pay attention to these seemingly obvious but often under-addressed problems. If left unresolved, this may render all current and future AMS initiatives pointless. PMID:27899924

The Use of Clinical Decision Support in Reducing Diagnosis of and Treatment of Asymptomatic Bacteriuria.

PubMed

Keller, Sara C; Feldman, Leonard; Smith, Janessa; Pahwa, Amit; Cosgrove, Sara E; Chida, Natasha

2018-06-01

Clinical decision support (CDS) embedded within the electronic health record (EHR) is a potential antibiotic stewardship strategy for hospitalized patients. Reduction in urine testing and treating asymptomatic bacteriuria (ASB) is an important strategy to promote antibiotic stewardship. We created an intervention focused on reducing urine testing for asymptomatic patients at a large tertiary care center. The objective of this study was to design an intervention to reduce unnecessary urinalysis and urine culture (UC) orders as well as the treatment of ASB. We performed a quasiexperimental study among adult inpatients at a single academic institution. We implemented a bundled intervention, including information broadcast in newsletters, hospitalwide screensavers, and passive CDS messages in the EHR. We investigated the impact of this strategy on urinalysis, UC orders, and on the treatment of ASB by using an interrupted time series analysis. Our intervention led to reduced UC order as well as reduced antibiotic orders in response to urinalysis orders and UC results. This easily implementable bundle may play an important role as an antibiotic stewardship strategy. © 2018 Society of Hospital Medicine.

76 FR 23335 - Wilderness Stewardship Plan/Environmental Impact Statement, Sequoia and Kings Canyon National...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-26

... planning and environmental impact analysis process required to inform consideration of alternative... 5, 1996. Based on an analysis of the numerous scoping comments received, and with consideration of a... proper food storage; party size; camping and campsites; human waste management; stock use; meadow...

Specifying an implementation framework for Veterans Affairs antimicrobial stewardship programmes: using a factor analysis approach.

PubMed

Chou, Ann F; Graber, Christopher J; Zhang, Yue; Jones, Makoto; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Glassman, Peter A

2018-06-04

Inappropriate antibiotic use poses a serious threat to patient safety. Antimicrobial stewardship programmes (ASPs) may optimize antimicrobial use and improve patient outcomes, but their implementation remains an organizational challenge. Using the Promoting Action on Research Implementation in Health Services (PARiHS) framework, this study aimed to identify organizational factors that may facilitate ASP design, development and implementation. Among 130 Veterans Affairs facilities that offered acute care, we classified organizational variables supporting antimicrobial stewardship activities into three PARiHS domains: evidence to encompass sources of knowledge; contexts to translate evidence into practice; and facilitation to enhance the implementation process. We conducted a series of exploratory factor analyses to identify conceptually linked factor scales. Cronbach's alphas were calculated. Variables with large uniqueness values were left as single factors. We identified 32 factors, including six constructs derived from factor analyses under the three PARiHS domains. In the evidence domain, four factors described guidelines and clinical pathways. The context domain was broken into three main categories: (i) receptive context (15 factors describing resources, affiliations/networks, formalized policies/practices, decision-making, receptiveness to change); (ii) team functioning (1 factor); and (iii) evaluation/feedback (5 factors). Within facilitation, two factors described facilitator roles and tasks and five captured skills and training. We mapped survey data onto PARiHS domains to identify factors that may be adapted to facilitate ASP uptake. Our model encompasses mostly mutable factors whose relationships with performance outcomes may be explored to optimize antimicrobial use. Our framework also provides an analytical model for determining whether leveraging existing organizational processes can potentially optimize ASP performance.

Identifying and Predicting Profiles of Medical Noncompliance: Pediatric Caregivers' Antibiotic Stewardship.

PubMed

Smith, Rachel A; Kim, Youllee; M'Ikanatha, Nkuchia M

2018-05-14

Sometimes compliance with medical recommendations is problematic. We investigated pediatric caregivers' (N = 606) patterns of noncompliance with antibiotic stewardship based on the obstacle hypothesis. We tested predictors of noncompliance framed by the obstacle hypothesis, dissonance theory, and psychological reactance. The results revealed four profiles of caregivers' stewardship: one marked by compliance (Stewards) and three marked by types of noncompliance (Stockers, Persuaders, and Dissenters). The covariate analysis showed that, although psychological reactance predicted being noncompliant, it was types of obstacles and discrepant experiences that predicted caregivers' patterns of noncompliance with antibiotic stewardship. Campaign planning often focuses on identifying the belief most associated with the targeted outcome, such as compliance. Noncompliance research, however, points out that persuaders may be successful to the extent to which they anticipate obstacles to compliance and address them in their influence attempts. A shift from medical noncompliance to patient engagement also affords an opportunity to consider how some recommendations create obstacles for others and to find positive ways to embrace conflicting needs, tensions, and reasons for refusal in order to promote collective goals.

Implementing national strategies on antimicrobial resistance in Thailand: potential challenges and solutions.

PubMed

Sommanustweechai, A; Tangcharoensathien, V; Malathum, K; Sumpradit, N; Kiatying-Angsulee, N; Janejai, N; Jaroenpoj, S

2018-04-01

Thailand has developed a national strategic plan on antimicrobial resistance (NSP-AMR) and endorsed by the Cabinet in August 2016. This study reviewed the main contents of the NSP-AMR and the mandates of relevant implementing agencies and identified challenges and recommends actions to mitigate implementation gaps. This study analysed the contents of NSP-AMR, reviewed institutional mandates and assessed the implementation gaps among agencies responsible for NSP-AMR. Two of six strategies are related to monitoring and surveillance of AMR and antimicrobial consumption in human and animal. Two other strategies aim to improve antibiotic stewardship and control the spread of AMR in both clinical and farm settings. The remaining two strategies aim to increase knowledge and public awareness on AMR and establish national governance for inter-sectoral actions. Strategies to overcome implementation challenges are sustaining cross-sectoral policy commitments, effective cross-sectoral coordination using One Health approach, generating evidence which guides policy implementation, and improving enforcement capacities in regulatory authorities. To address AMR, Thailand requires significant improvements in implementation capacities in two dimensions. First, technical capacities among implementing agencies are needed to translate policies into practice. Second, governance and organizational capacities enable effective multi-sectoral actions across human, animal, and environmental sectors. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

The antimicrobial stewardship program in Gulf Cooperation Council (GCC) states: insights from a regional survey.

PubMed

Enani, Mushira A

2016-01-01

The purpose of the current study is to describe the prevalence and characteristics of antimicrobial stewardship programs (ASP) in Gulf Cooperation Council (GCC) states to explore opportunities and overcome barriers to effective ASP implementation. A cross-sectional questionnaire survey was used to evaluate the current status of ASP: major stewardship components, barriers of implementation and program impact in acute care hospitals of GCC states. Forty-seven healthcare professionals responded from four GCC states, the majority from Saudi Arabia (81%). Twenty-nine (62%) participating hospitals had ASP in place. Of these established programs, 35 (75%) reported lack of funding and personnel as major barriers to program implementation. The top three objectives cited for the hospital ASP were to reduce resistance (72.3%), improve clinical outcomes (70.2%) and reduce costs (44.7%). The reported impact of existing ASP was reduction of inappropriate prescribing (68%), reduction of broad spectrum antibiotic use (63.8%), reduction of healthcare-associated infections (61.7%), reduction of length of stay or mortality metrics (59.6%), reduction in direct antibiotic cost (57.4%) and reduction of reported antibiotic resistance (55.3%). Survey participants from GCC states who have implemented ASP report significant impacts in the reduction of broad spectrum antibiotic use, hospital-acquired infection, inappropriate prescribing and antimicrobial resistance. These findings suggest a promising opportunity to enhance existing ASP through sharing of best practices and support the development of regional guidelines across GCC states.

The antimicrobial stewardship program in Gulf Cooperation Council (GCC) states: insights from a regional survey

PubMed Central

2015-01-01

Objectives: The purpose of the current study is to describe the prevalence and characteristics of antimicrobial stewardship programs (ASP) in Gulf Cooperation Council (GCC) states to explore opportunities and overcome barriers to effective ASP implementation. Methods: A cross-sectional questionnaire survey was used to evaluate the current status of ASP: major stewardship components, barriers of implementation and program impact in acute care hospitals of GCC states. Results: Forty-seven healthcare professionals responded from four GCC states, the majority from Saudi Arabia (81%). Twenty-nine (62%) participating hospitals had ASP in place. Of these established programs, 35 (75%) reported lack of funding and personnel as major barriers to program implementation. The top three objectives cited for the hospital ASP were to reduce resistance (72.3%), improve clinical outcomes (70.2%) and reduce costs (44.7%). The reported impact of existing ASP was reduction of inappropriate prescribing (68%), reduction of broad spectrum antibiotic use (63.8%), reduction of healthcare-associated infections (61.7%), reduction of length of stay or mortality metrics (59.6%), reduction in direct antibiotic cost (57.4%) and reduction of reported antibiotic resistance (55.3%). Conclusion: Survey participants from GCC states who have implemented ASP report significant impacts in the reduction of broad spectrum antibiotic use, hospital-acquired infection, inappropriate prescribing and antimicrobial resistance. These findings suggest a promising opportunity to enhance existing ASP through sharing of best practices and support the development of regional guidelines across GCC states. PMID:28989448

Antimicrobial stewardship programs: how to start and steer a successful program.

PubMed

Drew, Richard H

2009-03-01

Antimicrobial stewardship programs (ASPs) promote the appropriate use of antimicrobials by selecting the appropriate dose, duration, and route of administration. The appropriate use of antimicrobials has the potential to improve efficacy, reduce treatment-related costs, minimize drug-related adverse events, and limit the potential for emergence of antimicrobial resistance. To summarize ASP tactics that can improve the appropriate use of antimicrobials in the hospital setting. Several measures can be used to implement such programs and gain multidisciplinary support while addressing common barriers. Implementation of an ASP requires a multidisciplinary approach with an infectious diseases physician and a clinical pharmacist with infectious diseases training as its core team members. As identified by recently published guidelines, 2 proactive strategies for promoting antimicrobial stewardship include: (1) formulary restriction and pre-authorization, and (2) prospective audit with intervention and feedback. Other supplemental strategies involve education, guidelines and clinical pathways, antimicrobial order forms, de-escalation of therapy, intravenous-to-oral (IV-to-PO) switch therapy, and dose optimization. Several barriers exist to successful implementation of ASPs. These include obtaining adequate administrative support and compensation for team members. Gaining physician acceptance can also be challenging if there is a perceived loss of autonomy in clinical decision making. ASPs have the potential to reduce antimicrobial resistance, health care costs, and drug-related adverse events while improving clinical outcomes. The efforts and expense required to implement and maintain ASPs are more than justified given their potential benefits to both the hospital and the patient.

Technical note: Open-paleo-data implementation pilot - the PAGES 2k special issue

NASA Astrophysics Data System (ADS)

Kaufman, Darrell S.; Pages 2k Special-Issue Editorial Team

2018-05-01

Data stewardship is an essential element of the publication process. Knowing how to enact data polices that are described only in general terms can be difficult, however. Examples are needed to model the implementation of open-data polices in actual studies. Here we explain the procedure used to attain a high and consistent level of data stewardship across a special issue of the journal Climate of the Past. We discuss the challenges related to (1) determining which data are essential for public archival, (2) using data generated by others, and (3) understanding data citations. We anticipate that open-data sharing in paleo sciences will accelerate as the advantages become more evident and as practices that reduce data loss become the accepted convention.

Optimization of Antibiotic Use in Hospitals – Antimicrobial Stewardship and the EU Project ABS International

PubMed Central

Allerberger, Franz; Lechner, Arno; Wechsler-Fördös, Agnes; Gareis, Roland

2008-01-01

Background The problem of antimicrobial resistance requires common strategies at the European level. Methods We report on an EU initiative fostering antibiotic (AB) stewardship (ABS) in hospitals. Results The project ‘ABS International: implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the EU’ started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (AB list, guidelines for AB treatment and surgical prophylaxis, and AB-related organization) and valid process measures as well as quality indicators for AB use were developed. Specific ABS tools are being implemented in up to five health care facilities per country. Conclusion ABS International is the first EU-funded initiative focusing on the implementation of structural measures in hospitals to promote the prudent use of ABs. PMID:18667815

Servant leadership.

PubMed

Wilson, R T

1998-01-01

As corporations are eagerly pursuing reengineering and reorganization, leadership functions are changing to champion these efforts. Traditionally, organizations have had a "top-down" management approach, however, there is a gradual shift to other leadership models. Servant leadership is being successfully implemented in many settings. Servant leadership, first popularized by Robert Greenleaf in 1970, puts serving others as the number one priority. Ten characteristics of a servant leader include: Listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of people, and building community. Both servant leadership and the chaos theory have in common the central tenet of relationships. Since America is now approximately 80 percent a "service-economy," servant leadership can greatly benefit the individual employees, as well as help to facilitate the organization's pursuit of its changing strategic plans.

77 FR 42762 - Notice of September 10, 2012, Meeting of the Cape Cod National Seashore Advisory Commission

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-20

... Management Planning Highlands Center Update Alternate Transportation funding Ocean stewardship topics--shoreline change Pilgrim Power Station and Disaster Response Planning Herring Cove Beach/revetment Review of seashore houses, leasing, and demolition Climate Friendly Parks 6. Old Business 7. New Business 8. Date and...

76 FR 4139 - National Ocean Council; Development of Strategic Action Plans for the National Policy for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-24

... OFFICE OF SCIENCE AND TECHNOLOGY POLICY National Ocean Council; Development of Strategic Action Plans for the National Policy for the Stewardship of the Ocean, Our Coasts, and the Great Lakes ACTION... the Great Lakes. The National Policy provides a comprehensive approach, based on science and...

76 FR 19781 - Protection Island and San Juan Islands National Wildlife Refuges, Jefferson, San Juan, Skagit...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-08

...., Lopez Island, WA 98261. North Olympic Public Library..... 630 N. Sequim Ave., 360-683-1161 Sequim, WA...] Protection Island and San Juan Islands National Wildlife Refuges, Jefferson, San Juan, Skagit, Island, and Whatcom Counties, WA; Final Comprehensive Conservation Plan, Wilderness Stewardship Plan, and Finding of...

Human resources needed to perform antimicrobial stewardship teams' activities in French hospitals.

PubMed

Le Coz, P; Carlet, J; Roblot, F; Pulcini, C

2016-06-01

In January 2015, the French ministry of Health set up a task force on antibiotic resistance. Members of the task force's "antimicrobial stewardship" group conducted a study to evaluate the human resources needed to implement all the required activities of the multidisciplinary antimicrobial stewardship teams (AST - antibiotic/infectious disease lead supervisors, microbiologists, and pharmacists) in French healthcare facilities. We conducted an online cross-sectional nationwide survey. The questionnaire was designed based on regulatory texts and experts' consensus. The survey took place between March and May 2015. We used the mailing list of the French Infectious Diseases Society (SPILF) to send out questionnaires. A total of 65 healthcare facilities completed the questionnaire. The human resources needed to implement all AST's activities were estimated at 3.6 full-time equivalent (FTE) positions/1000 acute care beds for antibiotic/infectious disease lead supervisors, at 2.5 FTE/1000 beds for pharmacists, and at 0.6 FTE/1000 beds for microbiologists. This almost amounts to a total of 2000 FTE positions for all healthcare facilities (public and private) in France and to an annual cost of 200 million euros. Dedicated and sustainable funding for AST is urgently needed to implement comprehensive and functional AST programs in all healthcare facilities. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The Daniel K. Inouye College of Pharmacy Scripts

PubMed Central

Goo, Roy Alan SH; Chu, Cherie HL; Yoneda, Melissa K; Ma, Carolyn SJ

2016-01-01

In recent years the misuse of antimicrobials has contributed to the growing problem of antimicrobial resistance. Antimicrobial Stewardship Programs (ASP) decrease the misuse of antimicrobials by supporting a rational, systematic approach. ASP strategies vary from broad-ranging policies and other decision support tools to prospective audit review of patients on antimicrobials. Many healthcare facilities, however, have been slow to adopt stewardship attributable to the fact that early ASP models required individuals with specialized training, and a significant amount of time and infrastructural investment from facilities. In response to the increasing need for ASPs in Hawai‘i, the Hawai‘i Department of Health (HDOH) partnered with the Daniel K. Inouye College of Pharmacy (DKICP) to develop the Hawai‘i Antimicrobial Stewardship Collaborative (HASC), a voluntary collaboration whose main objective is to assist hospital institutions in the implementation of a simplified model of the Centers for Disease Control and Prevention's Core Elements of Hospital Antimicrobial Stewardship Programs. The work of HASC places Hawai‘i's health care institutions in an advantageous position to be able to comply with impending accreditation standards relating to antibiotics and infections. PMID:27437167

CDC, TJC Urge Providers To Up Their Game on Antibiotic Stewardship.

PubMed

Srinivasan, Arjun; Vento, Todd

2017-03-01

With data showing continued increases in the use of antibiotics, even in cases in which such prescribing is unnecessary and ill-advised, both the CDC and TJC are pushing initiatives aimed at improving antibiotic stewardship. The initiatives stress the importance of patient and provider education, the tracking of antibiotic use and resistance, and the need for top-level support. Although smaller hospitals face challenges in meeting the new standards, some health systems are getting around the problem through the use of telemedicine. The CDC is pushing hospitals to implement seven core elements that the agency maintains are critical to an effective antibiotic stewardship program. TJC has established a new standard requiring all hospitals to create antibiotic stewardship programs that are steered by a multidisciplinary team. Intermountain Healthcare in Salt Lake City is helping smaller hospitals in its network meet these new TJC and CDC directives by supplying support and expertise via telemedicine. The telehealth program also enables both emergency and inpatient providers to access infectious disease expertise when patients present with issues of concern.

ICMR programme on Antibiotic Stewardship, Prevention of Infection & Control (ASPIC).

PubMed

Chandy, Sujith J; Michael, Joy Sarojini; Veeraraghavan, Balaji; Abraham, O C; Bachhav, Sagar S; Kshirsagar, Nilima A

2014-02-01

Antimicrobial resistance and hospital infections have increased alarmingly in India. Antibiotic stewardship and hospital infection control are two broad strategies which have been employed globally to contain the problems of resistance and infections. For this to succeed, it is important to bring on board the various stakeholders in hospitals, especially the clinical pharmacologists. The discipline of clinical pharmacology needs to be involved in themes such as antimicrobial resistance and hospital infection which truly impact patient care. Clinical pharmacologists need to collaborate with faculty in other disciplines such as microbiology to achieve good outcomes for optimal patient care in the hospital setting. The ASPIC programme was initiated by the Indian Council of Medical Research (ICMR) in response to the above need and was designed to bring together faculty from clinical pharmacology, microbiology and other disciplines to collaborate on initiating and improving antibiotic stewardship and concurrently curbing hospital infections through feasible infection control practices. This programme involves the participation of 20 centres per year throughout the country which come together for a training workshop. Topics pertaining to the above areas are discussed in addition to planning a project which helps to improve antibiotic stewardship and infection control practices in the various centres. It is hoped that this programme would empower hospitals and institutions throughout the country to improve antibiotic stewardship and infection control and ultimately contain antimicrobial resistance.

77 FR 59970 - Notice of November 14, 2012, Meeting for Cape Cod National Seashore Advisory Commission

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-01

... Planning Highlands Center Update Alternate Transportation funding Ocean stewardship topics--shoreline change Herring Cove Beach/revetment Climate Friendly Parks 6. Old Business National Seashore Law...

Antibiotic Stewardship Initiatives as Part of the UK 5-Year Antimicrobial Resistance Strategy

PubMed Central

Johnson, Alan P.; Ashiru-Oredope, Diane; Beech, Elizabeth

2015-01-01

Antibiotic use is a major driver for the emergence and spread of antibiotic resistance. Antimicrobial stewardship programmes aim to improve antibiotic prescribing with the objectives of optimizing clinical outcomes while at the same time minimizing unintended consequences such as adverse effects and the selection of antibiotic resistance. In 2013, a five-year national strategy for tackling antimicrobial resistance was published in the UK. The overarching goal of the strategy is to slow the development and spread of resistance and to this end it has three strategic aims, namely to improve knowledge and understanding of resistance, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and novel therapies. This article reviews the antimicrobial stewardship activities included in the strategy and describes their implementation and evaluation. PMID:27025636

Universal coverage challenges require health system approaches; the case of India.

PubMed

Duran, Antonio; Kutzin, Joseph; Menabde, Nata

2014-02-01

This paper uses the case of India to demonstrate that Universal Health Coverage (UHC) is about not only health financing; personal and population services production issues, stewardship of the health system and generation of the necessary resources and inputs need to accompany the health financing proposals. In order to help policy makers address UHC in India and sort out implementation issues, the framework developed by the World Health Organization (WHO) in the World Health Report 2000 and its subsequent extensions are advocated. The framework includes final goals, generic intermediate objectives and four inter-dependent functions which interact as a system; it can be useful by diagnosing current shortcomings and facilitating the filling up of gaps between functions and goals. Different positions are being defended in India re the preconditions for UHC to succeed. This paper argues that more (public) money will be important, but not enough; it needs to be supplemented with broad interventions at various health system levels. The paper analyzes some of the most important issues in relation to the functions of service production, generation of inputs and the necessary stewardship. It also pays attention to reform implementation, as different from its design, and suggests critical aspects emanating from a review of recent health system reforms. Precisely because of the lack of comparative reference for India, emphasis is made on the need to accompany implementation with analysis, so that the "solutions" ("what to do?", "how to do it?") are found through policy analysis and research embedded into flexible implementation. Strengthening "evidence-to-policy" links and the intelligence dimension of stewardship/leadership as well as accountability during implementation are considered paramount. Countries facing similar challenges to those faced by India can also benefit from the above approaches. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Pathologic Analysis of Control Plans for Air Pollution Management in Tehran Metropolis: A Cross-Sectional Study

PubMed Central

Salehi Shahrabi, Narges; Pourezzat, Aliasghar; Mobaraki, Hossein; Mafimoradi, Shiva

2013-01-01

Abstract Background The centralization of human activities is associated with different pollutants which enter into environment easily and cause the urban environment more vulnerable. Regarding the importance of air pollution issue for Tehran metropolis, many plans and regulations have been developed. However, most of them failed to decline the pollution. The purpose of this study was to pathologically analyze air-pollution control plans to offer effective solutions for Tehran metropolis. Methods A Qualitative content analysis in addition to a semi-structured interview with 14 practicing professional were used to identify 1) key sources of Tehran’s air pollution, 2) recognize challenges towards effective performance of pertinent plans and 3), offer effective solutions. Results Related challenges to air-pollution control plans can be divided into two major categories including lack of integrated and organized stewardship and PEST challenges. Conclusion For controlling the air pollution of Tehran effectively, various controlling alternatives were identified as systematization of plan preparation process, standardization and utilization of new technologies & experts, infrastructural development, realization of social justice, developing coordination mechanisms, improving citizens’ participatory capacity and focusing on effective management of fuel and energy. Controlling air pollution in Tehran needs a serious attention of policymakers to make enforcements through applying a systemic cycle of preparation comprehensive plans. Further, implement the enforcements and evaluate the environmental impact of the plans through involving all stakeholders. PMID:26171340

7 CFR 1450.213 - Levels and rates for establishment payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... (a) CCC will pay not more than 75 percent of the actual or average cost (whichever is lower) of... stewardship plan, or equivalent plan. (b) The average cost of performing a practice may be determined by CCC based on recommendations from the State Technical Committee. Such cost may be the average cost in a...

Nature connection, outdoor play, and environmental stewardship in residential environmental education

NASA Astrophysics Data System (ADS)

Andrejewski, Robert G.

A lack of exposure to the natural world has led to a generation of children disconnected from nature. This phenomenon has profound negative implications for the physical and psychological well being of today's youth. Residential environmental education provides one avenue to connect children to nature. One purpose of this study was to investigate the role of Outdoor School, a residential environmental education program, on ecological knowledge, children's connection to nature, school belonging, outdoor play attitude, environmental stewardship attitude, outdoor play behavior, and environmental stewardship behavior, as reported by participants. A quasi-experimental research design was utilized in the study. A total of 228 fifth grade students (156 treatment, 72 control) from central Pennsylvania participated. The results of the program evaluation indicated that Outdoor School was successful in achieving significant, positive gains in the areas of ecological knowledge, connection to nature, outdoor play behavior, and environmental stewardship behavior. No change was found from pretest to post-test in outdoor play attitudes, environmental stewardship attitudes, and school belonging. Additionally, the study addressed gaps in the literature regarding the relationship between connection to nature, environmental stewardship, and outdoor play using two different approaches. An adaptation of the Theory of Planned Behavior (TPB) was used to predict outdoor play behavior in children. In this model, favorable attitudes, subjective norms, and perceived behavioral control lead to intentions to perform a given behavior. Intention to perform the behavior is the best predictor for behavior performance. For this study, participants' feeling of connection to nature was added as an affective independent variable. This model explained 45% of the variance in outdoor play. The hypothesis that a connection to nature would be a significant predictor of both attitudes toward outdoor play was supported by testing of the model. Finally, nature connection was tested as a full mediator of the relationship between outdoor play and environmental stewardship. There is support for the idea that direct experience in the outdoors facilitates environmental behaviors, but more research is needed to understand this relationship. Testing of the model failed to demonstrate that nature connection fully mediated the relationship between outdoor play and environmental stewardship; however, a feeling of connectedness to nature augmented the influence that outdoor play behavior exerts on environmental stewardship behavior.

Antimicrobial Stewardship in a Community Hospital: Attacking the More Difficult Problems

PubMed Central

Philmon, Carla L.; Johnson, Gregory D.; Ward, William S.; Rivers, LaToya L.; Williamson, Sharon A.; Goodman, Edward L.

2014-01-01

Background: Antibiotic stewardship has been proposed as an important way to reduce or prevent antibiotic resistance. In 2001, a community hospital implemented an antimicrobial management program. It was successful in reducing antimicrobial utilization and expenditure. In 2011, with the implementation of a data-mining tool, the program was expanded and its focus transitioned from control of antimicrobial use to guiding judicious antimicrobial prescribing. Objective: To test the hypothesis that adding a data-mining tool to an existing antimicrobial stewardship program will further increase appropriate use of antimicrobials. Design: Interventional study with historical comparison. Methods: Rules and alerts were built into the data-mining tool to aid in identifying inappropriate antibiotic utilization. Decentralized pharmacists acted on alerts for intravenous (IV) to oral conversion, perioperative antibiotic duration, and restricted antimicrobials. An Infectious Diseases (ID) Pharmacist and ID Physician/Hospital Epidemiologist focused on all other identified alert types such as antibiotic de-escalation, bug-drug mismatch, and double coverage. Electronic chart notes and phone calls to physicians were utilized to make recommendations. Results: During 2012, 2,003 antimicrobial interventions were made with a 90% acceptance rate. Targeted broad-spectrum antimicrobial use decreased by 15% in 2012 compared to 2010, which represented cost savings of $1,621,730. There were no statistically significant changes in antimicrobial resistance, and no adverse patient outcomes were noted. Conclusions: The addition of a data-mining tool to an antimicrobial stewardship program can further decrease inappropriate use of antimicrobials, provide a greater reduction in overall antimicrobial use, and provide increased cost savings without negatively affecting patient outcomes. PMID:25477615

Development and impact of a massive open online course (MOOC) for antimicrobial stewardship.

PubMed

Sneddon, Jacqueline; Barlow, Gavin; Bradley, Sally; Brink, Adrian; Chandy, Sujith J; Nathwani, Dilip

2018-04-01

The University of Dundee and the BSAC developed a massive open online course (MOOC) to address the global need for education to support antimicrobial stewardship in low- and middle-income countries. An interactive course, Antimicrobial Stewardship: Managing Antibiotic Resistance, was developed and delivered via the FutureLearn© platform. The course ran over four 6 week periods during 2015 and 2016 supported by educators and was evaluated via data on uptake and feedback from learners on impact on clinical practice. In total, 32 944 people, 70% of them healthcare professionals, from 163 countries joined the course from Europe (49%), Asia (16%), Africa (13%), North America (9%), Australia (8%) and South America (5%). Between 33% and 37% of joiners in each run completed at least one step in any week of the course and 219 participants responded to a post-course survey. The course was rated good or excellent by 208 (95%) of the participants, and 83 (38%) intended to implement stewardship interventions in their own setting. A follow-up survey 6 months later suggested that 49% had implemented such interventions. The MOOC has addressed a global learning need by providing education free at the point of access, and learning from its development will help others embarking upon similar educational solutions. Initial quantitative and qualitative feedback suggests it has engaged participants and complements traditional educational methods. Measuring its real impact on clinical practice remains a challenge. The FutureLearn© platform offers flexibility for MOOCs to be sustainable through modification to remove educator facilitation but maintain active participant discussion.

Fighting antibiotic resistance in Portuguese hospitals: Understanding antibiotic prescription behaviours to better design antibiotic stewardship programmes.

PubMed

Simões, Alexandra S; Alves, Daniela A; Gregório, João; Couto, Isabel; Dias, Sónia; Póvoa, Pedro; Viveiros, Miguel; Gonçalves, Luzia; Lapão, Luís V

2018-06-01

Since physicians play an important role in antibiotic usage, it is vital to understand their antibiotic-prescribing behaviour and knowledge on antimicrobial resistance in order to develop and implement effective antibiotic stewardship interventions. The aim of this study was to evaluate Portuguese physicians' knowledge and to understand prescription behaviours, difficulties and barriers in their antibiotic prescription process in order to promote better and well-adapted antibiotic stewardship policies. This study was conducted in 2016 using a self-administered questionnaire to physicians in two tertiary public hospitals from two different regions in Portugal. Participating physicians [response rate 47.6% (30/63)] identified antibiotic resistance as a global problem; however, one-third did not recognise antibiotic resistance as a major problem on their own hospital. Factors that most influenced antibiotic prescription were 'microbiology laboratory results', 'patient clinical situation' and patient 'co-morbidities'. On the other hand, 'colleagues' opinion' and 'costs control' were considered as less determining factors. Regarding difficulties and bottlenecks in the antibiotic prescription process, participant physicians reported 'lack of (or delayed) microbiological results' and 'no access to antibiotic susceptibility patterns' as major barriers. 'Education and training' was considered the most effective intervention to improve antibiotic prescription. These results suggest that the design and implementation of antibiotic stewardship interventions should provide better data management and sharing tools between physicians and the microbiology laboratory, especially through the creation of antimicrobial prescribing guidelines according to hospital epidemiology, and easy access to hospital antibiotic susceptibility patterns and epidemiological data. Copyright © 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

Antimicrobial Stewardship Among Hospitalized Patients with Influenza Respiratory Tract Infections

PubMed Central

Lindsay, Patrick; Taggart, Linda; Leung, Elizabeth; Havey, Thomas

2017-01-01

Abstract Background Overlap between Influenza and bacterial respiratory illnesses contributes to the inappropriate use of antibiotics. One major study from the United States suggests a significant number of patients are being treated with antibiotics inappropriately. This paper however, did not perform an intervention to evaluate whether an Antimicrobial Stewardship Program (ASP) is effective in decreasing inappropriate antibiotic use. Appropriate use of antibiotics in Influenza patients has not been formally assessed in Canadian healthcare systems. Given ASP’s have been shown to be effective in previous studies, an opportunity has arisen for implementation in the setting of antibiotics in patients with Influenza, which has not previously been studied Methods We retrospectively identified all adults admitted to hospital who tested positive for Influenza from January 2016 to January 2017. We assessed the appropriateness of antibiotic use during the patient’s admission, evaluating whether antibiotics have been used according to standard of care for community acquired pneumonia. Antibiotic use and length of duration pre and post Stewardship implementation will be analyzed. After data has been collected, the results of this retrospective cohort study will inform the implementation of an ASP Results Eighty-one patients recorded positive Influenza tests. Twenty-six were collected from ICU patients and were excluded. Mean time to diagnosis from swab collection and final diagnosis was 2.8 days. Of the 55 non-ICU patients, 13 (24%) patients were continued on antibiotics after the diagnosis of Influenza was confirmed, with an average of 4.7 days of antibiotic use. It was deemed that 9 of these patients were continued appropriately on antibiotics with 4 patients having CXR infiltrate, 4 patients immunocompromised and 1 blood culture positive with strep pneumonia. Four (8%) patients were treated inappropriately with antibiotics for >24 hours after positive Influenza test, with a mean duration of 2.5 days after positive result Conclusion There is an opportunity for improvements in the appropriate use of antibiotics. Implementation of an ASP whereby positive Influenza results are delivered directly to the Stewardship team, could be an effective strategy to improve judicious antibiotic therapy Disclosures All authors: No reported disclosures.

Toward a Conceptual Framework for Blending Social and Biophysical Attributes in Conservation Planning: A Case-Study of Privately-Conserved Lands

NASA Astrophysics Data System (ADS)

Pasquini, Lorena; Twyman, Chasca; Wainwright, John

2010-11-01

There has been increasing recognition within systematic conservation planning of the need to include social data alongside biophysical assessments. However, in the approaches to identify potential conservation sites, there remains much room for improvement in the treatment of social data. In particular, few rigorous methods to account for the diversity of less-easily quantifiable social attributes that influence the implementation success of conservation sites (such as willingness to conserve) have been developed. We use a case-study analysis of private conservation areas within the Little Karoo, South Africa, as a practical example of the importance of incorporating social data into the process of selecting potential conservation sites to improve their implementation likelihood. We draw on extensive data on the social attributes of our case study obtained from a combination of survey questionnaires and semi-structured interviews. We discuss the need to determine the social attributes that are important for achieving the chosen implementation strategy by offering four tested examples of important social attributes in the Little Karoo: the willingness of landowners to take part in a stewardship arrangement, their willingness to conserve, their capacity to conserve, and the social capital among private conservation area owners. We then discuss the process of using an implementation likelihood ratio (derived from a combined measure of the social attributes) to assist the choice of potential conservation sites. We conclude by summarizing our discussion into a simple conceptual framework for identifying biophysically-valuable sites which possess a high likelihood that the desired implementation strategy will be realized on them.

How Partners are Producing Science and Addressing Issues of Scale for Springs Management in the Desert Southwest

NASA Astrophysics Data System (ADS)

Johnson, G.; Springer, A. E.; Misztal, L.; Grabau, M.

2017-12-01

Climate changes in the arid Southwest are expected to further stress critical water sources, such as springs, in the near future. Springs are abundant features in the Southwest, providing habitat for listed species and water for wildlife, agricultural, cities, recreation, and the base flow for many rivers. But springs occupy a small fraction of the land area and, as a result, they have not been significantly studied or mapped. Managers recognize that effective stewardship of these critical resources requires a landscape-scale understanding of distribution, ecological integrity, and risks; access to comprehensive inventory, assessment and restoration protocols; and local implementation. They need easy access to information at varying scales to respond to stressors like climate change. The Desert Landscape Conservation Cooperative, Sky Island Alliance, and Springs Stewardship Institute worked with scientists, resource managers, and conservationists to develop and increase access to data by involving them in the entire research process through field surveys, workshops, trainings, and development of products needed to solve critical management challenges. We built on and connected existing efforts underway in the Southwest, including developing: 1) Springs Inventory Protocol, 2) an online geospatial database, 3) methodologies for climate-savvy monitoring and 4) a springs restoration handbook. We also worked with partners to evaluate the condition and risk of springs' resources at the local scale to create products used in site-specific management planning. Our results indicate that coproduction resulted in more understanding of common issues, more focus on solving management challenges, and increased use of the science and protocols produced. Information developed through this project assists managers in understanding how their springs contribute at local and landscape scales. New information developed through this project is being used in support of planning and decisions that address resource protection at the regional level and in climate change adaptation planning for natural resources. This work highlights the need to increase collaboration and coproduction of information tailored for management issues at different spatial and temporal scales.

Consensus guidelines for implementation of quality processes to prevent invasive fungal disease and enhanced surveillance measures during hospital building works, 2014.

PubMed

Chang, C C; Ananda-Rajah, M; Belcastro, A; McMullan, B; Reid, A; Dempsey, K; Athan, E; Cheng, A C; Slavin, M A

2014-12-01

Healthcare-associated fungal outbreaks impose a substantial economic burden on the health system and typically result in high patient morbidity and mortality, particularly in the immunocompromised host. As the population at risk of invasive fungal infection continues to grow due to the increased burden of cancer and related factors, the need for hospitals to employ preventative measures has become increasingly important. These guidelines outline the standard quality processes hospitals need to accommodate into everyday practice and at times of healthcare-associated outbreak, including the role of antifungal stewardship programmes and best practice environmental sampling. Specific recommendations are also provided to help guide the planning and implementation of quality processes and enhanced surveillance before, during and after high-risk activities, such as hospital building works. Areas in which information is still lacking and further research is required are also highlighted. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

7 CFR 1469.22 - Conservation practice operation and maintenance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... life span of the conservation treatment, as identified in the contract or conservation stewardship plan... procedures as specified in § 1469.25. If an existing practice is part of a system that meets the quality...

7 CFR 1469.22 - Conservation practice operation and maintenance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... life span of the conservation treatment, as identified in the contract or conservation stewardship plan... procedures as specified in § 1469.25. If an existing practice is part of a system that meets the quality...

Stewplan: software for creating forest stewardship plans (Version 1.3)

Treesearch

Peter D. Knopp; Mark J. Twery

2003-01-01

Describes the purpose and function of the Stewplan computer program. Provides instructions for loading Stewplan, a tutorial for getting started, and instructions for use. A copy of the program is included. [User's manual; CD-ROM].

Contacts in the Office of Pesticide Programs, Biopesticides and Pollution Prevention Division

EPA Pesticide Factsheets

Contact the Biopesticides and Pollution Prevention Division (BPPD) about regulatory activities associated with biologically-based pesticides, implementation of integrated pest management and the Pesticide Environmental Stewardship Program.

Reconnecting cities to the biosphere: stewardship of green infrastructure and urban ecosystem services.

PubMed

Andersson, Erik; Barthel, Stephan; Borgström, Sara; Colding, Johan; Elmqvist, Thomas; Folke, Carl; Gren, Åsa

2014-05-01

Within-city green infrastructure can offer opportunities and new contexts for people to become stewards of ecosystem services. We analyze cities as social-ecological systems, synthesize the literature, and provide examples from more than 15 years of research in the Stockholm urban region, Sweden. The social-ecological approach spans from investigating ecosystem properties to the social frameworks and personal values that drive and shape human interactions with nature. Key findings demonstrate that urban ecosystem services are generated by social-ecological systems and that local stewards are critically important. However, land-use planning and management seldom account for their role in the generation of urban ecosystem services. While the small scale patchwork of land uses in cities stimulates intense interactions across borders much focus is still on individual patches. The results highlight the importance and complexity of stewardship of urban biodiversity and ecosystem services and of the planning and governance of urban green infrastructure.

Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda

PubMed Central

2013-01-01

Background Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. Methods We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Results Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. Conclusion TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks -governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately. PMID:23915376

Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda.

PubMed

Buregyeya, Esther; Nuwaha, Fred; Verver, Suzanne; Criel, Bart; Colebunders, Robert; Wanyenze, Rhoda; Kalyango, Joan N; Katamba, Achilles; Mitchell, Ellen Mh

2013-08-01

Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks--governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately.

Ward round template: enhancing patient safety on ward rounds.

PubMed

Gilliland, Niall; Catherwood, Natalie; Chen, Shaouyn; Browne, Peter; Wilson, Jacob; Burden, Helena

2018-01-01

Concerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets. The quality improvement technique of plan-do-study-act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template. Documentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%. Following introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.

Advanced Simulation and Computing: A Summary Report to the Director's Review

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

McCoy, M G; Peck, T

2003-06-01

It has now been three years since the Advanced Simulation and Computing Program (ASCI), as managed by Defense and Nuclear Technologies (DNT) Directorate, has been reviewed by this Director's Review Committee (DRC). Since that time, there has been considerable progress for all components of the ASCI Program, and these developments will be highlighted in this document and in the presentations planned for June 9 and 10, 2003. There have also been some name changes. Today, the Program is called ''Advanced Simulation and Computing,'' Although it retains the familiar acronym ASCI, the initiative nature of the effort has given way tomore » sustained services as an integral part of the Stockpile Stewardship Program (SSP). All computing efforts at LLNL and the other two Defense Program (DP) laboratories are funded and managed under ASCI. This includes the so-called legacy codes, which remain essential tools in stockpile stewardship. The contract between the Department of Energy (DOE) and the University of California (UC) specifies an independent appraisal of Directorate technical work and programmatic management. Such represents the work of this DNT Review Committee. Beginning this year, the Laboratory is implementing a new review system. This process was negotiated between UC, the National Nuclear Security Administration (NNSA), and the Laboratory Directors. Central to this approach are eight performance objectives that focus on key programmatic and administrative goals. Associated with each of these objectives are a number of performance measures to more clearly characterize the attainment of the objectives. Each performance measure has a lead directorate and one or more contributing directorates. Each measure has an evaluation plan and has identified expected documentation to be included in the ''Assessment File''.« less

Antimicrobial Stewardship in the Emergency Department and Guidelines for Development

PubMed Central

May, Larissa; Cosgrove, Sara; L’Archeveque, Michelle; Talan, David A.; Payne, Perry; Rothman, Richard E.

2013-01-01

Antimicrobial resistance is a mounting public health concern. Emergency departments (EDs) represent a particularly important setting for addressing inappropriate antimicrobial prescribing practices, given the frequent use of antibiotics in this setting that sits at the interface of the community and the hospital. This article outlines the importance of antimicrobial stewardship in the ED setting and provides practical recommendations drawn from existing evidence for the application of various strategies and tools that could be implemented in the ED including advancement of clinical guidelines, clinical decision support systems, rapid diagnostics, and expansion of ED pharmacist programs. PMID:23122955

Associations between antimicrobial stewardship program elements and Clostridium difficile infection performance.

PubMed

Barlow, Giulia; Patterson, Julie; Stultz, Jeremy; Pakyz, Amy L

2017-12-01

Hospitals are categorized as better, no different, or worse at a national level based on their Clostridium difficile infection performance. Institutional antimicrobial stewardship programs seek to decrease the occurrence of C difficile by implementing strategies to address antibiotic usage; however, optimal structure and strategies for accomplishing this remain largely unknown. We found that a higher proportion of hospitals with either a worse or no different rank used a postprescription audit and feedback strategy than hospitals with a better rank. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Environmental Stewardship at the Savannah River Site: Generations of Success - 13212

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

Looney, Brian B.; Bergren, Christopher L.; Gaughan, Thomas F.

2013-07-01

Approximately sixty years ago, the Savannah River Site (SRS) was built to produce nuclear materials. SRS production operations impacted air, soil, groundwater, ecology, and the local environment. Throughout its history, SRS has addressed these contamination issues directly and has maintained a commitment to environmental stewardship. The Site boasts many environmental firsts. Notably, SRS was the first major Department of Energy (DOE) facility to perform a baseline ecological assessment. This pioneering effort, by Ruth Patrick and the Philadelphia Academy of Sciences, was performed during SRS planning and construction in the early 1950's. This unique early generation of work set the stagemore » for subsequent efforts. Since that time, the scientists and engineers at SRS pro-actively identified environmental problems and developed and implemented effective and efficient environmental management and remediation solutions. This second generation, spanning the 1980's through the 2000's, is exemplified by numerous large and small cleanup actions to address metals and radionuclides, solvents and hydrocarbons, facility and area decommissioning, and ecological restoration. Recently, a third generation of environmental management was initiated as part of Enterprise SRS. This initiative to 'Develop and Deploy Next Generation Cleanup Technologies' formalizes and organizes the major technology matching, development, and implementation processes associated with historical SRS cleanup success as a resource to support future environmental management missions throughout DOE. The four elements of the current, third generation, effort relate to: 1) transition from active to passive cleanup, 2) in situ decommissioning of large nuclear facilities, 3) new long term monitoring paradigms, and 4) a major case study related to support for recovery and restoration of the Japanese Fukushima-Daiichi nuclear power plant and surrounding environment. (authors)« less

A framework for ensuring a balanced accounting of the impact of antimicrobial stewardship interventions.

PubMed

Toma, Madalina; Davey, Peter G; Marwick, Charis A; Guthrie, Bruce

2017-12-01

Drawing on a Cochrane systematic review, this paper examines the relatively limited range of outcomes measured in published evaluations of antimicrobial stewardship interventions (ASIs) in hospitals. We describe a structured framework for considering the range of consequences that ASIs can have, in terms of their desirability and the extent to which they were expected when planning an ASI: expected, desirable consequences (intervention goals); expected, undesirable consequences (intervention trade-offs); unexpected, undesirable consequences (unpleasant surprises); and unexpected, desirable consequences (pleasant surprises). Of 49 randomized controlled trials identified by the Cochrane review, 28 (57%) pre-specified increased length of stay and/or mortality as potential trade-offs of ASI, with measurement intended to provide reassurance about safety. In actuality, some studies found unexpected decreases in length of stay (a pleasant surprise). In contrast, only 11 (10%) of 110 interrupted time series studies included any information about unintended consequences, with 10 examining unexpected, undesirable outcomes (unpleasant surprises) using case-control, qualitative or cohort designs. Overall, a large proportion of the ASIs reported in the literature only assess impact on their targeted process goals-antimicrobial prescribing-with limited examination of other potential outcomes, including microbial and clinical outcomes. Achieving a balanced accounting of the impact of an ASI requires careful consideration of expected undesirable effects (potential trade-offs) from the outset, and more consideration of unexpected effects after implementation (both pleasant and unpleasant surprises, although the latter will often be more important). The proposed framework supports the systematic consideration of all types of consequences of improvement before and after implementation. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Robotic System for Condition Assessment of Concrete Bridge Decks : Data Driven Decisions [Tech Brief

DOT National Transportation Integrated Search

2012-12-11

In the United States, the stewardship and management of approximately 599,000 bridges present ongoing planning, operational, maintenance, and economic challenges for Federal, State, and local transportation agencies. To help overcome these challenges...

New Developments in NOAA's Comprehensive Large Array-Data Stewardship System

NASA Astrophysics Data System (ADS)

Ritchey, N. A.; Morris, J. S.; Carter, D. J.

2012-12-01

The Comprehensive Large Array-data Stewardship System (CLASS) is part of the NOAA strategic goal of Climate Adaptation and Mitigation that gives focus to the building and sustaining of key observational assets and data archives critical to maintaining the global climate record. Since 2002, CLASS has been NOAA's enterprise solution for ingesting, storing and providing access to a host of near real-time remote sensing streams such as the Polar and Geostationary Operational Environmental Satellites (POES and GOES) and the Defense Meteorological Satellite Program (DMSP). Since October, 2011 CLASS has also been the dedicated Archive Data Segment (ADS) of the Suomi National Polar-orbiting Partnership (S-NPP). As the ADS, CLASS receives raw and processed S-NPP records for archival and distribution to the broad user community. Moving beyond just remote sensing and model data, NOAA has endorsed a plan to migrate all archive holdings from NOAA's National Data Centers into CLASS while retiring various disparate legacy data storage systems residing at the National Climatic Data Center (NCDC), National Geophysical Data Center (NGDC) and the National Oceanographic Data Center (NODC). In parallel to this data migration, CLASS is evolving to a service-oriented architecture utilizing cloud technologies for dissemination in addition to clearly defined interfaces that allow better collaboration with partners. This evolution will require implementation of standard access protocols and metadata which will lead to cost effective data and information preservation.

Antimicrobial Stewardship in the Emergency Department: Challenges, Opportunities, and a Call to Action for Pharmacists.

PubMed

Bishop, Bryan M

2016-12-01

Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance. © The Author(s) 2015.

Pharmacist-driven antimicrobial stewardship program in an institution without infectious diseases physician support.

PubMed

Waters, C Dustin

2015-03-15

Improved drug-utilization and cost outcomes achieved by a pharmacist-led antimicrobial stewardship program (ASP) are described. Pharmacists may be tasked to lead ASP development and implementation with little or no support from an infectious diseases (ID) physician and other hospital personnel whose involvement on ASP teams is recommended (e.g., clinical microbiologists, infection control specialists, hospital epidemiologists). Several years ago, Intermountain Healthcare's 325-bed McKay-Dee Hospital in Utah implemented an ASP led by an antimicrobial stewardship pharmacist. In addition to reviewing patient profiles and meeting with physicians to discuss cases daily (Monday-Friday), the pharmacist was available to provide afterhours phone consultations; support was provided by an infection prevention nurse, two physician ASP champions, the pharmacy leadership, pharmacy informatics and hospital laboratory personnel, and the chief medical officer. In the program's first 33 months, the pharmacist made a total of 2,457 interventions or recommendations, with an acceptance rate of 91.8%. Comparison of selected outcomes during one-year periods before and after ASP implementation indicated substantial decreases in the utilization of four commonly used antimicrobial agents and classes (carbapenems, daptomycin, echinocandins, and levofloxacin) in the postimplementation period, with a significant decline in the average length of stay for community-acquired pneumonia (mean ± S.D., 2.69 ± 0.10 days versus 3.40 ± 0.23 days; p = 0.03). Two years after ASP implementation, annual cost savings attributed to the program were estimated at $355,000. In the absence of ID physician support and oversight, the pharmacist-led ASP achieved substantial reductions in antimicrobial utilization and associated expenditures. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Using Implementation and Program Theory to Examine Communication Strategies in National Wildlife Federation's Backyard Wildlife Habitat Program

ERIC Educational Resources Information Center

Palmer, Dain; Dann, Shari L.

2004-01-01

Our evaluative approach used implementation theory and program theory, adapted from Weiss (1998) to examine communication processes and results for a national wildlife habitat stewardship education program. Using a mail survey of 1427 participants certified in National Wildlife Federation's (NWF) Backyard Wildlife Habitat (BWH) program and a study…

Taking Another Look at the Data Management Life Cycle: Deconstruction, Agile, and Community

NASA Astrophysics Data System (ADS)

Young, J. W.; Lenhardt, W. C.; Parsons, M. A.; Benedict, K. K.

2014-12-01

The data life cycle has figured prominently in describing the context of digital scientific data stewardship and cyberinfractructure in support of science. There are many different versions of the data life cycle, but they all follow a similar basic pattern: plan, collect, ingest, asses, preserve, discover, and reuse. The process is often interpreted in a fairly linear fashion despite it being a cycle conceptually. More recently at GeoData 2014 and elsewhere, questions have been raised about the utility of the data life cycle as it is currently represented. We are proposing to the community a re-examination of the data life cycle using an agile lens. Our goal is not to deploy agile methods, but to use agile principles as a heuristic to think about how to incorporate data stewardship across the scientific process from proposal stage to research and beyond. We will present alternative conceptualizations of the data life cycle with a goal to solicit feedback and to develop a new model for conceiving and describing the overall data stewardship process. We seek to re-examine past assumptions and shed new light on the challenges and necessity of data stewardship. The ultimate goal is to support new science through enhanced data interoperability, usability, and preservation.

Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. II. Drug disposal, waste reduction, and future directions.

PubMed Central

Daughton, Christian G

2003-01-01

Since the 1980s, the occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants, originating primarily from consumer use and actions rather than manufacturer effluents, continues to become more firmly established. The growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on (or from) water supplies are minimized. Despite a paucity of effects data from long-term, simultaneous exposure at low doses to multiple xenobiotics (particularly non-target-organism exposure to PPCPs), a wide range of proactive actions could be implemented for reducing or minimizing the introduction of PPCPs to the environment. Most of these actions fall under what could be envisioned as a holistic stewardship program--overseen by the health care industry and consumers alike. Significantly, such a stewardship program would benefit not just the environment--additional, collateral benefits could automatically accrue, including the lessening of medication expense for the consumer and improving patient health and consumer safety. In this article (the second of two parts describing the "green pharmacy") I focus on those actions and activities tied more closely to the end user (e.g., the patient) and issues associated with drug disposal/recycling that could prove useful in minimizing the environmental disposition of PPCPs. I also outline some recommendations and suggestions for further research and pose some considerations regarding the future. In this mini-monograph I attempt to capture cohesively for the first time the wide spectrum of actions available for minimizing the release of PPCPs to the environment. A major objective is to generate an active dialog or debate across the many disciplines that must become actively involved to design and implement a successful approach to life-cycle stewardship of PPCPs. PMID:12727607

Development and assessment of national performance indicators for infection prevention and control and antimicrobial stewardship in European long-term care facilities.

PubMed

Cookson, B; Mackenzie, D; Kafatos, G; Jans, B; Latour, K; Moro, M L; Ricchizzi, E; Van de Mortel, M; Suetens, C; Fabry, J

2013-09-01

Healthcare-associated infections in long-term care facilities (LTCFs) are of increasing importance. To develop consensus national performance indicators (NPIs) for infection control (ICPI) and antimicrobial stewardship (ASPI) in LTCFs, and assess the performance of 32 European countries against these NPIs. Previously established European standards were the basis for consensus and the same iterative approach with national representatives from the 32 countries. A World Health Organization scoring system recorded how close each country was to implementing each standard. The 42 agreed component indicators were grouped into six NPI categories: 'national programme', 'guidelines', 'expert advice', 'IC structure' (not present in the ASPI), 'surveillance' and 'composite'. 'Guidelines' scored the highest mean total possible score (60%, range 20-100%), followed by 'composite' (53%, range 30-100%), 'expert advice' (48%, range 20-100%), 'surveillance' (47%, range 20-83%), 'national programme' (42%, range 20-100%) and 'IC structure' (39%, range 20-100%). Although several scores were low, some countries were able to implement all NPIs, indicating that this was feasible. Most NPIs were very significantly related, indicating that they were considered to be important by the countries. 'Guidelines' and 'IC structure' were significantly related to European region (P ≤ 0.05). Accreditation/inspection was not evident in seven (22%) countries, nine (28%) countries had accreditation/inspection that included IC assessments, and seven (22%) countries had accreditation/inspection that included IC and antimicrobial stewardship assessments. Multi-variable analysis found that only the NPI and the ICPI 'expert advice' were associated with accreditation/inspection which included IC and antimicrobial stewardship. The identified gaps represent significant potential patient safety issues. The NPIs should serve as a basis for monitoring improvements over the coming years. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

76 FR 33726 - National Ocean Council; Strategic Action Plan Content Outlines

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-09

...On July 19, 2010, President Obama signed Executive Order 13547 establishing a National Policy for the Stewardship of the Ocean, our Coasts, and the Great Lakes (``National Ocean Policy''). The National Ocean Policy provides an implementation strategy, which describes nine priority objectives that seek to address some of the most pressing challenges facing the ocean, our coasts, and the Great Lakes. The National Ocean Council is responsible for developing strategic action plans for each of the nine priority objectives. As a first step, Federal interagency writing teams have developed content outlines for each draft strategic action plan. The NOC is seeking public review and comment of these content outlines. The purpose of the draft content outlines (outlines) is to provide the public with an initial view of potential actions that could be taken to further the national priority objectives. As such, they are an interim step toward development of the first full draft of each strategic action plan. In developing the outlines, the writing teams were informed by the comments received during an initial public scoping period that closed on April 29. Each outline presents in bulleted form potential actions to further the particular priority objective. It describes the reasons for taking the action, expected outcomes and milestones, gaps and needs in science and technology, and the timeframe for completing the action. The outlines also provide an overview of the priority objective, greater context for the strategic action plan in implementing the National Ocean Policy, and an overview of the preparation of the plan . Public comments received on the outlines will be collated and posted on the NOC Web site. The comments on the outlines will inform the preparation of full draft strategic action plans, which will be released for public review in the fall of 2011, allowing additional opportunity for the public to provide comments. Final strategic action plans are expected to be completed by early 2012.

Dramatic effects of a new antimicrobial stewardship program in a rural community hospital.

PubMed

Libertin, Claudia R; Watson, Stephanie H; Tillett, William L; Peterson, Joy H

2017-09-01

New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia. An educational grand rounds lecture series was provided before implementation of the ASP to all prescribers. After implementation, algorithms to aid the selection of empirical antibiotics for specific infectious disease syndromes based on local antibiograms were provided to prescribers to improve this selection. Rates of C difficile infections, total targeted antimicrobial costs, and drug utilization rates were calculated for 1 year pre-ASP implementation (2013) and 1 year post-ASP implementation (October 2014-December 2015). The patient safety metric of C difficile infections decreased from 3.35 cases per 1,000 occupied bed days (OBDs) in 2013 to 1.35 cases per 1,000 OBDs in 2015. Total targeted antimicrobial costs decreased 50% from $16.93 per patient day in 2013 to $8.44 per patient day in 2015. Overall antimicrobial use decreased 10% from before the ASP initiative to 1 year after it. Annualized savings were $280,000 in 1 year, based on drug savings only. Judicious use of antimicrobials and resources can improve a patient safety metric and decrease costs dramatically in rural institutions where the average hospital census is <100 patients per day. The savings would allow the institutions to spend better while improving the use of antimicrobials. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Evolution of data stewardship over two decades at a NASA data center

NASA Astrophysics Data System (ADS)

Armstrong, E. M.; Moroni, D. F.; Hausman, J.; Tsontos, V. M.

2013-12-01

Whether referred to as data science or data engineering, the technical nature and practice of data curation has seen a noticeable shift in the last two decades. The majority of this has been driven by factors of increasing data volumes and complexity, new data structures, and data virtualization through internet access that have themselves spawned new fields or advances in semantic ontologies, metadata, advanced distributed computing and new file formats. As a result of this shifting landscape, the role of the data scientist/engineer has also evolved.. We will discuss the key elements of this evolutionary shift from the perspective of data curation at the NASA Physical Oceanography Distributed Active Archive Center (PO.DAAC), which is one of 12 NASA Earth Science data centers responsible for archiving and distributing oceanographic satellite data since 1993. Earlier responsibilities of data curation in the history of the PO.DAAC focused strictly on data archiving, low-level data quality assessments, understanding and building read software for terse binary data or limited applications of self-describing file formats and metadata. Data discovery was often word of mouth or based on perusing simple web pages built for specific products. At that time the PO.DAAC served only a few tens of datasets. A single data engineer focused on a specific mission or suite of datasets from a specific physical parameter (e.g., ocean topography measurements). Since that time the number of datasets in the PO.DAAC has grown to approach one thousand, with increasing complexity of data and metadata structures in self-describing formats. Advances in ontologies, metadata, applications of MapReduce distributed computing and "big data", improvements in data discovery, data mining, and tools for visualization and analysis have all required new and evolving skill sets. The community began requiring more rigorous assessments of data quality and uncertainty. Although the expert knowledge of the physical domain was still critical, especially relevant to assessments of data quality, additional skills in computer science, statistics and system engineering also became necessary. Furthermore, the level of effort to implement data curation has not expanded linearly either. Management of ongoing data operations demands increased productivity on a continual basis and larger volumes of data, with constraints on funding, must be managed with proportionately less human resources. The role of data curation has also changed within the perspective of satellite missions. In many early missions, data management and curation was an afterthought (since there were no explicit data management plans written into the proposals), while current NASA mission proposals must have explicit data management plans to identify resources and funds for archiving, distribution and implementing overall data stewardship. In conclusion, the role of the data scientist/engineer at the PO.DAAC has shifted from supporting singular missions and primarily representing a point of contact for the science community to complete end-to-end stewardship through the implementation of a robust set of dataset lifecycle policies from ingest, to archiving, including data quality assessment for a broad swath of parameter based datasets that can number in the hundreds.

A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options.

PubMed

Rani, Manju; Nusrat, Sharmin; Hawken, Laura H

2012-10-16

Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes. Drawing on qualitative review of policy and program documents from five LMICs and data from global key-informant surveys conducted in 2004 and 2010, we examine current status of governance of response to NCDs at national level along three dimensions- institutional arrangements for stewardship and program management and implementation; policies/plans; and multisectoral coordination and partnerships. Several positive trends were noted in the organization and governance of response to NCDs: shift from specific NCD-based programs to integrated NCD programs, increasing inclusion of NCDs in sector-wide health plans, and establishment of high-level multisectoral coordination mechanisms.Several areas of concern were identified. The evolving NCD-specific institutional structures are being treated as 'program management and implementation' entities rather than as lead 'technical advisory' bodies, with unclear division of roles and responsibilities between NCD-specific and sector-wide structures. NCD-specific and sector-wide plans are poorly aligned and lack prioritization, costing, and appropriate targets. Finally, the effectiveness of existing multisectoral coordination mechanisms remains questionable. The 'technical functions' and 'implementation and management functions' should be clearly separated between NCD-specific units and sector-wide institutional structures to avoid duplicative segmented service delivery systems. Institutional capacity building efforts for NCDs should target both NCD-specific units (for building technical and analytical capacity) and sector-wide organizational units (for building program management and implementation capacity) in MOH.The sector-wide health plans should reflect NCDs in proportion to their public health importance. NCD specific plans should be developed in close consultation with sector-wide health- and non-health stakeholders. These plans should expand on the directions provided by sector-wide health plans specifying strategically prioritized, fully costed activities, and realistic quantifiable targets for NCD control linked with sector-wide expenditure framework. Multisectoral coordination mechanisms need to be strengthened with optimal decision-making powers and resource commitment and monitoring of their outputs.

Effect of a Stewardship Intervention on Adherence to Uncomplicated Cystitis and Pyelonephritis Guidelines in an Emergency Department Setting

PubMed Central

Hecker, Michelle T.; Fox, Clinton J.; Son, Andrea H.; Cydulka, Rita K.; Siff, Jonathan E.; Emerman, Charles L.; Sethi, Ajay K.; Muganda, Christine P.; Donskey, Curtis J.

2014-01-01

Objective To evaluate adherence to uncomplicated urinary tract infections (UTI) guidelines and UTI diagnostic accuracy in an emergency department (ED) setting before and after implementation of an antimicrobial stewardship intervention. Methods The intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18 – 65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1), and after audit and feedback (period 2). Results Adherence to UTI guidelines increased from 44% (baseline) to 68% (period 1) to 82% (period 2) (P≤.015 for each successive period). Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline) to 14% (period 1) to 13% (period 2) (P<.001 and P = .7 for each successive period). Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period). For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods. Conclusions A stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI. PMID:24498394

Impact of Implementing Antibiotic Stewardship Programs in 15 Small Hospitals: A Cluster-Randomized Intervention.

PubMed

Stenehjem, Edward; Hersh, Adam L; Buckel, Whitney R; Jones, Peter; Sheng, Xiaoming; Evans, R Scott; Burke, John P; Lopansri, Bert K; Srivastava, Rajendu; Greene, Tom; Pavia, Andrew T

2018-02-23

Studies on the implementation of antibiotic stewardship programs (ASPs) in small hospitals are limited. Accreditation organizations now require all hospitals to have ASPs. The objective of this cluster-randomized intervention was to assess the effectiveness of implementing ASPs in Intermountain Healthcare's 15 small hospitals. Each hospital was randomized to 1 of 3 ASPs of escalating intensity. Program 1 hospitals were provided basic antibiotic stewardship education and tools, access to an infectious disease hotline, and antibiotic utilization data. Program 2 hospitals received those interventions plus advanced education, audit and feedback for select antibiotics, and locally controlled antibiotic restrictions. Program 3 hospitals received program 2 interventions plus audit and feedback on the majority of antibiotics, and an infectious diseases-trained clinician approved restricted antibiotics and reviewed microbiology results. Changes in total and broad-spectrum antibiotic use within programs (intervention versus baseline) and the difference between programs in the magnitude of change in antibiotic use (eg, program 3 vs 1) were evaluated with mixed models. Program 3 hospitals showed reductions in total (rate ratio, 0.89; confidence interval, .80-.99) and broad-spectrum (0.76; .63-.91) antibiotic use when the intervention period was compared with the baseline period. Program 1 and 2 hospitals did not experience a reduction in antibiotic use. Comparison of the magnitude of effects between programs showed a similar trend favoring program 3, but this was not statistically significant. Only the most intensive ASP intervention was associated with reduction in total and broad-spectrum antibiotic use when compared with baseline. NCT03245879.

Promoting country ownership and stewardship of health programs: The global fund experience.

PubMed

Atun, Rifat; Kazatchkine, Michel

2009-11-01

The Global Fund to Fight AIDS, Tuberculosis and Malaria was established in 2002 to provide large-scale financing to middle- and low-income countries to intensify the fight against the 3 diseases. Its model has enabled strengthening of local health leadership to improve governance of HIV programs in 5 ways. First, the Global Fund has encouraged development of local capacity to generate technically sound proposals reflecting country needs and priorities. Second, through dual-track financing-where countries are encouraged to nominate at least one government and one nongovernment principal recipient to lead program implementation-the Global Fund has enabled civil society and other nongovernmental organizations to play a critical role in the design, implementation, and oversight of HIV programs. Third, investments to strengthen community systems have enabled greater involvement of community leaders in effective mobilization of demand and scale-up for services to reach vulnerable groups. Fourth, capacity building outside the state sector has improved community participation in governance of public health. Finally, an emphasis on inclusiveness and diversity in planning, implementation, and oversight has broadly enhanced country coordination capacity. Strengthening local leadership capacity and governance are critical to building efficient and equitable health systems to deliver universal coverage of HIV services.

Impact of Antimicrobial Stewardship on Physician Practice in a Geriatric Facility

PubMed Central

Kassett, Nina; Sham, Rosalind; Aleong, Rosanne; Yang, Daisy; Kirzner, Michael; Craft, Aidlee

2016-01-01

Background There is a paucity of literature describing the implementation of antimicrobial stewardship programs (ASPs) in long-term care (LTC) facilities. The current study evaluated the impact of an ASP that was implemented across a geriatric facility, which included an inpatient specialty hospital and an LTC facility. The program included prospective audits with feedback, multidisciplinary education, information technology interventions, and guideline development. Objective To investigate the impact of the ASP on physicians’ prescribing practices in this geriatric facility. Methods Utilization data for antibiotics commonly used to treat urinary tract infections were retrieved for the period September 1, 2011, to August 31, 2013. The study examined whether there were significant changes in overall antibiotic use, ciprofloxacin use, and physician prescribing behaviour after program implementation in September 2012. Results There was no significant change in the total number of antibiotic prescriptions for urinary tract infections in the hospital or the LTC facility after ASP implementation. Significant reductions were seen in the average days of therapy initially prescribed and the actual days of therapy after ASP implementation in the LTC facility but not the hospital. Across both facilities, significant reductions were seen in the number of ciprofloxacin prescriptions. Conclusions The current study showed that an ASP can affect physicians’ antibiotic prescribing behaviour and antibiotic usage in an LTC environment. PMID:28123192

Influence of a 5-year serial infection control and antibiotic stewardship intervention on cardiac surgical site infections.

PubMed

Frenette, Charles; Sperlea, David; Tesolin, Joey; Patterson, Connie; Thirion, Daniel J G

2016-09-01

Surgical site infections (SSIs) complicate surgery, resulting in higher morbidity and mortality. Infection control bundles and antibiotic stewardship can be effective at reducing SSIs. The influence of long-term serial interventions is unclear. The goal of this retrospective quasiexperimental study was to assess the influence of a 5-year serial infection control and antibiotic stewardship intervention on SSIs. The multidisciplinary program actively implemented pre-, intra-, and postoperative strategies over a 5-year period from 2009-2014 for all patients undergoing coronary artery bypass graft (CABG), valve replacement, or both at a tertiary care public institution. Outcomes are compared with a 2-year preinterventions period (2007-2009) and 1-year postinterventions period (2014-2015). A total of 6,518 procedures were included. After interventions, the overall combined infection rate for CABG, CABG and valve, and valve procedures decreased by 66.3%, from 11.9%-4.0% (odds ratio, 0.34; 95% confidence interval, 0.23-0.49; P < .001). A significant decrease of >50% (P < .001) relative rate was observed in overall, sternum, leg, CABG, and combined CABG and valve infection rates when comparing pre- and postinterventions groups. The antibiotic stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 46.8%, from 39.8%-86.6% (95% confidence interval, 41.0-52.4; P < .001). Long-term, serial comprehensive infection control and antibiotic stewardship interventions decrease overall SSIs in patients undergoing CABG and valve replacement procedures. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The scope and value of an anticoagulation stewardship program at a community teaching hospital.

PubMed

Wychowski, Maura K; Ruscio, Christina I; Kouides, Peter A; Sham, Ronald L

2017-04-01

To report the impact of an inpatient anticoagulation stewardship program at a community hospital to promote optimal anticoagulant use. The anticoagulation team (ACT) stewardship program consists of two clinical pharmacists and hematologists to provide oversight of anticoagulants, high cost reversal agents including prothrombin complex concentrate (PCC, Kcentra™), and heparin-induced thrombocytopenia (HIT) management. Intervention data and number of charts reviewed were collected. Average cost avoidance data was applied to ACT interventions to estimate cost savings. The PCC analysis was conducted via retrospective chart review during the pre-intervention period. Prospective monitoring continued in the post-intervention period to determine the percentage of PCC use within the institution's guidelines or approved by ACT or hematology. A total of 19,445 patient charts were reviewed, and 1930 (10%) contained stewardship opportunity. Of the interventions, 71% were provided to the medical service and 22% to surgical services with acceptance rates of 91 and 83%, respectively. Intervention cost-avoidance calculated to be $694,217. Regarding HIT interventions, 52% of interventions involved pharmacokinetic/pharmacodynamics optimization in 18 patients with suspected or confirmed HIT. Regarding PCC use, 55.8% of PCC orders were considered inappropriate in the pre-invention period versus 2.6% post-intervention. Appropriate PCC doses per month post-intervention were consistent with pre-intervention doses (7.67 vs. 6.73, respectively). The projected annual PCC cost savings is $385,473. The overall estimated financial impact of ACT is $799,690 saved. Implementation of an anticoagulation stewardship program reduced costs and improved clinical outcomes. It is also expected that anticoagulant optimization and provider education improved overall safety.

Antibiotic stewardship: does it work in hospital practice? A review of the evidence base.

PubMed

Hulscher, M E J L; Prins, J M

2017-11-01

Guidelines for developing and implementing stewardship programmes include recommendations on appropriate antibiotic use to guide the stewardship team's choice of potential stewardship objectives. They also include recommendations on behavioural change interventions to guide the team's choice of potential interventions to ensure that professionals actually use antibiotics appropriately in daily practice. To summarize the evidence base of both appropriate antibiotic use recommendations (the 'what') and behavioural change interventions (the 'how') in hospital practice. Published systematic reviews/Medline. The literature shows low-quality evidence of the positive effects of appropriate antibiotic use in hospital patients. The literature shows that any behavioural change intervention might work to ensure that professionals actually perform appropriate antibiotic use recommendations in daily practice. Although effects were overall positive, there were large differences in improvement between studies that tested similar change interventions. The literature showed a clear need for studies that apply appropriate study designs- (randomized) controlled designs-to test the effectiveness of appropriate antibiotic use on achieving meaningful outcomes. Most current studies used designs prone to confounding by indication. In the process of selecting behavioural change interventions that might work best in a chosen setting, much should be learned from behavioural sciences. The challenge for stewardship teams lies in selecting change interventions on the careful assessment of barriers and facilitators, and on a theoretical base while linking determinants to change interventions. Future studies should apply more robust designs and evaluations when assessing behavioural change interventions. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

BEMRP: Conducting research, sharing results

Treesearch

Greg Jones

2007-01-01

A couple of years ago the Bitterroot National Forest began planning the Trapper Bunkhouse Land Stewardship Project (Trapper-Bunkhouse Project). This project includes fuels reduction, watershed improvements, noncommercial thinning in plantations to improve resiliency to insects and disease, and commercial timber harvest to provide economic value to the community and...

Strategic Plan for Federal Research and Monitoring of Ocean Acidification

EPA Science Inventory

On July 19, 2010, the President signed an Executive Order establishing the nation’s first comprehensive National Policy for the Stewardship of the Ocean, Our Coasts, and Great Lakes and adopted the Final Recommendations of the Ocean Policy Task Force (OPTF 2010). The Final Recom...

76 FR 17180 - Meeting of the Regional Resource Stewardship Council

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-28

.... The management of the Tennessee Valley reservoirs and the lands adjacent to them has long been an... developing a Natural Resource Plan (NRP) that will help prioritize techniques for the management of TVA's biological and cultural resource management activities, recreation management activities, water resource...

75 FR 80566 - Meeting of the Regional Resource Stewardship Council

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-22

... this meeting is given under the Federal Advisory Committee Act (FACA), 5 U.S.C. App. 2. The management... Resource Plan (NRP) that will help prioritize techniques for the management of TVA's biological and cultural resource management activities, recreation management activities, water resource protection and...

Kennedy Space Center Five Year Sustainability Plan

NASA Technical Reports Server (NTRS)

Williams, Ann T.

2016-01-01

The Federal Government is committed to following sustainable principles. At its heart, sustainability integrates environmental, societal and economic solutions for present needs without compromising the ability of future generations to meet their needs. Building upon its pledge towards environmental stewardship, the Administration generated a vision of sustainability spanning ten goals mandated within Executive Order (EO) 13693, Planning for Federal Sustainability in the Next Decade. In November 2015, the National Aeronautics and Space Administration (NASA) responded to this EO by incorporating it into a new release of the NASA Strategic Sustainability Performance Plan (SSPP). The SSPP recognizes the importance of aligning environmental practices in a manner that preserves, enhances and strengthens NASA's ability to perform its mission indefinitely. The Kennedy Space Center (KSC) is following suit with KSC's Sustainability Plan (SP) by promoting, maintaining and pioneering green practices in all aspects of our mission. KSC's SP recognizes that the best sustainable solutions use an interdisciplinary, collaborative approach spanning civil servant and contractor personnel from across the Center. This approach relies on the participation of all employees to develop and implement sustainability endeavors connected with the following ten goals: Reduce greenhouse gas (GHG) emissions. Design, build and maintain sustainable buildings, facilities and infrastructure. Leverage clean and renewable energy. Increase water conservation. Improve fleet and vehicle efficiency and management. Purchase sustainable products and services. Minimize waste and prevent pollution. Implement performance contracts for Federal buildings. Manage electronic equipment and data centers responsibly. Pursue climate change resilience. The KSC SP details the strategies and actions that address the following objectives: Reduce Center costs. center dot Increase energy and water efficiencies. Promote smart buying practices. Increase reuse and recycling while decreasing waste. Benefit the community. Meet or exceed the EO and NASA SSPP sustainability goals.

THE SOUTHWEST REGIONAL GAP PROJECT: A DATABASE MODEL FOR REGIONAL LANDSCAPE ASSESSMENT, RESOURCE PLANNING, AND VULNERABILITY ANALYSIS

EPA Science Inventory

The Gap Analysis Program (GAP) is a national interagency program that maps the distribution of plant communities and selected animal species and compares these distributions with land stewardship to identify biotic elements at potential risk of endangerment. Acquisition of primar...

75 FR 43929 - National Weather Service (NWS) Strategic Plan, 2011-2020

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... management, and private sector, research and operations partners. NWS invites comments on the contents of... 18234, Silver Spring, Maryland 20910. E-mail comments to nws.great.ideas@noaa.gov . NWS prefers that... prediction and monitoring. NOAA's commitment to science, service, and stewardship informs society to respond...

36 CFR 230.9 - Payment to landowners.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Payment to landowners. 230.9 Section 230.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND... needed to meet the objectives of the landowner forest stewardship plan; or (2) The landowner establishes...

36 CFR 230.9 - Payment to landowners.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Payment to landowners. 230.9 Section 230.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND... needed to meet the objectives of the landowner forest stewardship plan; or (2) The landowner establishes...

Economics/Environment/Educational Outcomes of Site Planning.

ERIC Educational Resources Information Center

Grube, Karl W.; Bewley, Mary

Few school leaders and school architects have recognized or comprehended the potential symbiosis between school site resources and the enrichment of the instructional program, the urgency of repairing and improving the biosphere, the broadening of community life onto school sites, and the recognition of the responsibility role of stewardship of…

77 FR 15933 - Conservation Loan Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-19

... ``Conservation Practice'' to coincide with the definition in NRCS regulations. FSA will add a definition of... though forestry practices are included in 7 CFR 762.121 and 764.231 as an authorized loan purpose or use... conservation practice included in the Forest Stewardship Management Plan will be an eligible use of CL funds...

Using wilderness character to improve wilderness stewardship

Treesearch

Peter Landres; Wade M. Vagias; Suzy Stutzman

2012-01-01

This article describes how understanding wilderness character leads to improved communication among staff and with the public, helping park staff make more informed decisions about park planning, management, and monitoring in wilderness. Wilderness character is defined in terms of five qualities: natural, solitude or primitive and unconfined recreation, undeveloped,...

77 FR 21526 - Eastern Washington Cascades Provincial Advisory Committee and the Yakima Provincial Advisory...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-10

... Parks office, 270 9th Street NE., East Wenatchee, WA has been replaced with an open public meeting... Stewardship Challenge, Yakima River Basin Integrated Water Resource Management Plan, Holden Mine Remediation..., Okanogan- Wenatchee National Forest, 215 Melody Lane, Wenatchee, Washington 98801, phone 509-664-9200...

A National Strategic Plan for Natural Resources and Environmental Management Education.

ERIC Educational Resources Information Center

Fridgen, Cynthia

1995-01-01

The Natural Resources and Environmental Management Program is designed to help people understand their relationship to the environment, practice stewardship, make informed decisions, and appreciate biodiversity. Areas of emphasis include air, land, and water quality; citizen responsibility; conflict management; approaches to land use and species…

The physician as a manager.

PubMed

McDonagh, T J

1982-02-01

The practice of occupational medicine has undergone considerable change over the last decade. Increased awareness of potential health hazards associated with the workplace and its products and wastes, the interest of society and workers in these subjects, and related governmental regulation have resulted in expanded occupational health programs within industry. The occupational physician has become a key company resource in the optimal management of the business impacts of health-related issues. Health-related matters often have noteworthy business implications, and the occupational physician needs to spend considerable time as a manager in the planning, resourcing, implementation, evaluation, and stewardship of programs. Thus he is experiencing greater demands and often is inadequately prepared for this nonclinical, nonscientific role. Therefore, the preparation of occupational physicians to assume such managerial responsibilities needs to receive high priority. The physician must be willing to accept this challenge both to ensure the program's success and to retain a leadership position in occupational health programs.

A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.

PubMed

Agwu, Allison L; Lee, Carlton K K; Jain, Sanjay K; Murray, Kara L; Topolski, Jason; Miller, Robert E; Townsend, Timothy; Lehmann, Christoph U

2008-09-15

Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World Wide Web-based antimicrobial approval program, will effectively enhance antimicrobial stewardship programs.

FY 2017 Stockpile Stewardship and Management Plan - Biennial Plan Summary

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

None, None

2016-03-01

This year’s summary report updates the Fiscal Year 2016 Stockpile Stewardship and Management Plan (FY 2016 SSMP), the 25-year strategic program of record that captures the plans developed across numerous NNSA programs and organizations to maintain and modernize the scientific tools, capabilities, and infrastructure necessary to ensure the success of NNSA’s nuclear weapons mission. The SSMP is a companion to the Prevent, Counter, and Respond: A Strategic Plan to Reduce Global Nuclear Threats (FY 2017-2021) report, the planning document for NNSA’s nuclear threat reduction mission. New versions of both reports are published each year in response to new requirements andmore » challenges. Much was accomplished in FY 2015 as part of the program of record described in this year’s SSMP. The science-based Stockpile Stewardship Program allowed the Secretaries of Energy and Defense to certify for the twentieth time that the stockpile remains safe, secure, and effective without the need for underground nuclear explosive testing. The talented scientists, engineers, and technicians at the three national security laboratories, the four nuclear weapons production plants, and the national security site are primarily responsible for this continued success. Research, development, test, and evaluation programs have advanced NNSA’s understanding of weapons physics, component aging, and material properties through first-of-a-kind shock physics experiments, along with numerous other critical experiments conducted throughout the nuclear security enterprise. The multiple life extension programs (LEPs) that are under way made progress toward their first production unit dates. The W76-1 LEP is past the halfway point in total production, and the B61-12 completed three development flight tests. Critical to this success is the budget. The Administration’s budget request for NNSA’s Weapons Activities has increased for all but one of the past seven years, resulting in a total increase of approximately 45 percent since 2010. If adopted by Congress, the FY 2017 budget request will increase funding by $396 million (about 4.5 percent) from the enacted FY 2016 level. A significant portion of the increase would fund the research for multiple life extension programs, support the programs in Directed Stockpile Work, and modernize the physical infrastructure of the nuclear security enterprise.« less

Blind inlets: Conservation practices to reduce herbicide losses from closed depressional areas

USDA-ARS?s Scientific Manuscript database

Pesticides are designed to benefit agricultural production and may inadvertently affect water quality if environmental stewardship programs are not implemented. Closed depressional areas (potholes) are typical in the US Midwest and are usually drained with tile risers, however sediment and contamina...

Controversies in Antimicrobial Stewardship: Focus on New Rapid Diagnostic Technologies and Antimicrobials

PubMed Central

Wenzler, Eric; Wong, Jordan R.; Goff, Debra A.; Jankowski, Christopher A.; Bauer, Karri A.

2016-01-01

Antimicrobial stewardship programs (ASPs) are challenged with ensuring appropriate antimicrobial use while minimizing expenditures. ASPs have consistently demonstrated improved patient outcomes and significant cost reductions but are continually required to justify the costs of their existence and interventions due to the silo mentality often adopted by hospital administrators. As new technologies and antimicrobials emerge, ASPs are in a constant tug-of-war between providing optimal clinical outcomes and ensuring cost containment. Additionally, robust data on cost-effectiveness of new rapid diagnostic technologies and antimicrobials with subsequent ASP interventions to provide justification are lacking. As the implementation of an ASP will soon be mandatory for acute care hospitals in the United States, ASPs must find ways to justify novel interventions to align themselves with healthcare administrators. This review provides a framework for the justification of implementing a rapid diagnostic test or adding a new antimicrobial to formulary with ASP intervention, reviews approaches to demonstrating cost-effectiveness, and proposes methods for which ASPs may reduce healthcare expenditures via alternative tactics. PMID:27025521

Next step in antibiotic stewardship: Pharmacist-provided penicillin allergy testing.

PubMed

Gugkaeva, Z; Crago, J S; Yasnogorodsky, M

2017-08-01

Penicillin allergy limits therapeutic options for patients but often disappears over time, leaving patients erroneously labelled allergic and leading to the utilization of broad-spectrum and more expensive antibiotics. Penicillin allergy can be effectively assessed via skin testing. To improve patient access to penicillin allergy testing by implementing a pharmacist-provided service in a hospital setting. Beta-lactams remain a mainstream therapy for many infections due to their effectiveness, low side effects and affordability. Typically, patient access to penicillin allergy testing is limited by the availability of allergy specialists, who traditionally perform such testing. A pharmacist-provided penicillin allergy testing service was implemented at our hospital in 2015 and became a powerful antibiotic stewardship tool. Removing penicillin allergy from patient profiles significantly expanded therapeutic options, expedited discharges and reduced costs of care. Pharmacists can expand patient access to penicillin allergy testing. Pharmacist-provided penicillin allergy testing permitted optimized antibiotic treatment and expedited discharges. © 2017 John Wiley & Sons Ltd.

The effectiveness of agricultural stewardship for improving water quality at the catchment scale: Experiences from an NVZ and ECSFDI watershed

NASA Astrophysics Data System (ADS)

Kay, Paul; Grayson, Richard; Phillips, Martin; Stanley, Karen; Dodsworth, Alan; Hanson, Ann; Walker, Andrew; Foulger, Miles; McDonnell, Iain; Taylor, Simon

2012-02-01

SummaryAgriculture is estimated to be responsible for 70% of nitrate and 30-50% of phosphorus pollution, contributing to ecological and water treatment problems. Despite the fact that significant gaps remain in our understanding, it is known that agricultural stewardship can be highly effective in controlling water pollution at the plot and field scales. Knowledge at the catchment scale is, to a large extent, entirely lacking though and this is of paramount concern given that the catchment is the management unit used by regulatory authorities. The few studies that have examined the impact of agricultural stewardship at the catchment scale have found that Nitrate Vulnerable Zones (NVZs) in the UK have resulted in little improvement in water quality which concurs with the current catchment study. In addition to NVZs, there was little evidence to suggest that the England Catchment Sensitive Farming Delivery Initiative had impacted water quality and suggestions have been made for improvements, such as ensuring that stewardship measures are used in key pollution source areas and their implementation and impacts are monitored more closely. This will be essential if agricultural catchment management schemes are going to provide the benefits expected of them. Nevertheless, more intensive monitoring than that carried out by regulators showed a significant trend in decreasing winter nitrate peaks in some streams which is hypothesised to be due to recent reduced inorganic fertiliser application as a result of increasing prices. It was concluded that, collectively, these findings indicate that agricultural stewardship measures have the potential to improve water quality at the catchment scale but that voluntary schemes with insufficient financial reward or regulatory pressure are unlikely to be successful.

Antimicrobial stewardship program in a Malaysian district hospital: First year experience

PubMed Central

Sing, Diana Yap Fui; Boo, Yang Liang; Mukhlis, Roshalina; Chin, Pek Woon; Hoo, Fan Kee

2016-01-01

Backgrounds & Objective: Antimicrobial resistance is an alarming public health threat that requires urgent global solution. Implementation of antimicrobial stewardship program (ASP) is an essential practice element for healthcare institutions in gate-keeping judicious antimicrobial use. This study highlighted the development, first year experience, and result of the implementation of ASP utilizing persuasive and restrictive approaches in a Malaysian district hospital. Methods: An observational study was conducted between January 2015 to December 2015 on implementation of ASP among hospitalized inpatients age 12 years old and above. Results: Recommendations were provided for 60% of cases (110 patients) with the average acceptance rate of 83.33%. Majority of the interventions were to stop the antimicrobial therapy (30.3%), and the most common audited antimicrobials was Piperacillin/Tazobactam (25.5%), followed by Meropenem (11.82%), Amoxicillin/Clavulanate and Vancomycin (8.18%) respectively. The concordance rate towards authorization policy was increased in 2015 (71.59% of cases) as compared before the implementation of ASP in 2014 (60.6% of cases). Restrictive enforcement under ASP had been shown to improve significantly adherence rate towards antimicrobials authorization policy (p-value: 0.004). Conclusion: ASP was successfully implemented in a district hospital. Future studies on its clinical outcomes are important to evaluate its effectiveness as well as focus on the improvement to the pre-existing strategies and measures. PMID:27648056

Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. I. Rationale for and avenues toward a green pharmacy.

PubMed Central

Daughton, Christian G

2003-01-01

Since the 1980s, the occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants, originating primarily from consumer use and actions rather than manufacturer effluents, continues to become more firmly established. Although PPCPs typically have been identified in surface and ground waters, some are also undoubtedly associated with solid phases such as suspended particulates, sediments, and sewage sludges, despite their relatively high affinity for water. Often amenable to degradation, their continual introduction to waste-receiving waters results from their widespread, continuous, combined use by individuals and domestic animals, giving PPCPs a "pseudo-persistence" in the environment. Little is known about the environmental or human health hazards that might be posed by chronic, subtherapeutic levels of these bioactive substances or their transformation products. The continually growing, worldwide importance of freshwater resources, however, underscores the need for ensuring that any aggregate or cumulative impacts on (or from) water supplies are minimized. Despite the paucity of effects data from long-term, simultaneous exposure at low doses to multiple xenobiotics (particularly non-target-organism exposure to PPCPs), a wide range of proactive actions could be implemented to reduce or minimize the introduction of PPCPs to the environment. Most of these actions fall under what could be envisioned as a holistic stewardship program--overseen by the health care industry and consumers alike. Significantly, such a stewardship program would benefit not just the environment; additional, collateral benefits could automatically accrue, including reducing consumers' medication expenses and improving patient health and consumer safety. In this article, the first of a two-part mini-monograph describing the "green pharmacy," I focus initially on the background behind the imperative for an ecologically oriented stewardship program for PPCPs. I then present a broad spectrum of possible source control/reduction actions, controlled largely by the health care industry, that could minimize the disposition of PPCPs to the environment. This two-part mini-monograph attempts to capture cohesively for the first time the wide spectrum of actions available for minimizing the release of PPCPs to the environment. A major objective is to generate an active dialog or debate across the many disciplines that must become actively involved to design and implement a successful approach to life-cycle stewardship of PPCPs. PMID:12727606

A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department.

PubMed

Losier, Mia; Ramsey, Tasha D; Wilby, Kyle John; Black, Emily K

2017-09-01

To improve antimicrobial utilization, development and implementation of antimicrobial stewardship programs in the emergency department (ED) has been recommended. The primary objective of this review was to characterize antimicrobial stewardship (AMS) in the ED and to identify interventions that improve patient outcomes or process of care and/or reduce consequences of antimicrobial use. This study was completed as a systematic review. The following databases were searched from inception through November, 2016: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Web of Science. Randomized controlled trials, nonrandomized controlled trials, controlled and uncontrolled before-and-after studies, interrupted time series studies, and repeated-measures studies evaluating AMS interventions in the ED were included in the review. Studies published in languages other than English were excluded. A total of 43 studies meeting inclusion criteria were identified from our search. Patient or provider education and guideline or clinical pathway implementation were the most commonly reported interventions. Few studies reported on audit and feedback, and no study evaluated preauthorization. Impact of interventions showed variable results. Where identified, benefits of AMS interventions primarily included improvement in delivery of care or a decrease in antimicrobial utilization; however, most studies were rated as having unclear or high risk of bias. AMS interventions in the ED may improve patient care. However, the optimal combination of interventions is unclear. Additional studies with more rigorous design evaluating core components of AMS programs, including prospective audit and feedback are needed.

77 FR 55452 - Lynn Canal-Icy Strait Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-10

... infrastructure (roads & trails), implementing stewardship objectives that enhance forested ecosystems, and/or... room, Admirality National Monument Office, 8510 Mendenhall Loop Road, Juneau, AK 99801. The public may attend the meeting via Video Teleconference (VTC) at the Hoonah Ranger District office, 430A Airport Road...

Pakistan's maternal and child health policy: analysis, lessons and the way forward.

PubMed

Siddiqi, S; Haq, I U; Ghaffar, A; Akhtar, T; Mahaini, R

2004-07-01

An estimated 400,000 infant and 16,500 maternal deaths occur annually in Pakistan. These translate into an infant mortality rate and maternal mortality ratio that should be unacceptable to any state. Disease states including communicable diseases and reproductive health (RH) problems, which are largely preventable account for over 50% of the disease burden. The analysis of Pakistan's maternal and child health (MCH) and family planning (FP) policy covers the period 1990-2002, and focuses on macroeconomic influences, priority programs and gaps, adequacy of resources, equity and organizational aspects, and the process of policy formulation. The overall MCH/FP policy is well directed. MCH/FP has been a priority in all policies; resource allocation, although unacceptably low, has substantially increased during the last decade; and there is a progressive shift from MCH to the reproductive health (RH) agenda. Areas in need of improvement include greater use of evidence as a basis for policy; increased priority to nutrition programs, measures to reduce neonatal and perinatal mortality, provision of emergency obstetric care, availability of skilled birth attendants, and a clear policy on integrated management of childhood illnesses. Enhanced planning capacity, development of a balanced human resource, improved governance to reduce staff absenteeism and frequent transfers, and a greater role of the private sector in the provision of services are some organizational aspects that need the governments' consideration. There are several lessons to be learnt: (i) Ministries of Health need sustained stewardship and well-documented evidence to protect cuts in resource allocation; (ii) frequent policy announcement sends inappropriate signals to managers and weakens on-going implementation; (iii) MCH/FP policies unless informed by evidence and participation of interest groups are unlikely to address gaps in programs; (iv) distributional and equity objectives of MCH/FP be addressed while setting overall national goals; (v) institutional capacity is a vital ingredient in translating MCH/FP policies into effective services. The suggested strategic directions emphasize, among others, the need for a comprehensive MCH/FP framework; strengthened stewardship in ministry of health, cost-effective strategies to address the gaps identified and doubling of the public sector resource allocation to MCH/FP over the next 5 years. The ability to ensure delivery of quality health services remains the biggest challenge in the Pakistani health sector. Unless sound policies are backed by well-functioning programs they are likely to become a victim of poor implementation.

Tackling the Sustainability Dilemma: A Holistic Approach to Preparing Students for the Professional Organization

ERIC Educational Resources Information Center

Mabry, Sibylle

2011-01-01

Increased knowledge of business sustainability as the basis of a holistic approach to value creation has inspired many managers to integrate ecological and social stewardship into their strategic business innovation plans. However, the coverage of sustainability issues in business courses remains small at many universities. This article…

77 FR 53908 - Winter Use Plan, Supplemental Draft Environmental Impact Statement, Yellowstone National Park

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-04

... whether to use their daily allocation of transportation events for snowmobiles or snowcoaches, but no more than 50 daily transportation events could come from snowmobiles. OSV use would continue to be 100..., Associate Director, Natural Resource Stewardship and Science National Park Service. [FR Doc. 2012-21829...

78 FR 62660 - Outer Continental Shelf (OCS), Gulf of Mexico (GOM), Oil and Gas Lease Sales Eastern Planning...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

.../Environmental-Assessment/NEPA/nepaprocess.aspx . Several libraries along the Gulf Coast have been sent copies of...-Stewardship/Environmental-Assessment/NEPA/nepaprocess.aspx . FOR FURTHER INFORMATION CONTACT: For more information on the Final EIS, you may contact Mr. Gary D. Goeke, Chief, Environmental Assessment Section...

78 FR 64242 - Outer Continental Shelf (OCS), Gulf of Mexico (GOM), Oil and Gas Lease Sales, Western Planning...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-28

...-Stewardship/Environmental-Assessment/NEPA/nepaprocess.aspx . Comments: Federal, State, and local government... Assessment Section, Office of Environment (GM 623E), Bureau of Ocean Energy Management, Gulf of Mexico OCS... (NOA) of the Draft Supplemental Environmental Impact Statement (EIS) and Public Meetings. SUMMARY: BOEM...

Few Governing Boards Engage in Sophisticated Financial Planning, Experts Say

ERIC Educational Resources Information Center

Fain, Paul

2009-01-01

Financial stewardship by college governing boards too often stops at balancing the budget. That was the message two finance experts presented last week during the annual meeting of the Association of Governing Boards of Universities and Colleges. Furthermore, the yearly budget exercise can give trustees a misperception of their institutions'…

Changing relationships with wilderness: A new focus for research and stewardship

Treesearch

Robert G. Dvorak; William T. Borrie

2007-01-01

Wilderness managers strive to provide quality recreation experiences. Because of this commitment, a need exists to further incorporate experiential aspects into current planning and management frameworks. This article suggests a focus on relationships with wilderness, moving beyond the examination of single transactions with a setting toward a consideration of the...

Defining the Molecular-Cellular-Field Continuum of Mercury Detoxification

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

Summers, Anne O.

Hg is of special interest to DOE due to past intensive use in manufacture of nuclear weapons at the Oak Ridge Reservation (ORR). Because of its facile oxidation/reduction [Hg(II)/Hg(0)] chemistry, ability to bond to carbon [as in highly toxic methylmercury: MeHg(I)] and its unique physical properties [e.g., volatility of Hg(0)], Hg has a complex environmental cycle involving soils, sediments, waterways and the atmosphere and including biotic and abiotic chemical and physical transport and transformations.1 Understanding such processes well enough to design stewardship plans that minimize negative impacts in diverse ecological settings requires rich knowledge of the contributing abiotic and bioticmore » processes. Prokaryotes are major players in the global Hg cycle. Facultative and anaerobic bacteria can form MeHg(I) with consequent intoxication of wildlife and humans. Sustainable stewardship of Hg-contaminated sites requires eliminating not only MeHg(I) but also the Hg(II) substrate for methylation. Fortunately, a variety of mercury resistant (HgR) aerobic and facultative bacteria and archaea can do both things. Prokaryotes harboring narrow or broad Hg resistance (mer) loci detoxify Hg(II) or RHg(I), respectively, to relatively inert, less toxic, volatile Hg(0). HgR microbes are enriched in highly contaminated sites and extensive field data show they depress levels of MeHg >500-fold in such zones2. So, enhancing the natural capacity of indigenous HgR microbes to remove Hg(II) and RHg(I) from soils, sediments and waterways is a logical component of a comprehensive plan for clean up and stewardship of contaminated sites.« less

Molecular Mechanisms of Bacterial Mercury Transformation

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

Summers, Anne O.; Smith, Jeremy C.

Hg is of special interest to DOE due to past intensive use in manufacture of nuclear weapons at the Oak Ridge Reservation (ORR). Because of its facile oxidation/reduction [Hg(II)/Hg(0)] chemistry, ability to bond to carbon [as in highly toxic methylmercury: MeHg(I)] and its unique physical properties [e.g., volatility of Hg(0)], Hg has a complex environmental cycle involving soils, sediments, waterways and the atmosphere and including biotic and abiotic chemical and physical transport and transformations. Understanding such processes well enough to design stewardship plans that minimize negative impacts in diverse ecological settings requires rich knowledge of the contributing abiotic and bioticmore » processes. Prokaryotes are major players in the global Hg cycle. Facultative and anaerobic bacteria can form MeHg(I) with consequent intoxication of wildlife and humans. Sustainable stewardship of Hg-contaminated sites requires eliminating not only MeHg(I) but also the Hg(II) substrate for methylation. Fortunately, a variety of mercury resistant (HgR) aerobic and facultative bacteria and archaea can do both things. Prokaryotes harboring narrow or broad Hg resistance (mer) loci detoxify Hg(II) or RHg(I), respectively, to relatively inert, less toxic, volatile Hg(0). HgR microbes are enriched in highly contaminated sites and extensive field data show they depress levels of MeHg >500-fold in such zones. So, enhancing the natural capacity of indigenous HgR microbes to remove Hg(II) and RHg(I) from soils, sediments and waterways is a logical component of a comprehensive plan for clean up and stewardship of contaminated sites.« less

A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options

PubMed Central

2012-01-01

Background Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes. Methods Drawing on qualitative review of policy and program documents from five LMICs and data from global key-informant surveys conducted in 2004 and 2010, we examine current status of governance of response to NCDs at national level along three dimensions— institutional arrangements for stewardship and program management and implementation; policies/plans; and multisectoral coordination and partnerships. Results Several positive trends were noted in the organization and governance of response to NCDs: shift from specific NCD-based programs to integrated NCD programs, increasing inclusion of NCDs in sector-wide health plans, and establishment of high-level multisectoral coordination mechanisms. Several areas of concern were identified. The evolving NCD-specific institutional structures are being treated as ‘program management and implementation’ entities rather than as lead ‘technical advisory’ bodies, with unclear division of roles and responsibilities between NCD-specific and sector-wide structures. NCD-specific and sector-wide plans are poorly aligned and lack prioritization, costing, and appropriate targets. Finally, the effectiveness of existing multisectoral coordination mechanisms remains questionable. Conclusions The ‘technical functions’ and ‘implementation and management functions’ should be clearly separated between NCD-specific units and sector-wide institutional structures to avoid duplicative segmented service delivery systems. Institutional capacity building efforts for NCDs should target both NCD-specific units (for building technical and analytical capacity) and sector-wide organizational units (for building program management and implementation capacity) in MOH. The sector-wide health plans should reflect NCDs in proportion to their public health importance. NCD specific plans should be developed in close consultation with sector-wide health- and non-health stakeholders. These plans should expand on the directions provided by sector-wide health plans specifying strategically prioritized, fully costed activities, and realistic quantifiable targets for NCD control linked with sector-wide expenditure framework. Multisectoral coordination mechanisms need to be strengthened with optimal decision-making powers and resource commitment and monitoring of their outputs. PMID:23067232

[The health system of Honduras].

PubMed

Bermúdez-Madriz, Juan Luis; Sáenz, María del Rocío; Muiser, Jorine; Acosta, Mónica

2011-01-01

This paper describes the health system of Honduras, including its challenges, structure coverage, sources of financing, resources and stewardship activities. This system counts with a public and a private sector. The public sector includes the Ministry of Health (MH) and the Honduran Social Security Institute (HSSI). The private sector is dominated by a set of providers offering services payed mostly out-of-pocket. The National Health Plan 2010-2014 includes a set of reforms oriented towards the creation of an integrated and plural system headed by the MH in its stewardship role. It also anticipates the creation of a public health insurance for the poor population and the transformation of the HSSI into a public insurance agency which contracts services for its affiliates with public and private providers under a family medicine model.

The Educational Facilities Professional's Practical Guide to Reducing the Campus Carbon Footprint

ERIC Educational Resources Information Center

Hignite, Karla

2009-01-01

As more institutions respond to the American College & University Presidents Climate Commitment, or are otherwise responsible for campus environmental stewardship, this implementation guide gives educational facilities professionals a practical framework for moving forward in their unique role within this process. The intent is to help facilities…

Implementing an Antibiotic Stewardship Information System to Improve Hospital Infection Control: A Co-Design Process.

PubMed

Maia, Mélanie R; Simões, Alexandra; Lapão, Luís V

2018-01-01

HAITooL information system design and implementation was based on Design Science Research Methodology, ensuring full participation, in close collaboration, of researchers and a multidisciplinary team of healthcare professionals. HAITooL enables effective monitoring of antibiotic resistance, antibiotic use and provides an antibiotic prescription decision-supporting system by clinicians, strengthening the patient safety procedures. The design, development and implementation process reveals benefits in organizational and behavior change with significant success. Leadership commitment multidisciplinary team and mainly informaticians engagement was crucial to the implementation process. Participants' motivation and the final product delivery and evolution depends on that.

Treating Wisely: The Surgeon's Role in Antibiotic Stewardship.

PubMed

Leeds, Ira L; Fabrizio, Anne; Cosgrove, Sara E; Wick, Elizabeth C

2017-05-01

: Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.

Effect of a wildlife conservation camp experience in China on student knowledge of animals, care, propensity for environmental stewardship, and compassionate behavior toward animals

NASA Astrophysics Data System (ADS)

Bexell, Sarah M.

The goal of conservation education is positive behavior change toward animals and the environment. This study was conducted to determine whether participation in a wildlife conservation education camp was effective in positively changing 8-12 year old students': (a) knowledge of animals, (b) care about animals, (c) propensity for environmental and wildlife stewardship, and (d) compassionate behavior toward animals. During the summer of 2005, 2 five-day camps were conducted at 2 zoological institutions in Chengdu, China. The camp curriculum was influenced by theory and research on the following: conservation psychology, social learning theory, empathy and moral development theory, socio-biological theory, constructivist theory, and conservation science. Camp activities were sensitive to Chinese culture and included Chinese conservation issues. Activities were designed to help children form bonds with animals and care enough about them to positively change their behavior toward animals and the environment. This mixed methods study triangulated quantitative and qualitative data from six sources to answer the following: (1) Did camp increase student knowledge of animals? (2) Did camp increase student caring about animals? (3) Did camp increase student propensity for environmental and wildlife stewardship? (4) Did camp affect student compassionate behavior toward animals? A conservation stewards survey revealed significant increases on pre-post, self-report of knowledge, care, and propensity. Pre-post, rubric-scored responses to human-animal interaction vignettes indicated a significant increase in knowledge, and stable scores on care and propensity. Qualitative data from student journals, vignettes, and end-of-camp questionnaires demonstrated knowledge, caring, and propensity, and revealed the emergent theme empathy. To address question 4, instructors tallied campers' behavior toward animals using a student behavior ethogram. Occurrence of positive behaviors was inconsistent, but negative behaviors decreased, indicating campers were more conscious of behaviors to avoid. Field notes helped determine that camps were implemented as planned, therefore not interfering with goals of the camp. This study contributes to an emerging and critical knowledge base of effective strategies to promote conservation behavior.

Impact of implementation of a novel antimicrobial stewardship tool on antibiotic use in nursing homes: a prospective cluster randomized control pilot study.

PubMed

Fleet, Elizabeth; Gopal Rao, G; Patel, Bharat; Cookson, Barry; Charlett, Andre; Bowman, Clive; Davey, Peter

2014-08-01

To evaluate the impact of 'Resident Antimicrobial Management Plan' (RAMP), a novel antimicrobial stewardship tool on systemic antibiotic use for treatment of infection in nursing homes (NHs). A pilot cluster randomized control study was conducted in 30 NHs in London. Pre-intervention, we collected point prevalence data on antimicrobial use on three occasions and total antimicrobial consumption for a 12 week period. Post-intervention data were collected in the same manner and included assessment of compliance with RAMP in the intervention group (IG). The number of residents included was 1628 pre-intervention [825 IG/803 control group (CG)] and 1610 post-intervention (838 IG/772 CG). The corresponding pre- and post-intervention point prevalence of systemic antibiotic prescribing for treatment of infection was 6.46% and 6.52% in the IG [estimated prevalence ratio: 1.01 (95% CI: 0.81-1.25), P = 0.94] compared with 5.27% and 5.83%, respectively, in the CG [estimated prevalence ratio: 1.11 (95% CI: 0.87-1.41), P = 0.4]. Total antibiotic consumption was 69.78 defined daily doses/1000 residents/day (DRD) pre-intervention and 66.53 DRD post-intervention in the IG compared with 49.68 and 51.92 DRD, respectively, in the CG. There was a significant decrease of 4.9% (3.25 DRD) in the IG (95% CI: 1.0%-8.6%) (P = 0.02) compared with a significant increase of 5.1% (2.24 DRD) in the CG (95% CI: 0.2%-10.2%) (P = 0.04). Main indications for antibiotics were lower respiratory tract infections (34.1%), urinary tract infections (28.5%) and skin/soft tissue infections (25.1%). This pilot study demonstrated that use of RAMP was associated with a statistically significant decrease in total antibiotic consumption and has the potential to be an important antimicrobial stewardship tool for NHs. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Nurse and Medical Provider Perspectives on Antibiotic Stewardship in Nursing Homes.

PubMed

Scales, Kezia; Zimmerman, Sheryl; Reed, David; Beeber, Anna Song; Kistler, Christine E; Preisser, John S; Weiner, Bryan J; Ward, Kimberly; Fann, Amy; Sloane, Philip D

2017-01-01

To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs). Cross-sectional survey. NHs in North Carolina (N = 31). Nursing staff (n = 182) and medical providers (n = 50). Respondents completed a self-administered questionnaire about their perspectives on antibiotic use in their NH, the influence of residents and families on antibiotic prescribing decisions, and readiness to improve antibiotic stewardship. Open-ended questions on barriers to antibiotic stewardship were also asked. Linear mixed modeling was used to analyze differences between respondent groups and to test for associations with individual and organizational characteristics. All respondents supported reducing antibiotic use, although medical providers' support was significantly stronger (P = .005). When asked about their perception of residents' and family members' preference for antibiotic use in the case of suspected infection and the influence of that preference on antibiotic-prescribing decisions, respondents indicated that residents and families favor antibiotic use and influence prescribing decisions. Nurses reported a stronger perception than medical providers that families prefer antibiotics (P = .04) and influence prescribing decisions (P = .02). All respondents reported commitment and efficacy to change practices (mean 4.0-4.1 for nurses and 3.6-3.9 for medical providers on a 5-point scale). Four significant associations related to organizational and individual characteristics were found: directors of nursing and specialist nurses reported greater self-efficacy for changing practice than other nurses (P = .003), medical providers with a subspecialty (e.g., geriatrics) reported greater self-efficacy (P = .007) and commitment to change (P = .001) than those without a subspecialty, and medical providers specializing in hospice and palliative care rated family influence (P = .006) higher than those with other subspecialties. Nursing staff and medical providers share a commitment to reducing unnecessary antibiotic use. Antibiotic stewardship interventions should foster cooperation and build competency to implement alternative management approaches and to educate residents and families. Nurse leaders and medical providers with long-term care training may be especially effective champions for antibiotic stewardship. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Experience With Rapid Microarray-Based Diagnostic Technology and Antimicrobial Stewardship for Patients With Gram-Positive Bacteremia.

PubMed

Neuner, Elizabeth A; Pallotta, Andrea M; Lam, Simon W; Stowe, David; Gordon, Steven M; Procop, Gary W; Richter, Sandra S

2016-11-01

OBJECTIVE To describe the impact of rapid diagnostic microarray technology and antimicrobial stewardship for patients with Gram-positive blood cultures. DESIGN Retrospective pre-intervention/post-intervention study. SETTING A 1,200-bed academic medical center. PATIENTS Inpatients with blood cultures positive for Staphylococcus aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae, S. pyogenes, S. agalactiae, S. anginosus, Streptococcus spp., and Listeria monocytogenes during the 6 months before and after implementation of Verigene Gram-positive blood culture microarray (BC-GP) with an antimicrobial stewardship intervention. METHODS Before the intervention, no rapid diagnostic technology was used or antimicrobial stewardship intervention was undertaken, except for the use of peptide nucleic acid fluorescent in situ hybridization and MRSA agar to identify staphylococcal isolates. After the intervention, all Gram-positive blood cultures underwent BC-GP microarray and the antimicrobial stewardship intervention consisting of real-time notification and pharmacist review. RESULTS In total, 513 patients with bacteremia were included in this study: 280 patients with S. aureus, 150 patients with enterococci, 82 patients with stretococci, and 1 patient with L. monocytogenes. The number of antimicrobial switches was similar in the pre-BC-GP (52%; 155 of 300) and post-BC-GP (50%; 107 of 213) periods. The time to antimicrobial switch was significantly shorter in the post-BC-GP group than in the pre-BC-GP group: 48±41 hours versus 75±46 hours, respectively (P<.001). The most common antimicrobial switch was de-escalation and time to de-escalation, was significantly shorter in the post-BC-GP group than in the pre-BC-GP group: 53±41 hours versus 82±48 hours, respectively (P<.001). There was no difference in mortality or hospital length of stay as a result of the intervention. CONCLUSIONS The combination of a rapid microarray diagnostic test with an antimicrobial stewardship intervention improved time to antimicrobial switch, especially time to de-escalation to optimal therapy, in patients with Gram-positive blood cultures. Infect Control Hosp Epidemiol 2016;1-6.

[The health system of Brazil].

PubMed

Montekio, Víctor Becerril; Medina, Guadalupe; Aquino, Rosana

2011-01-01

This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.

Best Practices for Curriculum, Teaching, and Evaluation Components of Aquatic Stewardship Education.

ERIC Educational Resources Information Center

Siemer, William F.

This paper reviews the literature to outline principles and best practices for aquatic stewardship education. Stewardship education develops an internalized stewardship ethic and the skills needed for decision making and environmentally responsible actions. Successful stewardship education programs are designed to influence beliefs, values,…

Education Strategic Plan 2009-2029: Focusing on Science, Service & Stewardship

ERIC Educational Resources Information Center

National Oceanic and Atmospheric Administration, 2009

2009-01-01

Global climate change, rising sea levels, changing weather patterns, collapsing fisheries, and habitat losses are real threats to the American economy and way of life. At the same time, America's youth continue to fall further behind their global peers in science and math, resulting in the threat of a future where fewer Americans are prepared for…

Sustainability at BPA 2012

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

None

BPA’s Sustainability Action Plan is grounded in our commitment to environmental stewardship and Executive Order 13514 that calls on the federal agencies to “lead by example” by setting a 2020 greenhouse gas emissions target, increasing energy efficiency; reducing fleet petroleum consumption; conserving water; reducing waste; supporting sustainable communities; and leveraging federal purchasing power to promoting environmentally responsible products and technologies.

"But the Pension Fund Was Just "SITTING" There...": The Politics of Teacher Retirement Plans

ERIC Educational Resources Information Center

Hess, Frederick M.; Squire, Juliet P.

2010-01-01

The tension at the heart of pension politics is the incentive to satisfy today's claimants in the here and now at the expense of long-term concerns. Teacher pensions, in particular, pose two challenges. The first is that political incentives invite irresponsible fiscal stewardship, as public officials make outsized short-term commitments to…

NED-1: integrated analyses for forest stewardship decisions

Treesearch

Mark J. Twery; H. Michael Rauscher; Deborah J. Bennett; Scott A. Thomasma; Susan L. Stout; James F. Palmer; Robin E. Hoffman; David S. DeCalesta; Eric Gustafson; J. Morgan Grove; Donald Nute; Geneho Kim; R. Peter Kollasch

2000-01-01

NED is a collective term for a set of software intended to help resource managers develop goals, assess current and potential conditions, and produce sustainable management plans for forest properties. The software tools are being developed by the USDA Forest Service, Northeastern and Southern Research Stations, in cooperation with many other collaborators. NED-1 is a...

Urban forest restoration cost modeling: a Seattle natural areas case study

Treesearch

Jean M. Daniels; Weston Brinkley; Michael D. Paruszkiewicz

2016-01-01

Cities have become more committed to ecological restoration and management activities in urban natural areas. Data about costs are needed for better planning and reporting. The objective of this study is to estimate the costs for restoration activities in urban parks and green space in Seattle, Washington. Stewardship activity data were generated from a new database...

77 FR 2991 - Gulf of Mexico (GOM), Outer Continental Shelf (OCS), Central Planning Area (CPA), Oil and Gas...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-20

... circumstances and information arising from, among other things, the Deepwater Horizon event. This Final... Supplemental EIS) is available at BOEM's Internet Web site at http://www.boem.gov/Environmental-Stewardship... visit BOEM's Internet Web site at http://www.gomr.boem.gov/homepg/regulate/environ/libraries.html . FOR...

Feasibility and applicability of antimicrobial stewardship in immunocompromised patients.

PubMed

Robilotti, Elizabeth; Holubar, Marisa; Seo, Susan K; Deresinski, Stan

2017-08-01

Antimicrobial stewardship is the primary intervention in the battle against antimicrobial resistance, but clinicians do not always apply many key antimicrobial stewardship principles to patients with significant immune defects due to lack of data and fear of bad outcomes. We review evidence regarding the application of stewardship principles to immunocompromised patients, with a focus on solid organ and hematopoietic stem cell transplant recipients. Antimicrobial stewardship programs (ASPs), targeting immunocompromised patient populations such as oncology and transplant, are gaining traction. Emerging literature suggests that several stewardship interventions can be adapted to immunocompromised hosts and improve antimicrobial utilization, but data supporting improved outcomes is very limited. The application of antimicrobial stewardship principles to immunocompromised patients is feasible, necessary, and urgent. As antimicrobial stewardship programs gain momentum across a diverse range of healthcare settings more immunocompromised patients will fall under their purview. It is imperative that centers applying antimicrobial stewardship principles share their experience and establish collaborative research efforts to advance our knowledge base in applying antimicrobial stewardship initiatives to immunocompromised host populations, both in terms of programmatic success and patient outcomes.

NATURAL RESOURCE MANAGEMENT PLAN FOR BROOKHAVEN NATIONAL LABORATORY.

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

GREEN,T.ET AL.

2003-12-31

Brookhaven National Laboratory (BNL) is located near the geographic center of Long Island, New York. The Laboratory is situated on 5,265 acres of land composed of Pine Barrens habitat with a central area developed for Laboratory work. In the mid-1990s BNL began developing a wildlife management program. This program was guided by the Wildlife Management Plan (WMP), which was reviewed and approved by various state and federal agencies in September 1999. The WMP primarily addressed concerns with the protection of New York State threatened, endangered, or species of concern, as well as deer populations, invasive species management, and the revegetationmore » of the area surrounding the Relativistic Heavy Ion Collider (RHIC). The WMP provided a strong and sound basis for wildlife management and established a basis for forward motion and the development of this document, the Natural Resource Management Plan (NRMP), which will guide the natural resource management program for BNL. The body of this plan establishes the management goals and actions necessary for managing the natural resources at BNL. The appendices provide specific management requirements for threatened and endangered amphibians and fish (Appendices A and B respectively), lists of actions in tabular format (Appendix C), and regulatory drivers for the Natural Resource Program (Appendix D). The purpose of the Natural Resource Management Plan is to provide management guidance, promote stewardship of the natural resources found at BNL, and to integrate their protection with pursuit of the Laboratory's mission. The philosophy or guiding principles of the NRMP are stewardship, adaptive ecosystem management, compliance, integration with other plans and requirements, and incorporation of community involvement, where applicable.« less

Impact of an antiretroviral stewardship strategy on medication error rates.

PubMed

Shea, Katherine M; Hobbs, Athena Lv; Shumake, Jason D; Templet, Derek J; Padilla-Tolentino, Eimeira; Mondy, Kristin E

2018-05-02

The impact of an antiretroviral stewardship strategy on medication error rates was evaluated. This single-center, retrospective, comparative cohort study included patients at least 18 years of age infected with human immunodeficiency virus (HIV) who were receiving antiretrovirals and admitted to the hospital. A multicomponent approach was developed and implemented and included modifications to the order-entry and verification system, pharmacist education, and a pharmacist-led antiretroviral therapy checklist. Pharmacists performed prospective audits using the checklist at the time of order verification. To assess the impact of the intervention, a retrospective review was performed before and after implementation to assess antiretroviral errors. Totals of 208 and 24 errors were identified before and after the intervention, respectively, resulting in a significant reduction in the overall error rate ( p < 0.001). In the postintervention group, significantly lower medication error rates were found in both patient admissions containing at least 1 medication error ( p < 0.001) and those with 2 or more errors ( p < 0.001). Significant reductions were also identified in each error type, including incorrect/incomplete medication regimen, incorrect dosing regimen, incorrect renal dose adjustment, incorrect administration, and the presence of a major drug-drug interaction. A regression tree selected ritonavir as the only specific medication that best predicted more errors preintervention ( p < 0.001); however, no antiretrovirals reliably predicted errors postintervention. An antiretroviral stewardship strategy for hospitalized HIV patients including prospective audit by staff pharmacists through use of an antiretroviral medication therapy checklist at the time of order verification decreased error rates. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

European Antibiotic Awareness Day 2017: training the next generation of health care professionals in antibiotic stewardship.

PubMed

Schrier, Lenneke; Hadjipanayis, Adamos; Del Torso, Stefano; Stiris, Tom; Emonts, Marieke; Dornbusch, Hans Juergen

2018-02-01

Antimicrobial stewardship (AMS) aims to optimise treatment, minimise the risk of adverse effects and reduce health care costs. In addition, it is recognised as a key component to stop the current spread of antimicrobial resistance in Europe. Educational programmes are particularly important for the successful implementation of AMS. Training should start during medical school, continue during clinical training and be reinforced throughout postgraduate training. National core curricula for paediatric training should include passive and active training of competencies needed for AMS and future paediatricians should be skilled in taking leadership roles in AMS initiatives. Other core members of the paediatric AMS team should also receive training focused on the unique medical needs of the paediatric patient. Ideally, all communities, hospitals and health regions in Europe should have AMS that serve all patient types, including children. We all have the responsibility to ensure that existing antibiotics remain effective. What is Known: • Antimicrobial stewardship (AMS) is a key component to stop the current spread of antimicrobial resistance • Educational programmes are particularly important for the successful implementation of AMS What is New: • All medical doctors in Europe who will be undertaking significant practice in child health should master the competencies needed to prescribe antibiotics to children rationally as described in the European Academy of Paediatrics (EAP) Curriculum for Common Trunk Training in Paediatrics • Interdisciplinary approaches of education need to be developed, as all hospitals and health regions in Europe ideally should have AMS programmes that serve all patient types, including children.

Working at the intersection of context, culture, and technology: Provider perspectives on antimicrobial stewardship in the emergency department using electronic health record clinical decision support.

PubMed

Chung, Phillip; Scandlyn, Jean; Dayan, Peter S; Mistry, Rakesh D

2017-11-01

Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado. We reviewed and coded the data using constant comparative analysis and framework analysis until a final set of themes emerged. Two dominant perceptions shaped providers' perspectives on ASPs in the ED and EHR CDS: (1) maintaining workflow efficiency and (2) constrained decision-making autonomy. Clinicians identified structural barriers to ASPs, such as pace of the ED, and various beliefs that shaped patterns of practice, including accommodating the prescribing decisions of other providers and managing parental expectations. Recommendations to enhance uptake focused on designing a simple yet flexible user interface, providing clinicians with performance data, and on-boarding clinicians to enhance buy-in. Developing a successful ED-based ASP using EHR CDS should attend to technologic needs, the institutional context, and the cultural beliefs of practice associated with providers' antibiotic prescribing. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Facility Decontamination and Decommissioning Program Surveillance and Maintenance Plan, Revision 2

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

Poderis, Reed J.; King, Rebecca A.

This Surveillance and Maintenance (S&M) Plan describes the activities performed between deactivation and final decommissioning of the following facilities located on the Nevada National Security Site, as documented in the Federal Facility Agreement and Consent Order under the Industrial Sites program as decontamination and decommissioning sites: ? Engine Maintenance, Assembly, and Disassembly (EMAD) Facility: o EMAD Building (Building 25-3900) o Locomotive Storage Shed (Building 25-3901) ? Test Cell C (TCC) Facility: o Equipment Building (Building 25-3220) o Motor Drive Building (Building 25-3230) o Pump Shop (Building 25-3231) o Cryogenic Lab (Building 25-3232) o Ancillary Structures (e.g., dewars, water tower, piping,more » tanks) These facilities have been declared excess and are in various stages of deactivation (low-risk, long-term stewardship disposition state). This S&M Plan establishes and implements a solid, cost-effective, and balanced S&M program consistent with federal, state, and regulatory requirements. A graded approach is used to plan and conduct S&M activities. The goal is to maintain the facilities in a safe condition in a cost-effective manner until their final end state is achieved. This plan accomplishes the following: ? Establishes S&M objectives and framework ? Identifies programmatic guidance for S&M activities to be conducted by National Security Technologies, LLC, for the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) ? Provides present facility condition information and identifies hazards ? Identifies facility-specific S&M activities to be performed and their frequency ? Identifies regulatory drivers, NNSA/NFO policies and procedures, and best management practices that necessitate implementation of S&M activities ? Provides criteria and frequencies for revisions and updates ? Establishes the process for identifying and dispositioning a condition that has not been previously identified or documented ? Provides instructions for implementing annual S&M inspections and activities The following facilities that were included in Revision 1 of this plan have reached final disposition and are no longer in the S&M program: ? Reactor Maintenance, Assembly, and Disassembly Facility, Building 25-3110 ? Test Cell A Facility, Building 25-3113 ? TCC Facility, Building 25-3210 ? Pluto Disassembly Facility, Building 26-2201 ? Super Kukla Facility, Building 27-5400« less

An Elective Course on Antimicrobial Stewardship.

PubMed

Gauthier, Timothy P; Sherman, Elizabeth M; Unger, Nathan R

2015-12-25

To implement an antimicrobial stewardship (AS) elective course for second-year and third-year pharmacy students and to assess its impact on students' perceptions regarding the application of AS principles. A 2-credit elective course focusing on principles of AS incorporated prelecture didactic recordings with primary literature and guideline-based reading assignments, in-class active-learning group work and student-led presentations, and student-generated examination items. Perceptions were assessed by precourse and postcourse survey items. Graded course assessments included completion of preclass assignments (readings, prerecorded lecture and writing assessment items), in-class active participation and group presentations, a midpoint examination, and a final examination. An AS-themed elective course in a doctor of pharmacy curriculum incorporating preclass, self-directed learning and in-class group-based active-learning strategies positively impacted students' perceived understanding of AS strategies.

The revival of old antibiotics for treatment of uncomplicated urinary tract infections in the era of antibiotic stewardship.

PubMed

Kranz, Jennifer; Helbig, Sina; Mandraka, Falitsa; Schmidt, Stefanie; Naber, Kurt G

2017-03-01

In the era of increasing antibiotic resistance worldwide, this review highlights the advantages of revival of old antibiotics for treatment of uncomplicated urinary tract infections (uUTIs). Recent studies have shown that these four oral old antibiotics, fosfomycin trometamol, nitrofurantoin, nitroxoline and pivmecillinam, show no increasing antibiotic resistance against uropathogens causing uUTI, are still effective for the treatment of uUTI and exhibit only minimal or no collateral damage as compared with fluoroquinolones or third-generation cephalosporines. According to the principles of antibiotic stewardship, the prudent use of antibiotics is needed. Therefore, recent international and national guidelines already favour these old oral antibiotics as first-choice treatment of uUTI. Unfortunately, implementation of these guidelines is still suboptimal.

Knowledge and Attitudes of Doctor of Pharmacy Students Regarding the Appropriate Use of Antimicrobials

PubMed Central

Justo, Julie Ann; Gauthier, Timothy P.; Scheetz, Marc H.; Chahine, Elias B.; Bookstaver, P. Brandon; Gallagher, Jason C.; Hermsen, Elizabeth D.; DePestel, Daryl D.; Ernst, Erika J.; Jacobs, David M.; Esterly, John S.; Suda, Katie J.; Olsen, Keith M.; Abbo, Lilian M.; MacDougall, Conan

2014-01-01

Pharmacists are key partners in antimicrobial stewardship efforts, yet their degree of education on and attitudes toward this topic during training are not well documented. An electronic survey measuring knowledge and attitudes regarding antimicrobial use and resistance was administered to graduating pharmacy students at 12 US schools of pharmacy. Of 1445 pharmacy students, 579 (40%) completed the survey. The vast majority (94%) believed that strong knowledge of antimicrobials was important for their pharmacy careers, and 89% desired more education on appropriate antimicrobial use. Most students (84%) considered their pharmacy education regarding antimicrobials useful or very useful, but there was significant variability on perceptions of preparation for most antimicrobial stewardship activities according to the students' school. The mean number of correct answers on a section of 11 knowledge questions was 5.8 (standard deviation 2.0; P value for score between schools <.001). On multivariable linear regression analysis, significant predictors of a higher knowledge score were pharmacy school attended, planned postgraduate training, completion of a clinical rotation in infectious diseases, perception of pharmacy school education as useful, use of resources to answer the knowledge questions, and use of Infectious Diseases Society of America guidelines and smartphone applications as frequent resources for learning about antimicrobials. Pharmacy students perceive antimicrobial stewardship to be an important healthcare issue and desire more education on the subject. Student perceptions of antimicrobial coursework and actual antimicrobial knowledge scores significantly varied by the school of pharmacy attended. Sharing of best practices among institutions may enhance the preparation of future pharmacists to contribute to effective antimicrobial stewardship. PMID:25261543

Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units.

PubMed

Ruiz-Ramos, Jesus; Frasquet, Juan; Romá, Eva; Poveda-Andres, Jose Luis; Salavert-Leti, Miguel; Castellanos, Alvaro; Ramirez, Paula

2017-06-01

To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.

Total quality management: managing the human dimension in natural resource agencies

Treesearch

Denzil Verardo

1995-01-01

Stewardship in an era of dwindling human resources requires new approaches to the way business is conducted in the public sector, and Total Quality Management (TQM) can be the avenue for this transformation. Resource agencies are no exception to this requirement, although modifications to "traditional" private enterprise versions of TQM implementation...

COPEing With Environmental Education Program Development and Infusion into the Global Studies Curricula of Rural Schools.

ERIC Educational Resources Information Center

Peters, Richard O.

An environmental education-oriented global studies program to promote attitudes of environmental stewardship can be implemented in K-12 rural school systems, as an integrated part of social studies instruction, without overburdening the curriculum, by using the Curriculum Organization and Program Evaluation (COPE) model. The model provides…

Assessing and comparing relationships between urban environmental stewardship networks and land cover in Baltimore and Seattle

Treesearch

Michele Romolini; J. Morgan Grove; Dexter H. Locke

2013-01-01

Implementation of urban sustainability policies often requires collaborations between organizations across sectors. Indeed, it is commonly agreed that governance by environmental networks is preferred to individual organizations acting alone. Yet research shows that network structures vary widely, and that these variations can impact network effectiveness. However,...

Amenable Performance Management in Higher Education: Integrating Principles of Agency and Stewardship Theories

ERIC Educational Resources Information Center

Seyama, Sadi Mokhaneli

2015-01-01

The considerable transformation of higher education (HE), driven by the South African government's demand for accountability of resources for the attainment of its mandate has altered the "business" of academia. In response to the financial austerity measures, performance management (PM) systems have been implemented in South African HE…

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

Kreie, Ken; Findlay, Rick

The U.S. Department of Energy (DOE) Office of Legacy Management (LM) prepared this Long-Term Surveillance and Maintenance Plan (LTSMP) for the Gnome-Coach, New Mexico, Site (the Gnome site). The Gnome site is approximately 25 miles east of Carlsbad in Eddy County, New Mexico (Figure 1). The site was the location of a 3-kiloton-yield underground nuclear test and radioisotope groundwater tracer test. The tests resulted in residual contamination and post-detonation features that require long-term oversight. Long-term responsibility for the site was transferred from the DOE National Nuclear Security Administration Nevada Site Office to LM on October 1, 2006. Responsibilities include surveillance,more » monitoring, and maintenance of institutional controls (ICs) as part of the long-term stewardship of the site. Long-term stewardship is designed to ensure protection of human health and the environment.« less

A national survey of pediatric dentists on antibiotic use in children.

PubMed

Sivaraman, Sujatha S; Hassan, Mohamed; Pearson, Julie M

2013-01-01

The purposes of this study were to: (1) examine the antibiotic prescribing practices of pediatric dentists and adherence to professional guidelines; and (2) assess their knowledge of and attitudes toward antibiotic resistance. A cross-sectional survey regarding antibiotic use, resistance, and knowledge of antibiotic stewardship programs was emailed to 4,636 members of the American Academy of Pediatric Dentistry (AAPD). 987 surveys (21 percent) were completed; 984 were analyzed. Lack of adherence to AAPD antibiotic guidelines was noted. There was a trend toward overuse of antibiotics for the following conditions: irreversible pulpitis with (32 percent) and without vital pulp (42 percent); localized dentoalveolar abscess with (68 percent) and without draining fistula (39 percent); mitral valve relapse with regurgitation (43 percent); intrusion (15 percent); extrusion (13 percent); and rheumatoid arthritis (12 percent). Determinants of antibiotic use were: facial swelling (88 percent); pain relief (15 percent); unavailable appointment for several weeks (six percent); and parental satisfaction (four percent). Although 98 percent of respondents believed that antibiotic resistance is of growing concern, only 15 percent were aware of antibiotic stewardship programs. AAPD members overprescribe antibiotics. Educational programs to increase knowledge of antibiotic resistance and stewardship programs should be implemented to increase adherence to professional guidelines.

Enabling Long-Term Earth Science Research: Changing Data Practices (Invited)

NASA Astrophysics Data System (ADS)

Baker, K. S.

2013-12-01

Data stewardship plans are shaped by our shared experiences. As a result, community engagement and collaborative activities are central to the stewardship of data. Since modes and mechanisms of engagement have changed, we benefit from asking anew: ';Who are the communities?' and ';What are the lessons learned?'. Data stewardship with its long-term care perspective, is enriched by reflection on community experience. This presentation draws on data management issues and strategies originating from within long-term research communities as well as on recent studies informed by library and information science. Ethnographic case studies that capture project activities and histories are presented as resources for comparative analysis. Agency requirements and funding opportunities are stimulating collaborative endeavors focused on data re-use and archiving. Research groups including earth scientists, information professionals, and data systems designers are recognizing the possibilities for new ways of thinking about data in the digital arena. Together, these groups are re-conceptualizing and reconfiguring for data management and data curation. A differentiation between managing data for local use and production of data for re-use remotely in locations and fields remote from the data origin is just one example of the concepts emerging to facilitate development of data management. While earth scientists as data generators have the responsibility to plan new workflows and documentation practices, data and information specialists have responsibility to promote best practices as well as to facilitate the development of community resources such as controlled vocabularies and data dictionaries. With data-centric activities and changing data practices, the potential for creating dynamic community information environments in conjunction with development of data facilities exists but remains elusive.

Implementation and impact of an audit and feedback antimicrobial stewardship intervention in the orthopaedics department of a tertiary-care hospital: a controlled interrupted time series study.

PubMed

Tavares, Margarida; Carvalho, Ana Cláudia; Almeida, José Pedro; Andrade, Paulo; São-Simão, Ricardo; Soares, Pedro; Alves, Carlos; Pinto, Rui; Fontanet, Arnaud; Watier, Laurence

2018-06-01

A prospective audit and feedback antimicrobial stewardship intervention conducted in the Orthopaedics Department of a university hospital in Portugal was evaluated by comparing an interrupted time series in the intervention group with a non-intervention (control) group. Monthly antibiotic use (except cefazolin) was measured as the World Health Organization's Anatomical Therapeutic Chemical defined daily doses (ATC-DDD) from January 2012 to September 2016, excluding the 6-month phase of intervention implementation starting on 1 January 2015. Compared with the control group, the intervention group had a monthly decrease in the use of fluoroquinolones by 2.3 DDD/1000 patient-days [95% confidence interval (CI) -3.97 to -0.63]. An increase in the use of penicillins by 103.3 DDD/1000 patient-days (95% CI 47.42 to 159.10) was associated with intervention implementation, followed by a decrease during the intervention period (slope = -5.2, 95% CI -8.56 to -1.82). In the challenging scenario of treatment of osteoarticular and prosthetic joint infections, an audit and feedback intervention reduced antibiotic exposure and spectrum. Copyright © 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

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.

Non-timber forest products and forest stewardship plans

Treesearch

Becky Barlow; Tanner Filyaw; Sarah W. Workman

2015-01-01

To many woodland owners “harvesting” typically means the removal of timber from forests. In recent years many landowners have become aware of the role non-timber forest products (NTFPs) can play in supplemental management strategies to produce income while preserving other forest qualities. NTFPs are a diverse group of craft, culinary, and medicinal products that have...

A collaborative fire hazard reduction/ecosystem restoration stewardship project in a Montana mixed ponderosa pine/Douglas-fir/western larch wildland urban interface

Treesearch

Steve Slaughter; Laura Ward; Michael Hillis; Jim Chew; Rebecca McFarlan

2004-01-01

Forest Service managers and researchers designed and evaluated alternative disturbance-based fire hazard reduction/ecosystem restoration treatments in a greatly altered low-elevation ponderosa pine/Douglas-fir/western larch wildland urban interface. Collaboratively planned improvement cutting and prescribed fire treatment alternatives were evaluated in simulations of...

Reshaping NASA's Aeronautics Program

NASA Technical Reports Server (NTRS)

Liang, Anita D.

2007-01-01

We will dedicate ourselves to the mastery and intellectual stewardship of the core competencies of Aeronautics for the Nation in all flight regimes. We will focus our research in areas that are appropriate to NASA's unique capabilities. we will directly address the R&D needs of the Next Generation Air Transportation System (NGATS) in partnership with the member agencies of the Joint Planning and development Office (JPDO).

Selecting indicators and understanding their role in wilderness experience stewardship at Gates of the Arctic National Park and Preserve

Treesearch

Brian Glaspell; Alan E. Watson; Katie Kneeshaw; Don Pendergrast

2003-01-01

The Limits of Acceptable Change (LAC) and other indicator-based planning frameworks (e.g., VERP, Visitor Experience and Resource Protection; VIM, Visitor Impact Management) have been widely adopted by wilderness managers. A central feature of these frameworks is the selection of indicators of conditions that influence experience quality, and which managers can...

Forestry in U.S. Climate Change Action Plans: From the Arch to Kyoto

Treesearch

Robert J. Moulton

1998-01-01

The international community has played a major role in prompting actions to address global climate change. The 1989 Summit of the Arch in Paris resulted in President Bush's announcement in his 1990 State of the Union message of the America the Beautiful (ATB) program, which greatly expanded federal funding for urban forestry and for forest stewardship programs...

Service-Learning in the Environmental Sciences for Teaching Sustainability Science

NASA Astrophysics Data System (ADS)

Truebe, S.; Strong, A. L.

2016-12-01

Understanding and developing effective strategies for the use of community-engaged learning (service-learning) approaches in the environmental geosciences is an important research need in curricular and pedagogical innovation for sustainability. In 2015, we designed and implemented a new community-engaged learning practicum course through the Earth Systems Program in the School of Earth, Energy and Environmental Sciences at Stanford University focused on regional open space management and land stewardship. Undergraduate and graduate students partnered with three different regional land trust and environmental stewardship organizations to conduct quarter-long research projects ranging from remote sensing studies of historical land use, to fire ecology, to ranchland management, to volunteer retention strategies. Throughout the course, students reflected on the decision-making processes and stewardship actions of the organizations. Two iterations of the course were run in Winter and Fall 2015. Using coded and analyzed pre- and post-course student surveys from the two course iterations, we evaluate undergraduate and graduate student learning outcomes and changes in perceptions and understanding of sustainability science. We find that engagement with community partners to conduct research projects on a wide variety of aspects of open space management, land management, and environmental stewardship (1) increased an understanding of trade-offs inherent in sustainability and resource management and (2) altered student perceptions of the role of scientific information and research in environmental management and decision-making. Furthermore, students initially conceived of open space as purely ecological/biophysical, but by the end of the course, (3) their understanding was of open space as a coupled human/ecological system. This shift is crucial for student development as sustainability scientists.

Strengthening the Health System to Better Confront Noncommunicable Diseases in India

PubMed Central

Duran, Antonio; Khot, Anagha

2011-01-01

The paper emphasizes the vital need to address the rising burden of noncommunicable diseases (NCDs) in India with a health systems approach. The authors argue that adoption of such approach may soon be imperative. Applying the health systems framework developed by the WHO in 2000 to NCDs means in summary re-examining the planning and organization of the entire health system, from service provision to financing, from information generation to ensuring adequate supply of pharmaceuticals/technologies or human resources, from improving facility management to performance monitoring. Using this framework the authors seek to highlight core issues and identify possible policy actions required. The challenge is to ensure the best implementation of what works, aligning the service provision function with the financial incentives, ensuring leadership/stewardship by the government across local/municipal, state or regional and national level while involving stakeholders. A health system perspective would also ensure that action against NCD goes hand in hand with tackling the remaining burden from communicable diseases, maternal, child health and nutrition issues. PMID:22628908

A comprehensive review of Farm Bill contributions to wildlife conservation, 1985-2000

USGS Publications Warehouse

Heard, P.L.; Allen, A.W.; Best, Louis B.; Brady, S.J.; Burger, W.; Esser, A.J.; Hackett, E.; Johnson, D.H.; Pederson, R.L.; Reynolds, R.E.; Rewa, C.; Ryan, M.R.; Molleur, R.T.; Buck, P.

2000-01-01

A comprehensive review of the scientific literature was undertaken to determine wildlife responses to programs established under the conservation title of the 1985 Food Security Act as amended in 1990 and 1996 (Farm Bill). Literature was annotated and summaries of wildlife responses were provided for the Conservation Reserve Program CRP, Wetlands Reserve Program (WRP), Wildlife Habitat Incentives Program (WHIP) and Environmental Quality Incentives Program (EQIP). The report recognized that Farm Bill conservation programs were created to serve many purposes. Foremost among these purposes was to enable Americaa??s farmers and ranchers to be better stewards of their lands. In general, wildlife responded positively to improvements in land stewardship, particularly when the needs of wildlife were considered in conservation planning and implementation. Whereas authors acknowledged that their understanding of wildlife responses to Farm Bill conservation programs was still incomplete, they concluded that these programs were making significant contributions toward conservation of the nationa??s fish and wildlife resources.

ASC FY17 Implementation Plan, Rev. 1

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

Hamilton, P. G.

The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computationalmore » resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balance of resources, including technical staff, hardware, simulation software, and computer science solutions.« less

Environmental Stewardship: A Conceptual Review and Analytical Framework.

PubMed

Bennett, Nathan J; Whitty, Tara S; Finkbeiner, Elena; Pittman, Jeremy; Bassett, Hannah; Gelcich, Stefan; Allison, Edward H

2018-04-01

There has been increasing attention to and investment in local environmental stewardship in conservation and environmental management policies and programs globally. Yet environmental stewardship has not received adequate conceptual attention. Establishing a clear definition and comprehensive analytical framework could strengthen our ability to understand the factors that lead to the success or failure of environmental stewardship in different contexts and how to most effectively support and enable local efforts. Here we propose such a definition and framework. First, we define local environmental stewardship as the actions taken by individuals, groups or networks of actors, with various motivations and levels of capacity, to protect, care for or responsibly use the environment in pursuit of environmental and/or social outcomes in diverse social-ecological contexts. Next, drawing from a review of the environmental stewardship, management and governance literatures, we unpack the elements of this definition to develop an analytical framework that can facilitate research on local environmental stewardship. Finally, we discuss potential interventions and leverage points for promoting or supporting local stewardship and future applications of the framework to guide descriptive, evaluative, prescriptive or systematic analysis of environmental stewardship. Further application of this framework in diverse environmental and social contexts is recommended to refine the elements and develop insights that will guide and improve the outcomes of environmental stewardship initiatives and investments. Ultimately, our aim is to raise the profile of environmental stewardship as a valuable and holistic concept for guiding productive and sustained relationships with the environment.

Environmental Stewardship: A Conceptual Review and Analytical Framework

NASA Astrophysics Data System (ADS)

Bennett, Nathan J.; Whitty, Tara S.; Finkbeiner, Elena; Pittman, Jeremy; Bassett, Hannah; Gelcich, Stefan; Allison, Edward H.

2018-04-01

There has been increasing attention to and investment in local environmental stewardship in conservation and environmental management policies and programs globally. Yet environmental stewardship has not received adequate conceptual attention. Establishing a clear definition and comprehensive analytical framework could strengthen our ability to understand the factors that lead to the success or failure of environmental stewardship in different contexts and how to most effectively support and enable local efforts. Here we propose such a definition and framework. First, we define local environmental stewardship as the actions taken by individuals, groups or networks of actors, with various motivations and levels of capacity, to protect, care for or responsibly use the environment in pursuit of environmental and/or social outcomes in diverse social-ecological contexts. Next, drawing from a review of the environmental stewardship, management and governance literatures, we unpack the elements of this definition to develop an analytical framework that can facilitate research on local environmental stewardship. Finally, we discuss potential interventions and leverage points for promoting or supporting local stewardship and future applications of the framework to guide descriptive, evaluative, prescriptive or systematic analysis of environmental stewardship. Further application of this framework in diverse environmental and social contexts is recommended to refine the elements and develop insights that will guide and improve the outcomes of environmental stewardship initiatives and investments. Ultimately, our aim is to raise the profile of environmental stewardship as a valuable and holistic concept for guiding productive and sustained relationships with the environment.

Impact of Environmental Education on the Knowledge and Attitude of Students towards the Environment

ERIC Educational Resources Information Center

Erhabor, Norris I.; Don, Juliet U.

2016-01-01

Environmentally aware and empowered youths are potentially the greatest agent of change for the long term protection and stewardship of the environment. Thus environmental education which promotes such change will enable these youths to have a greater voice on environmental issue if effectively implemented in Nigeria. Hence, this study was…

Assessing Environmental Stewardship Motivation

ERIC Educational Resources Information Center

Bramston, Paul; Pretty, Grace; Zammit, Charlie

2011-01-01

Environmental stewardship networks flourish across Australia. Although the environment benefits, this article looks to identify what volunteers draw from their stewardship. The authors adapted 16 questions that purportedly tap environmental stewardship motivation and administered them to a convenience sample of 318 university students and then to…

77 FR 18879 - Meeting of the Regional Resource Stewardship Council

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... TENNESSEE VALLEY AUTHORITY Meeting of the Regional Resource Stewardship Council AGENCY: Tennessee Valley Authority (TVA). ACTION: Notice of meeting. SUMMARY: The TVA Regional Resource Stewardship Council... Stewardship Council, Tennessee Valley Authority, 400 West Summit Hill Drive, WT-11 B, Knoxville, Tennessee...

Report: Ongoing Management Improvements and Further Evaluation Vital to EPA Stewardship and Voluntary Programs

EPA Pesticide Factsheets

Report #2005-P-00007, February 17, 2005. We asked stakeholders to define stewardship, list motivators and obstacles to participating in stewardship programs, and outline key roles for EPA to play to foster participating in environmental stewardship.

An Elective Course on Antimicrobial Stewardship

PubMed Central

Sherman, Elizabeth M.; Unger, Nathan R.

2015-01-01

Objective. To implement an antimicrobial stewardship (AS) elective course for second-year and third-year pharmacy students and to assess its impact on students’ perceptions regarding the application of AS principles. Design. A 2-credit elective course focusing on principles of AS incorporated prelecture didactic recordings with primary literature and guideline-based reading assignments, in-class active-learning group work and student-led presentations, and student-generated examination items. Assessment. Perceptions were assessed by precourse and postcourse survey items. Graded course assessments included completion of preclass assignments (readings, prerecorded lecture and writing assessment items), in-class active participation and group presentations, a midpoint examination, and a final examination. Conclusion. An AS-themed elective course in a doctor of pharmacy curriculum incorporating preclass, self-directed learning and in-class group-based active-learning strategies positively impacted students’ perceived understanding of AS strategies. PMID:26889069

Knowledge and attitudes of doctor of pharmacy students regarding the appropriate use of antimicrobials.

PubMed

Justo, Julie Ann; Gauthier, Timothy P; Scheetz, Marc H; Chahine, Elias B; Bookstaver, P Brandon; Gallagher, Jason C; Hermsen, Elizabeth D; DePestel, Daryl D; Ernst, Erika J; Jacobs, David M; Esterly, John S; Suda, Katie J; Olsen, Keith M; Abbo, Lilian M; MacDougall, Conan

2014-10-15

Pharmacists are key partners in antimicrobial stewardship efforts, yet their degree of education on and attitudes toward this topic during training are not well documented. An electronic survey measuring knowledge and attitudes regarding antimicrobial use and resistance was administered to graduating pharmacy students at 12 US schools of pharmacy. Of 1445 pharmacy students, 579 (40%) completed the survey. The vast majority (94%) believed that strong knowledge of antimicrobials was important for their pharmacy careers, and 89% desired more education on appropriate antimicrobial use. Most students (84%) considered their pharmacy education regarding antimicrobials useful or very useful, but there was significant variability on perceptions of preparation for most antimicrobial stewardship activities according to the students' school. The mean number of correct answers on a section of 11 knowledge questions was 5.8 (standard deviation 2.0; P value for score between schools <.001). On multivariable linear regression analysis, significant predictors of a higher knowledge score were pharmacy school attended, planned postgraduate training, completion of a clinical rotation in infectious diseases, perception of pharmacy school education as useful, use of resources to answer the knowledge questions, and use of Infectious Diseases Society of America guidelines and smartphone applications as frequent resources for learning about antimicrobials. Pharmacy students perceive antimicrobial stewardship to be an important healthcare issue and desire more education on the subject. Student perceptions of antimicrobial coursework and actual antimicrobial knowledge scores significantly varied by the school of pharmacy attended. Sharing of best practices among institutions may enhance the preparation of future pharmacists to contribute to effective antimicrobial stewardship. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Education and Communication in an Interprofessional Antimicrobial Stewardship Program.

PubMed

Foral, Pamela A; Anthone, Jennifer M; Destache, Christopher J; Vivekanandan, Renuga; Preheim, Laurel C; Gorby, Gary L; Horne, John M; Dobronski, Leo A; Syed, Javeria J; Mindru, Cezarina; Ali, Mir A; Ali, Karim F; Neemann, Kari A; Bittner, Marvin J

2016-09-01

Interprofessional education/interprofessional practice (IPE/IPP) is an essential component in medical education and training. A collaborative interprofessional team environment ensures optimal patient-centered care. To describe the implementation of 2 interprofessional antimicrobial stewardship program (ASP) teams using IPE/IPP and to assess the acceptance rate by the primary medical and surgical teams of ASP recommendations for antimicrobial interventions. A business plan for the ASP was approved at 2 academic medical centers used for the present study. During a 3-year study period, 2 interprofessional ASP teams included an attending physician specializing in infectious disease (ID), an ID physician fellow, an ASP pharmacist, physician residents, medical students, pharmacy residents, and pharmacy students. Educational seminars were presented for all adult-admitting physicians to discuss the need for the ASP and the prospective audit and feedback process. Cases were presented for discussion during ASP/ID rounds and recommendations were agreed upon by the ASP team. A motivational interviewing face-to-face technique was frequently used to convey the ASP team recommendation to the primary medical or surgical team in a noncoercive and educational manner. The ASP team recommendations for ASP interventions were documented in the medical records. The overall acceptance rate of recommendations by the primary medical and surgical teams were greater than 90% (2051 of 2266). The most frequent interventions provided were streamline therapy (601), route of administration change (452), bug-drug mismatch (190), and discontinuation of therapy (179). Route of administration change was also the most frequently accepted intervention (96%). The motivational face-to-face communication technique was particularly useful in conveying ASP team member recommendations to the primary medical or surgical teams. Communicating recommendations as a multidisciplinary team in an educational manner seems to have resulted in to greater acceptance of recommendations.

Understanding social influences on wilderness fire stewardship decisions

Treesearch

Katie Knotek

2006-01-01

Federal land managers and the public engage in many decisions about stewardship of wilderness in the United States, including decisions about stewardship of fire. To date, social science research lacks a holistic examination of the decision-making context of managers and the public about stewardship of fire inside wilderness and across its boundaries. A conceptual...

The organisational structure of urban environmental stewardship

Treesearch

Dana R. Fisher; Lindsay Campbell; Erika S. Svendsen

2012-01-01

How is the organisational structure of urban environmental stewardship groups related to the diverse ways that civic stewardship is taking place in urban settings? The findings of the limited number of studies that have explored the organisational structure of civic environmentalism are combined with the research on civic stewardship to answer this question. By...

Serendipity and Stewardship: Teaching with the Spirit in a Secular Classroom

ERIC Educational Resources Information Center

Hall, Bradford J.

2009-01-01

Can one appropriately teach with the spirit in a secular classroom? This chapter addresses the question by exploring how the concepts of serendipity and stewardship encourage a form of spirituality that is inclusive and appropriate for the university setting. Serendipity and stewardship work hand in hand. Stewardship resists the temptation of…

[Health system in Afghanistan: problems and institutional perspectives].

PubMed

Lejars, M

2008-10-01

Afghanistan has been ravaged by years of conflict. To provide emergency services and restore access health services, the Public Health Ministry with the assistance of partners developed first a package of basic health services delivered by NGO contractors and second a package of essential hospital services. The Ministry's role consists of providing guidance. To reduce the many issues and problems affecting this role, reforms are now being undertaken and a new national health care strategy is being developed within the framework of the National Development Strategy. An institution-building project has been initiated with European Union funding to allow the Health Ministry to carry out its stewardship and management functions with greater effectiveness and transparency. This project is essential for the successful outcome of all future strategies and programs planned by the Health Ministry to enhance its institutional effectiveness. The objectives of this project are to strengthen planning and auditing activities, promote quality assurance, implement funding mechanisms for health-related activities, organize management of human resources, maintain ongoing efforts to reform the administration and fight against corruption, and lay the foundations for managing finances and procurement. The scope of this project underlines the importance of its outcome. However the institution-building process will be long and constantly threatened by political instability and insecurity.

Operations & Maintenance Best Practices - A Guide to Achieving Operational Efficiency Release 3.0

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

None

This Operations and Maintenance (O&M) Best Practices Guide was developed under the direction of the U.S. Department of Energy’s Federal Energy Management Program (FEMP). The mission of FEMP is to facilitate the Federal Government’s implementation of sound, cost effective energy management and investment practices to enhance the nation’s energy security and environmental stewardship.

Assessment of 6- to 20-Grade Educators' Climate Knowledge and Perceptions: Results from the Climate Stewardship Survey

ERIC Educational Resources Information Center

McNeal, Karen S.; Walker, Scott L.; Rutherford, David

2014-01-01

The southeastern United States (SEUS) faces numerous potential impacts from a changing climate; however, the population has been characterized with a predominance of naysayers and few climate policies have been implemented by state governments in the region. As such, public education is an important avenue for achieving a climate literate…

Dataset Lifecycle Policy

NASA Technical Reports Server (NTRS)

Armstrong, Edward; Tauer, Eric

2013-01-01

The presentation focused on describing a new dataset lifecycle policy that the NASA Physical Oceanography DAAC (PO.DAAC) has implemented for its new and current datasets to foster improved stewardship and consistency across its archive. The overarching goal is to implement this dataset lifecycle policy for all new GHRSST GDS2 datasets and bridge the mission statements from the GHRSST Project Office and PO.DAAC to provide the best quality SST data in a cost-effective, efficient manner, preserving its integrity so that it will be available and usable to a wide audience.

Impact of an Infection Control and Antimicrobial Stewardship Program on Solid Organ Transplantation and Hepatobiliary Surgical Site Infections.

PubMed

Frenette, Charles; Sperlea, David; Leharova, Yveta; Thirion, Daniel J G

2016-12-01

OBJECTIVE The goal of this long-term quasi-experimental retrospective study was to assess the impact of a 5-year serial infection control and antimicrobial stewardship intervention on surgical site infections (SSIs). METHODS This study was conducted in a tertiary-care public teaching institution over a 5-year period from January 2010 to December 2014. All patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation were included. Outcomes were compared between a preintervention group (2010-2011) and a postintervention group (2012-2014). RESULTS A total of 1,424 procedures averaged an overall SSI rate of 11.2%. After implementation of the interventions, a decrease of 52.8% in SSI rates from 17.4% to 8.2% was observed (P50% (relative rate; P<.001) was observed in superficial incisional and organ-space infections between pre- and postintervention groups. In addition, a 54.9% decrease from 19.7% to 8.9% (P<.001; OR, 2.2; 95% CI, 1.4-3.5) and a 51.6% decrease from 15.5% to 7.5% (P=.001; OR, 2.2; 95% CI, 1.4-3.5) were observed for SSI rates in hepatobiliary surgery and solid organ transplantation, respectively. The antimicrobial stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 15.2% (absolute rate) from 45.1% to 60.3% (P<.003; 95% CI, 5.4-24.9). CONCLUSIONS A long-term serial infection control and antimicrobial stewardship intervention decreased SSIs among patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation. Infect Control Hosp Epidemiol 2016;1468-1474.

Organizing urban ecosystem services through environmental stewardship governance in New York City

Treesearch

James J. Connolly; Erika S. Svendsen; Dana R. Fisher; Lindsay K. Campbell

2013-01-01

How do stewardship groups contribute to the management of urban ecosystem services? In this paper, we integrate the research on environmental stewardship with the social-ecological systems literature to explain how stewardship groups serve as bridge organizations between public agencies and civic organizations, working across scales and sectors to build the flexible...

Evaluating ecological monitoring of civic environmental stewardship in the Green-Duwamish watershed, Washington

Treesearch

Jacob C. Sheppard; Clare M. Ryan; Dale J. Blahna

2017-01-01

The ecological outcomes of civic environmental stewardship are poorly understood, especially at scales larger than individual sites. In this study we characterized civic environmental stewardship programs in the Green-Duwamish watershed in King County, WA, and evaluated the extent to which stewardship outcomes were monitored. We developed a four-step process based on...

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

Elvado Environmental LLC; Environmental Compliance Department Environment, Safety, and Health Division Y-12 National Security Complex

This document presents the Groundwater Protection Program (GWPP) management plan for the U.S. Department of Energy (DOE) Y-12 National Security Complex (hereafter referenced as Y-12). The Y-12 GWPP functions as the primary point-of-contact for groundwater-related issues at Y-12, provides stewardship of the extensive network of groundwater monitoring wells at Y-12, and serves as a resource for technical expertise, support, and historical data for groundwater-related activities at Y-12. These organizational functions each serve the primary programmatic purpose of the GWPP, which is to ensure that groundwater monitoring activities within areas under Y-12 administrative control provide representative data in compliance with themore » multiple purposes of applicable state and federal regulations, DOE orders, and the corporate policies of BWXT Y-12, L.L.C. (hereafter referenced as BWXT), the Y-12 management and operations (M&O) contractor for DOE. This GWPP management plan addresses the requirements of DOE Order 450.1 (BWXT Y12 S/RID) regarding the implementation of a site-wide approach for groundwater protection at each DOE facility. Additionally, this plan is a ''living'' document that is reviewed annually, revised and reissued every three years, and is formatted to provide for updating individual sections independent of the rest of the document. Section 2 includes a short description of the groundwater system at Y-12, the history of groundwater monitoring at Y-12 and the corresponding evolution of the GWPP, and an overview of ongoing Y-12 groundwater monitoring activities. Section 3 describes the key elements of the GWPP management strategy. Organizational roles and responsibilities of GWPP personnel are outlined in Section 4. Section 5 presents an overview of the GWPP project plans for applicable programmatic elements. Section 6 lists the reports, plans, and documents that are referenced for technical and administrative details.« less

[Infectious diseases - a specialty of internal medicine].

PubMed

Fätkenheuer, G; Jung, N; Kern, W V; Fölsch, U R; Salzberger, B

2018-04-01

Infectious diseases have recently gained wide public interest. Emerging infections and rising rates of antibiotic resistance are determining this trend. Both challenges will need to be addressed in international and local collaborations between different specialties in medicine and basic science. Infectious diseases as a clinical specialty in this scenario is directly responsible for the care of patients with infectious diseases. Its involvement in the care of patients with complicated infections has proved to be highly effective. Antibiotic stewardship programmes are effective measures in slowing the development of antibiotic resistance and have been widely implemented. But antibiotic stewardship specialists should not be confused with or taken as an alternative to infectious disease experts. Infectious diseases requires appropriate and specific training. It mainly uses the instrumentarium of internal medicine. With the current challenges in modern medicine, infectious diseases in Germany should thus be upgraded from a subspecialty to a clinical specialty, ideally within Internal Medicine.

Medical table: A major tool for antimicrobial stewardship policy.

PubMed

Roger, P-M; Demonchy, E; Risso, K; Courjon, J; Leroux, S; Leroux, E; Cua, É

2017-09-01

Infectious diseases are unpredictable, with heterogeneous clinical presentations, diverse pathogens, and various susceptibility rates to anti-infective agents. These features lead to a wide variety of clinical practices, which in turn strongly limits their evaluation. We have been using a medical table since 2005 to monitor the medical activity in our department. The observation of heterogeneous therapeutic practices led to drafting up our own antibiotic guidelines and to implementing a continuous evaluation of their observance and impact on morbidity and mortality associated with infectious diseases, including adverse effects of antibiotics, duration of hospital stay, use of intensive care, and deaths. The 10-year analysis of medical practices using the medical table is based on more than 10,000 hospitalizations. It shows simplified antibiotic therapies and a reduction in infection-related morbidity and mortality. The medical table is a major tool for antimicrobial stewardship, leading to constant benefits for patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Natural Resource Management Plan for Brookhaven National Laboratory

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

green, T.

This comprehensive Natural Resource Management Plan (NRMP) for Brookhaven National Laboratory (BNL) was built on the successful foundation of the Wildlife Management Plan for BNL, which it replaces. This update to the 2003 plan continues to build on successes and efforts to better understand the ecosystems and natural resources found on the BNL site. The plan establishes the basis for managing the varied natural resources located on the 5,265 acre BNL site, setting goals and actions to achieve those goals. The planning of this document is based on the knowledge and expertise gained over the past 10 years by themore » Natural Resources management staff at BNL in concert with local natural resource agencies including the New York State Department of Environmental Conservation, Long Island Pine Barrens Joint Planning and Policy Commission, The Nature Conservancy, and others. The development of this plan is an attempt at sound ecological management that not only benefits BNL's ecosystems but also benefits the greater Pine Barrens habitats in which BNL is situated. This plan applies equally to the Upton Ecological and Research Reserve (Upton Reserve). Any difference in management between the larger BNL area and the Upton Reserve are noted in the text. The purpose of the Natural Resource Management Plan (NRMP) is to provide management guidance, promote stewardship of the natural resources found at BNL, and to sustainably integrate their protection with pursuit of the Laboratory's mission. The philosophy or guiding principles of the NRMP are stewardship, sustainability, adaptive ecosystem management, compliance, integration with other plans and requirements, and the incorporation of community involvement, where applicable. The NRMP is periodically reviewed and updated, typically every five years. This review and update was delayed to develop documents associated with a new third party facility, the Long Island Solar Farm. This two hundred acre facility will result in significant changes to this plan warranting the delay. The body of this plan establishes the management goals and actions necessary for managing the natural resources at BNL in a sustainable manner. The appendices provide specific management requirements for threatened and endangered amphibians and fish (Appendices A and B, respectively), and lists of actions in tabular format - including completed items as well as ongoing and new action items (Appendices C and D, respectively).« less

Antimicrobial Stewardship Programs: Comparison of a Program with Infectious Diseases Pharmacist Support to a Program with a Geographic Pharmacist Staffing Model

PubMed Central

Ma, Andrew; Clegg, Daniel; Fugit, Randolph V.; Pepe, Anthony; Goetz, Matthew Bidwell; Graber, Christopher J.

2015-01-01

Background: Stewardship of antimicrobial agents is an essential function of hospital pharmacies. The ideal pharmacist staffing model for antimicrobial stewardship programs is not known. Objective: To inform staffing decisions for antimicrobial stewardship teams, we aimed to compare an antimicrobial stewardship program with a dedicated Infectious Diseases (ID) pharmacist (Dedicated ID Pharmacist Hospital) to a program relying on ward pharmacists for stewardship activities (Geographic Model Hospital). Methods: We reviewed a randomly selected sample of 290 cases of inpatient parenteral antibiotic use. The electronic medical record was reviewed for compliance with indicators of appropriate antimicrobial stewardship. Results: At the hospital staffed by a dedicated ID pharmacist, 96.8% of patients received initial antimicrobial therapy that adhered to local treatment guidelines compared to 87% of patients at the hospital that assigned antimicrobial stewardship duties to ward pharmacists (P < .002). Therapy was modified within 24 hours of availability of laboratory data in 86.7% of cases at the Dedicated ID Pharmacist Hospital versus 72.6% of cases at the Geographic Model Hospital (P < .03). When a patient’s illness was determined not to be caused by a bacterial infection, antibiotics were discontinued in 78.0% of cases at the Dedicated ID Pharmacist Hospital and in 33.3% of cases at the Geographic Model Hospital (P < .0002). Conclusion: An antimicrobial stewardship program with a dedicated ID pharmacist was associated with greater adherence to recommended antimicrobial therapy practices when compared to a stewardship program that relied on ward pharmacists. PMID:26405339

Sustainability Action Planning and Initiatives at Twentynine Palms Marine Corps Air Ground Combat Center (MCAGCC)

DTIC Science & Technology

2011-05-01

Energy and water security/ independence; sustain leadership • Compliance and environmental stewardship (cannot impact training mission...reduction, with efforts underway and cogeneration opportunities 18.3% of energy consumed by facilities is produced or procured from renewable...payback timeframes of ɠ years on existing cogeneration plant and ɛ years on new cogeneration plant Renewable Energy • In FY2010, approximately 6.2% of

Selective reporting of antibiotic susceptibility test results in European countries: an ESCMID cross-sectional survey.

PubMed

Pulcini, Céline; Tebano, Gianpiero; Mutters, Nico T; Tacconelli, Evelina; Cambau, Emmanuelle; Kahlmeter, Gunnar; Jarlier, Vincent

2017-02-01

Selective reporting of antibiotic susceptibility test (AST) results is one possible laboratory-based antibiotic stewardship intervention. The primary aim of this study was to identify where and how selective reporting of AST results is implemented in Europe both in inpatient and in outpatient settings. An ESCMID cross-sectional, self-administered, internet-based survey was conducted among all EUCIC (European Committee on Infection Control) or EUCAST (European Committee on Antimicrobial Susceptibility Testing) national representatives in Europe and Israel. Of 38 countries, 36 chose to participate in the survey. Selective reporting of AST results was implemented in 11/36 countries (31%), was partially implemented in 4/36 (11%) and was limited to local initiatives or was not adopted in 21/36 (58%). It was endorsed as standard of care by health authorities in only three countries. The organisation of selective reporting was everywhere discretionally managed by each laboratory, with a pronounced intra- and inter-country variability. The most frequent application was in uncomplicated community-acquired infections, particularly urinary tract and skin and soft-tissue infections. The list of reported antibiotics ranged from a few first-line options, to longer reports where only last-resort antibiotics were hidden. Several barriers to implementation were reported, mainly lack of guidelines, poor system support, insufficient resources, and lack of professionals' capability. In conclusion, selective reporting of AST results is poorly implemented in Europe and is applied with a huge heterogeneity of practices. Development of an international framework, based on existing initiatives and identified barriers, could favour its dissemination as one important element of antibiotic stewardship programmes. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Cost-minimization model of a multidisciplinary antibiotic stewardship team based on a successful implementation on a urology ward of an academic hospital.

PubMed

Dik, Jan-Willem H; Hendrix, Ron; Friedrich, Alex W; Luttjeboer, Jos; Panday, Prashant Nannan; Wilting, Kasper R; Lo-Ten-Foe, Jerome R; Postma, Maarten J; Sinha, Bhanu

2015-01-01

In order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit, which was financially evaluated here to calculate the return on investment from a hospital perspective. Effects were evaluated by comparing audited patients with a historic cohort with the same diagnosis-related groups. Based upon this evaluation a cost-minimization model was created that can be used to predict the financial effects of a day 2 case-audit. Sensitivity analyses were performed to deal with uncertainties. Finally, the model was used to financially evaluate the A-Team. One whole year including 114 patients was evaluated. Implementation costs were calculated to be €17,732, which represent total costs spent to implement this A-Team. For this specific patient group admitted to a urology ward and consulted on day 2 by the A-Team, the model estimated total savings of €60,306 after one year for this single department, leading to a return on investment of 5.9. The implemented multi-disciplinary A-Team performing a day 2 case-audit in the hospital had a positive return on investment caused by a reduced length of stay due to a more appropriate antibiotic therapy. Based on the extensive data analysis, a model of this intervention could be constructed. This model could be used by other institutions, using their own data to estimate the effects of a day 2 case-audit in their hospital.

Product stewardship in the composites industry

NASA Technical Reports Server (NTRS)

Aldrich, Donald C.; Merriman, Edmund A.

1994-01-01

The definition and purpose of Product Stewardship is discussed. Its' impact in the composites industry is stated. The report also outlines 12 ways that Product Stewardship can be utilized by consumers.

Clinical and economic impact of an antibiotics stewardship programme in a regional hospital in Hong Kong.

PubMed

Ng, C K; Wu, T C; Chan, W M J; Leung, Y S W; Li, C K P; Tsang, D N C; Leung, G M

2008-10-01

Inappropriate use of antibiotics is one of the important factors attributing to emergence of drug-resistant pathogens. Infection with multidrug-resistant pathogens adversely affects quality of medical care. Queen Elizabeth Hospital, an 1800-bed acute service hospital in Hong Kong. Antibiotics are commonly prescribed for treating acute infections. Reduce inappropriate prescription of broad-spectrum antibiotics and overall antibiotic prescription through implementation of a multidisciplinary antibiotics stewardship programme (ASP). A multidisciplinary programme involving policy and guideline formulation, education and feedback, monthly antibiotic consumption and cost monitoring, antimicrobial susceptibility pattern reporting and concurrent feedbacks for commonly prescribed broad-spectrum antibiotics was implemented in 2004. Predefined logistics to prescribe "restricted" antibiotics were formulated and implemented with collaborative efforts from clinical and non-clinical departments. The programme was supported by management at department and hospital levels. Broad-spectrum antibiotics were prescribed inappropriately in 28.9% (n = 192) clinical scenarios. The ASP reduced the restricted and total antibiotic consumption as well as the antibiotics-related costs. Predefined clinical outcomes were not adversely affected. Economic analysis suggested that the extra human cost in running ASP could be offset by savings from antibiotic expenditure. It is cost-effective to implement a multidisciplinary ASP in acute service hospitals as the programme reduces antibiotic consumption and results in overall cost savings. The quality of medical care is not jeopardized as the important clinical outcomes are not adversely affected. The generalisability and sustainability of ASPs in other clinical contexts warrant further studies to ensure the continuous success of this programme.

Seed Balls and the Circle of Courage: A Decolonization Model of Youth Development in an Environmental Stewardship Program

ERIC Educational Resources Information Center

Wenger-Schulman, A. R. S.; Hoffman, Lauren

2018-01-01

Middle School 88 in Brooklyn, New York serves a community of students often considered at high risk for dropping out of high school and other socially undesirable behaviors. In this high-need setting, the authors designed and implemented an environmental education program designed to meet the needs of urban youth of color. The approach they used,…

The Potential for Collaborative Agri-Environment Schemes in England: Can a Well-Designed Collaborative Approach Address Farmers' Concerns with Current Schemes?

ERIC Educational Resources Information Center

Emery, Steven B.; Franks, Jeremy R.

2012-01-01

There is increasing recognition that whilst agri-environment schemes in England have had discernable benefits, their success in relation to certain species and resources has been inhibited by the piecemeal implementation of Environmental Stewardship (ES) on the basis of single farm agreements. In this paper we examine the receptivity of farmers to…

Predicting Opportunities for Greening and Patterns of Vegetation on Private Urban Lands

NASA Astrophysics Data System (ADS)

Troy, Austin R.; Grove, J. Morgan; O'Neil-Dunne, Jarlath P. M.; Pickett, Steward T. A.; Cadenasso, Mary L.

2007-09-01

This paper examines predictors of vegetative cover on private lands in Baltimore, Maryland. Using high-resolution spatial data, we generated two measures: “possible stewardship,” which is the proportion of private land that does not have built structures on it and hence has the possibility of supporting vegetation, and “realized stewardship,” which is the proportion of possible stewardship land upon which vegetation is growing. These measures were calculated at the parcel level and averaged by US Census block group. Realized stewardship was further defined by proportion of tree canopy and grass. Expenditures on yard supplies and services, available by block group, were used to help understand where vegetation condition appears to be the result of current activity, past legacies, or abandonment. PRIZM™ market segmentation data were tested as categorical predictors of possible and realized stewardship and yard expenditures. PRIZM™ segmentations are hierarchically clustered into 5, 15, and 62 categories, which correspond to population density, social stratification (income and education), and lifestyle clusters, respectively. We found that PRIZM 15 best predicted variation in possible stewardship and PRIZM 62 best predicted variation in realized stewardship. These results were further analyzed by regressing each dependent variable against a set of continuous variables reflective of each of the three PRIZM groupings. Housing age, vacancy, and population density were found to be critical determinants of both stewardship metrics. A number of lifestyle factors, such as average family size, marriage rates, and percentage of single-family detached homes, were strongly related to realized stewardship. The percentage of African Americans by block group was positively related to realized stewardship but negatively related to yard expenditures.

75 FR 48742 - Renewal of the Regional Resource Stewardship Council Charter

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-11

... its natural resource stewardship activities through a balanced and broad range of diverse views and... for public input regarding stewardship issues. Dated: July 26, 2010. Anda A. Ray, Senior Vice...

Fifteen years of sector-wide approach (SWAp) in Bangladesh health sector: an assessment of progress

PubMed Central

Ahsan, Karar Zunaid; Streatfield, Peter Kim; Ijdi, Rashida -E-; Escudero, Gabriela Maria; Khan, Abdul Waheed; Reza, M M

2016-01-01

The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh embarked on a sector-wide approach (SWAp) modality for the health, nutrition and population (HNP) sector in 1998. This programmatic shift initiated a different set of planning disciplines and practices along with institutional changes in the MOHFW. Over the years, the SWAp modality has evolved in Bangladesh as the MOHFW has learnt from its implementation and refined the program design. This article explores the progress made, both in terms of achievement of health outcomes and systems strengthening results, since the implementation of the SWAp for Bangladesh’s health sector. Secondary analyses of survey data from 1993 to 2011 as well as a literature review of published and grey literature on health SWAp in Bangladesh was conducted for this assessment. Results of the assessment indicate that the MOHFW made substantial progress in health outcomes and health systems strengthening. SWAps facilitated the alignment of funding and technical support around national priorities, and improved the government’s role in program design as well as in implementation and development partner coordination. Notable systemic improvements have taken place in the country systems with regards to monitoring and evaluation, procurement and service provision, which have improved functionality of health facilities to provide essential care. Implementation of the SWAp has, therefore, contributed to an accelerated improvement in key health outcomes in Bangladesh over the last 15 years. The health SWAp in Bangladesh offers an example of a successful adaptation of such an approach in a complex administrative structure. Based on the lessons learned from SWAp implementation in Bangladesh, the MOHFW needs to play a stronger stewardship and regulatory role to reap the full benefits of a SWAp in its subsequent programming. PMID:26582744

Point-of-Prescription Interventions to Improve Antimicrobial Stewardship

PubMed Central

Hamilton, Keith W.; Gerber, Jeffrey S.; Moehring, Rebekah; Anderson, Deverick J.; Calderwood, Michael S.; Han, Jennifer H.; Mehta, Jimish M.; Pollack, Lori A.; Zaoutis, Theoklis; Srinivasan, Arjun; Camins, Bernard C.; Schwartz, David N.; Lautenbach, Ebbing

2015-01-01

Antimicrobial stewardship is pivotal to improving patient outcomes, reducing adverse events, decreasing healthcare costs, and preventing further emergence of antimicrobial resistance. In an era in which antimicrobial resistance is increasing, judicious antimicrobial use is the responsibility of every healthcare provider. Antimicrobial stewardship programs (ASPs) have made headway in improving antimicrobial prescribing using such “top-down” methods as formulary restriction and prospective audit with feedback; however, engagement of prescribers has not been fully explored. Strategies that include frontline prescribers and other unit-based healthcare providers have the potential to expand stewardship, both to augment existing centralized ASPs and to provide alternative approaches to perform stewardship at healthcare facilities with limited resources. This review discusses interventions focusing on antimicrobial prescribing at the point of prescription as well as a pilot project to engage unit-based healthcare providers in antimicrobial stewardship. PMID:25595748

An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage

PubMed Central

Pakyz, Amy L.; Moczygemba, Leticia R.; Wang, Hui; Stevens, Michael P.; Edmond, Michael B.

2015-01-01

Objectives To determine whether an antimicrobial stewardship ‘intensity’ score predicts hospital antimicrobial usage. Methods An antimicrobial stewardship score for 44 academic medical centres was developed that comprised two main categories: resources (antimicrobial stewardship programme personnel and automated surveillance software) and strategies (preauthorization, audit with intervention and feedback, education, guidelines and clinical pathways, parenteral to oral therapy programmes, de-escalation of therapy, antimicrobial order forms and dose optimization). Multiple regression analyses were used to assess whether the composite score and also the categories were associated with either total or antimicrobial stewardship programme-target antimicrobial use as measured in days of therapy. Results The mean antimicrobial stewardship programme score was 55 (SD 21); the total composite score was not significantly associated with total or target antimicrobial use [estimate –0.49 (95% CI –2.30 to 0.89)], while the category strategies was significantly and negatively associated with target antimicrobial use [–5.91 (95% CI –9.51 to –2.31)]. Conclusions The strategy component of a score developed to measure the intensity of antimicrobial stewardship was associated with the amount of antimicrobials used. Thus, the number and types of strategies employed by antimicrobial stewardship programmes may be of particular importance in programme effectiveness. PMID:25614043

How can Multi-Professional Education Support Better Stewardship?

PubMed Central

Pereira, Nuno Rocha; Castro-Sanchez, Enrique; Nathwani, Dilip

2017-01-01

Antimicrobial stewardship is widely accepted as an efficient strategy to combat the growing threat of antimicrobial resistance. Education is one of the cornerstones of successful antimicrobial stewardship programs. There is also general agreement that antimicrobial stewardship is a team effort that must involve the whole continuum of healthcare workers. Providing adequate education for all different professionals although challenging is deemed crucial to achieve good results. This paper reviews the different strategies available to educate the multiple healthcare workers, discusses how education can improve antimicrobial stewardship programs and outlines some of the challenges faced and research gaps that need to be addressed in order to improve education in this field. PMID:28458801

Reduction of Broad-Spectrum Antimicrobial Use in a Tertiary Children's Hospital Post Antimicrobial Stewardship Program Guideline Implementation.

PubMed

Lee, Kelley R; Bagga, Bindiya; Arnold, Sandra R

2016-03-01

The core strategies recommended for antimicrobial stewardship programs, formulary restriction with preauthorization and prospective audit and feedback, can be difficult to implement with limited resources; therefore, we took an approach of guideline development and education with the goal of reducing overall antibiotic use and unwarranted use of broad-spectrum antimicrobials. Retrospective chart review before and after intervention. Le Bonheur Children's Hospital pediatric, neonatal, and cardiac ICUs. All patients in our pediatric, neonatal, and cardiac ICUs within the time frame of the study. Baseline review in our ICUs revealed excessive use of broad-spectrum antibiotics and inconsistency in managing common pediatric infections. Guidelines were developed and implemented using cycles of education, retrospective review, and feedback. Purchasing and antibiotic use data were obtained to assess changes before and after guideline implementation. Unit-specific days of therapy were measured using periodic chart audit. Segmented regression analysis was used to assess changes in purchasing and broad-spectrum antibiotic days of therapy. The change in median monthly purchases was assessed using 2-tail Student t test. Hospital-wide targeted broad-spectrum antibiotic days of therapy/1,000 patient-days during the preimplementation year averaged 105 per month and decreased 33% to 70 per month during the postimplementation year. The overall antibiotic days of therapy decreased 41%, 21%, and 18%, and targeted broad-spectrum antibiotic days of therapy decreased by 99%, 75%, and 61% in the cardiac, pediatric, and neonatal ICUs, respectively, after guideline implementation. Yearly purchases of our most common broad-spectrum antibiotics decreased 62% from $230,059 to $86,887 after guideline implementation. Median monthly purchases of these drugs before implementation were $19,389 and $11,043 after implementation (p < 0.001). Guideline implementation was successful in reducing targeted broad-spectrum antibiotic use and acquisition cost. Programs with very limited resources may find similar implementation of guidelines effective to provide initial success, so that putting into practice one of the more resource intensive core strategies, such as prospective audit and feedback, may be feasible.

National Aeronautics and Space Administration: 1998 Accountability Report

NASA Technical Reports Server (NTRS)

1999-01-01

This Accountability Report summarizes NASA's program accomplishments and its stewardship over budget and financial resources. The report is the culmination of NASA's management process, which begins with mission definition and program planning, continues with formulation and justification of NASA's budgets for the President and Congress, and ends with NASA scientific and engineering program accomplishments. This report covers NASA's activities from October 1, 1997, through September 30, 1998, with discussion of some subsequent events.

Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study.

PubMed

Skodvin, Brita; Aase, Karina; Brekken, Anita Løvås; Charani, Esmita; Lindemann, Paul Christoffer; Smith, Ingrid

2017-09-01

Many countries are on the brink of establishing antibiotic stewardship programmes in hospitals nationwide. In a previous study we found that communication between microbiology laboratories and clinical units is a barrier to implementing efficient antibiotic stewardship programmes in Norway. We have now addressed the key communication barriers between microbiology laboratories and clinical units from a laboratory point of view. Qualitative semi-structured interviews were conducted with 18 employees (managers, doctors and technicians) from six diverse Norwegian microbiological laboratories, representing all four regional health authorities. Interviews were recorded and transcribed verbatim. Thematic analysis was applied, identifying emergent themes, subthemes and corresponding descriptions. The main barrier to communication is disruption involving specimen logistics, information on request forms, verbal reporting of test results and information transfer between poorly integrated IT systems. Furthermore, communication is challenged by lack of insight into each other's area of expertise and limited provision of laboratory services, leading to prolonged turnaround time, limited advisory services and restricted opening hours. Communication between microbiology laboratories and clinical units can be improved by a review of testing processes, educational programmes to increase insights into the other's area of expertise, an evaluation of work tasks and expansion of rapid and point-of-care test services. Antibiotic stewardship programmes may serve as a valuable framework to establish these measures. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study

PubMed Central

Skodvin, Brita; Aase, Karina; Brekken, Anita Løvås; Charani, Esmita; Lindemann, Paul Christoffer; Smith, Ingrid

2017-01-01

Abstract Background Many countries are on the brink of establishing antibiotic stewardship programmes in hospitals nationwide. In a previous study we found that communication between microbiology laboratories and clinical units is a barrier to implementing efficient antibiotic stewardship programmes in Norway. We have now addressed the key communication barriers between microbiology laboratories and clinical units from a laboratory point of view. Methods Qualitative semi-structured interviews were conducted with 18 employees (managers, doctors and technicians) from six diverse Norwegian microbiological laboratories, representing all four regional health authorities. Interviews were recorded and transcribed verbatim. Thematic analysis was applied, identifying emergent themes, subthemes and corresponding descriptions. Results The main barrier to communication is disruption involving specimen logistics, information on request forms, verbal reporting of test results and information transfer between poorly integrated IT systems. Furthermore, communication is challenged by lack of insight into each other’s area of expertise and limited provision of laboratory services, leading to prolonged turnaround time, limited advisory services and restricted opening hours. Conclusions Communication between microbiology laboratories and clinical units can be improved by a review of testing processes, educational programmes to increase insights into the other’s area of expertise, an evaluation of work tasks and expansion of rapid and point-of-care test services. Antibiotic stewardship programmes may serve as a valuable framework to establish these measures. PMID:28633405

Infection prevention and control practices related to Clostridium difficile infection in Canadian acute and long-term care institutions.

PubMed

Wilkinson, Krista; Gravel, Denise; Taylor, Geoffrey; McGeer, Allison; Simor, Andrew; Suh, Kathryn; Moore, Dorothy; Kelly, Sharon; Boyd, David; Mulvey, Michael; Mounchili, Aboubakar; Miller, Mark

2011-04-01

Clostridium difficile is an important pathogen in Canadian health care facilities, and infection prevention and control (IPC) practices are crucial to reducing C difficile infections (CDIs). We performed a cross-sectional study to identify CDI-related IPC practices in Canadian health care facilities. A survey assessing facility characteristics, CDI testing strategies, CDI contact precautions, and antimicrobial stewardship programs was sent to Canadian health care facilities in February 2005. Responses were received from 943 (33%) facilities. Acute care facilities were more likely than long-term care (P < .001) and mixed care facilities (P = .03) to submit liquid stools from all patients for CDI testing. Physician orders were required before testing for CDI in 394 long-term care facilities (66%)-significantly higher than the proportions in acute care (41%; P < .001) and mixed care sites (49%; P < .001). A total of 841 sites (93%) had an infection control manual, 639 (76%) of which contained CDI-specific guidelines. Antimicrobial stewardship programs were reported by 40 (29%) acute care facilities; 19 (54%) of these sites reported full enforcement of the program. Canadian health care facilities have widely varying C difficile IPC practices. Opportunities exist for facilities to take a more active role in IPC policy development and implementation, as well as antimicrobial stewardship. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Integrating GIS, Archeology, and the Internet.

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

Sera White; Brenda Ringe Pace; Randy Lee

2004-08-01

At the Idaho National Engineering and Environmental Laboratory's (INEEL) Cultural Resource Management Office, a newly developed Data Management Tool (DMT) is improving management and long-term stewardship of cultural resources. The fully integrated system links an archaeological database, a historical database, and a research database to spatial data through a customized user interface using ArcIMS and Active Server Pages. Components of the new DMT are tailored specifically to the INEEL and include automated data entry forms for historic and prehistoric archaeological sites, specialized queries and reports that address both yearly and project-specific documentation requirements, and unique field recording forms. The predictivemore » modeling component increases the DMT’s value for land use planning and long-term stewardship. The DMT enhances the efficiency of archive searches, improving customer service, oversight, and management of the large INEEL cultural resource inventory. In the future, the DMT will facilitate data sharing with regulatory agencies, tribal organizations, and the general public.« less

From Cleanup to Stewardship. A companion report to Accelerating Cleanup: Paths to Closure and background information to support the scoping process required for the 1998 PEIS Settlement Study

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

None, None

1999-10-01

Long-term stewardship is expected to be needed at more than 100 DOE sites after DOE's Environmental Management program completes disposal, stabilization, and restoration operations to address waste and contamination resulting from nuclear research and nuclear weapons production conducted over the past 50 years. From Cleanup to stewardship provides background information on the Department of Energy (DOE) long-term stewardship obligations and activities. This document begins to examine the transition from cleanup to long-term stewardship, and it fulfills the Secretary's commitment to the President in the 1999 Performance Agreement to provide a companion report to the Department's Accelerating Cleanup: Paths to Closuremore » report. It also provides background information to support the scoping process required for a study on long-term stewardship required by a 1998 Settlement Agreement.« less

Collaborative Development of e-Infrastructures and Data Management Practices for Global Change Research

NASA Astrophysics Data System (ADS)

Samors, R. J.; Allison, M. L.

2016-12-01

An e-infrastructure that supports data-intensive, multidisciplinary research is being organized under the auspices of the Belmont Forum consortium of national science funding agencies to accelerate the pace of science to address 21st century global change research challenges. The pace and breadth of change in information management across the data lifecycle means that no one country or institution can unilaterally provide the leadership and resources required to use data and information effectively, or needed to support a coordinated, global e-infrastructure. The five action themes adopted by the Belmont Forum: 1. Adopt and make enforceable Data Principles that establish a global, interoperable e-infrastructure. 2. Foster communication, collaboration and coordination between the wider research community and Belmont Forum and its projects through an e-Infrastructure Coordination, Communication, & Collaboration Office. 3. Promote effective data planning and stewardship in all Belmont Forum agency-funded research with a goal to make it enforceable. 4. Determine international and community best practice to inform Belmont Forum research e-infrastructure policy through identification and analysis of cross-disciplinary research case studies. 5. Support the development of a cross-disciplinary training curriculum to expand human capacity in technology and data-intensive analysis methods. The Belmont Forum is ideally poised to play a vital and transformative leadership role in establishing a sustained human and technical international data e-infrastructure to support global change research. In 2016, members of the 23-nation Belmont Forum began a collaborative implementation phase. Four multi-national teams are undertaking Action Themes based on the recommendations above. Tasks include mapping the landscape, identifying and documenting existing data management plans, and scheduling a series of workshops that analyse trans-disciplinary applications of existing Belmont Forum projects to identify best practices and critical gaps that may be uniquely or best addressed by the Belmont Forum funding model. Concurrent work will define challenges in conducting international and interdisciplinary data management implementation plans and identify sources of relevant expertise and knowledge.

Knowledge translation in Iranian universities: need for serious interventions.

PubMed

Gholami, Jaleh; Ahghari, Sharareh; Motevalian, Abbas; Yousefinejad, Vahid; Moradi, Ghobad; Keshtkar, Abbasali; Alami, Ali; Mazloomzadeh, Saeideh; Vakili, Mohammad Masoud; Chaman, Reza; Salehi, Bahman; Fazelzadeh, Omid; Majdzadeh, Reza

2013-11-13

The aim of this study was to assess the status of knowledge translation (KT) in Iranian medical science universities in order to assess the strengths and weaknesses of the most important organizations responsible for producing knowledge in the country. The KT activities were assessed qualitatively and quantitatively in nine universities using the Self-Assessment Tool for Research Institutes. The strengths and weaknesses of universities were determined using seven main themes: priority setting; research quality and timeliness; researchers' KT capacities; interaction with research users; the facilities and prerequisites of KT; the processes and regulations supporting KT; and promoting and evaluating the use of evidence.The quantitative and qualitative results showed that the Iranian universities did not have an appropriate context for KT. There were significant shortcomings in supportive regulations, facilities for KT activities, and the level of interaction between the researchers and research users. The shortcomings in KT were mostly in the area of stewardship and policymaking (macro level), followed by planning and implementation at the universities. In order to strengthen KT in Iran, it should occupy a prominent and focused role in the strategies of the country's health research system.

75 FR 20991 - NACEPT Subcommittee on Promoting Environmental Stewardship

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9141-2] NACEPT Subcommittee on Promoting Environmental Stewardship AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of meeting. SUMMARY: Under the... (NACEPT) is to advise the U.S. Environmental Protection Agency on how to promote environmental stewardship...

Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry.

PubMed

Berrevoets, Marvin Ah; Ten Oever, Jaap; Sprong, Tom; van Hest, Reinier M; Groothuis, Ingeborg; van Heijl, Inger; Schouten, Jeroen A; Hulscher, Marlies E; Kullberg, Bart-Jan

2017-08-15

The Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the quality of antibiotic use are monitored by antimicrobial stewardship teams (A-teams) and can be used as indicators for the stewardship registry. In this pilot study we aimed to determine which stewardship objectives are eligible for the envisioned registry. We performed an observational pilot study among five Dutch hospitals. We assessed which of the 14 validated stewardship objectives (11 process of care recommendations and 3 structure of care recommendations) the A-teams monitored and documented in individual patients. They provided, where possible, data to compute quality indicator (QI) performance scores in line with recently developed QIs to measure appropriate antibiotic use in hospitalized adults for the period of January 2015 through December 2015 RESULTS: All hospitals had a local antibiotic guideline describing recommended antimicrobial use. All A-teams monitored the performance of bedside consultations in Staphylococcus aureus bacteremia and the prescription of restricted antimicrobials. Documentation and reporting were the best for the use of restricted antimicrobials: 80% of the A-teams could report data. Lack of time and the absence of an electronic medical record system enabling documentation during the daily work flow were the main barriers hindering documentation and reporting. Five out of 11 stewardship objectives were actively monitored by A-teams. Without extra effort, 4 A-teams could report on the quality of use of restricted antibiotics. Therefore, this aspect of antibiotic use should be the starting point of the national antimicrobial stewardship registry. Our registry is expected to become a powerful tool to evaluate progress and impact of antimicrobial stewardship programs in hospitals.

Health in the 5th 5-years Development Plan of Iran: Main Challenges, General Policies and Strategies

PubMed Central

Vosoogh Moghaddam, A; Damari, B; Alikhani, S; Salarianzedeh, MH; Rostamigooran, N; Delavari, A; Larijani, B

2013-01-01

Access to the right to the highest attainable level of health is a constitutional right that obliges governments and other players to take step to increase all individuals’ chances of obtaining good health. At the least, health and education are two crucial requirements for this as well. Iran’s vision 2025 is going to lead the country to a developed state with the highest rank of economic, scientific and technological status in the region. Enjoying health, welfare, food security, social security, equal opportunities, etc, are also considered as part of characteristics of Iranian society in 2025. Although health system of Iran has many achievements in providing health services specially for the poor following the Islamic Revolution of 1979, but the evidences gathered to develop the 5th 5-years economical, social and cultural plan (5th5YDP:2011–2015), listed a variety of main challenges in stewardship, financing, resources generation and service provision functions of the existing health system. Thus, to overcome the main challenges, about 11% of general policies of 5th5YDP are directly address health related issues with emphasizing on healthy human and comprehensive health approach with considering: Integration of policy making, planning, evaluation, supervision and public financing; Developing both quantity and quality of health insurance system and reducing out-of-pocket expenditures for health services to 30% by the end of the 5th plan. The strategies of 5th5YDP adopted by the parliament as an Act will change the health system fundamentally through tuning the main drivers; so, its implementation needs brave leaders, capable managers, motivated technical staff and social mobilization. PMID:23865015

LONG-TERM STEWARDSHIP AT DOE HANFORD SITE - 12575

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

MOREN RJ; GRINDSTAFF KD

2012-01-11

The U.S. Department of Energy's (DOE) Hanford Site is located in southeast Washington and consists of 1,518 square kilometers (586 square miles) of land. Established in 1943 as part of the Manhattan Project, Hanford workers produced plutonium for our nation's nuclear defense program until the mid 1980's. Since then, the site has been in cleanup mode that is being accomplished in phases. As we achieve remedial objectives and complete active cleanup, DOE will manage Hanford land under the Long-Term Stewardship (LTS) Program until completion of cleanup and the site becomes ready for transfer to the post cleanup landlord - currentlymore » planned for DOE's Office of Legacy Management (LM). We define Hanford's LTS Program in the ''Hanford Long-Term Stewardship Program Plan,'' (DOE/RL-201 0-35)[1], which describes the scope including the relationship between the cleanup projects and the LTS Program. DOE designed the LTS Program to manage and provide surveillance and maintenance (S&M) of institutional controls and associated monitoring of closed waste sites to ensure the protection of human health and the environment. DOE's Richland Operations Office (DOE-RL) and Hanford cleanup and operations contractors collaboratively developed this program over several years. The program's scope also includes 15 key activities that are identified in the DOE Program Plan (DOE/RL-2010-35). The LTS Program will transition 14 land segments through 2016. The combined land mass is approximately 570 square kilometers (220 square miles), with over 1,300 active and inactive waste sites and 3,363 wells. Land segments vary from buffer zone property with no known contamination to cocooned reactor buildings, demolished support facilities, and remediated cribs and trenches. DOE-RL will transition land management responsibilities from cleanup contractors to the Mission Support Contract (MSC), who will then administer the LTS Program for DOE-RL. This process requires an environment of cooperation between the contractors and DOE-RL. Information Management (IM) is a key part of the LTS program. The IM Program identifies, locates, stores, protects and makes accessible Hanford LTS records and data to support the transfer of property ultimately to LM. As such, DOE-RL manages the Hanford LTS Program in a manner consistent with LM's goals, policies, and procedures.« less

Adopting Open Source Software to Address Software Risks during the Scientific Data Life Cycle

NASA Astrophysics Data System (ADS)

Vinay, S.; Downs, R. R.

2012-12-01

Software enables the creation, management, storage, distribution, discovery, and use of scientific data throughout the data lifecycle. However, the capabilities offered by software also present risks for the stewardship of scientific data, since future access to digital data is dependent on the use of software. From operating systems to applications for analyzing data, the dependence of data on software presents challenges for the stewardship of scientific data. Adopting open source software provides opportunities to address some of the proprietary risks of data dependence on software. For example, in some cases, open source software can be deployed to avoid licensing restrictions for using, modifying, and transferring proprietary software. The availability of the source code of open source software also enables the inclusion of modifications, which may be contributed by various community members who are addressing similar issues. Likewise, an active community that is maintaining open source software can be a valuable source of help, providing an opportunity to collaborate to address common issues facing adopters. As part of the effort to meet the challenges of software dependence for scientific data stewardship, risks from software dependence have been identified that exist during various times of the data lifecycle. The identification of these risks should enable the development of plans for mitigating software dependencies, where applicable, using open source software, and to improve understanding of software dependency risks for scientific data and how they can be reduced during the data life cycle.

PS1-20: VDW Operational Committee: Current Activities and Future Directions

PubMed Central

Brown, Jeffrey; McDonald, Sarah; Moore, Kristen; Saylor, Gwyn; Hart, Gene; Hornbrook, Mark; Magid, David; Go, Alan

2010-01-01

Background/Aims: The Virtual Data Warehouse (VDW) is the HMO Research Network (HMORN) approach for facilitating multisite research while protecting the privacy of members and proprietary corporate information. A valid and sustainable VDW is critical to the success of the HMORN, and is needed for HMORN’s inclusion in many of the most important public health initiatives planned for the next few years. Methods: In November 2007 the HMORN Governing Board approved the VDW 5-Year Strategic Plan, including creation of a VDW Operational Committee (VOC), reporting to the Assets Stewardship Committee (ASC) and providing coordinated oversight of the development, maintenance, and enhancement of the VDW. The seven members of the VOC are investigators and analysts representing HMORN’s major consortia projects: CERT, CVRN and CRN. Results: In 2008, the VOC accomplished two major short term goals: Creation of a comprehensive data quality checking system, implemented by seven content area expert Working Groups (WGs) consisting of 23 investigators and 23 programmer\\analysts. The content areas of the WGs are enrollment and demographics, pharmacy, utilization, tumor, vital signs, laboratory, and census. The WGs assessed data availability and completeness for their content area and reported findings to the VOC and ASC, including recommendations for changes and enhancements. WG reports will form the basis for ongoing VDW documentation that will be used to standardize HMORN VDW descriptions for grants and proposals; Development of a budget, staffing plan and priorities for 2009. The 2009 priorities include development of VOC standard operating procedures for creating new data content areas and changing current data areas/definitions, documenting policies for use of the VDW, promoting use of the VDW, and creation of additional WGs for death (new VDW content area), informatics, implementation, and data documentation. The documentation WG will oversee issues such as data dictionaries, data checking documentation, programming resources, a clinical concepts library, user guides, and incorporating updated VDW information in the HMORN Collaboration Toolkit. Looking forward, the VDW 5-year Strategic Plan includes streamlining IRB approval for multisite research and enhancing HMORN informatics capabilities. Conclusions: The newly created VOC has made substantial progress in helping make the HMORN VDW an even more valuable and useful resource for the network.

Incorporating pharmacy student activities into an antimicrobial stewardship program in a long-term acute care hospital.

PubMed

Benson, John M

2014-02-01

The impact on antimicrobial costs of an antimicrobial stewardship program (ASP) that integrated pharmacy students as integral members was evaluated. Demographic and discharge disposition data and antimicrobial acquisition cost data were retrospectively collected for all patients admitted to Promise Hospital of Salt Lake between June 1, 2009, and May 31, 2012. During this study, the primary role of pharmacy students in the ASP was to monitor all infection-related patient problems in the facility and meet daily with the infectious diseases pharmacist and clinical pharmacist to develop recommendations for optimizing antimicrobial use. The primary outcome measure was the mean antimicrobial acquisition cost per patient per day, calculated before ASP implementation (baseline period) and two years after ASP implementation (intervention period). The acquisition costs of antimicrobial agents per patient day were compared before and two years after implementation of the ASP involving pharmacy students. Statistical significance was determined using Student's t test for continuous data and the chi-square test for nominal data. The rate of patient discharge to skilled nursing facilities was significantly higher during the intervention period versus the baseline period (p = 0.016); no other significant comparisons were found. The mean ± S.D. antimicrobial costs per patient day were $75.37 ± $11.85 in the baseline period and $64.13 ± $13.78 in the intervention period (p = 0.022). This difference represents a cost savings of $261,630 during the two-year intervention period. Decreased antimicrobial costs were observed over a two-year period after implementation of an ASP that incorporated pharmacy students as integral members of the program.

The emergence of pan-resistant Gram-negative pathogens merits a rapid global political response.

PubMed

Walsh, Timothy R; Toleman, Mark A

2012-01-01

Recent media coverage of New Delhi metallo-β-lactamase (NDM-1) put antibiotic resistance back on the political map if only for the wrong reasons, mainly the reaction to the naming of NDM-1 and the incorrect assumption that medical tourism was being deliberately targeted. However, work on NDM-1 has most certainly highlighted the rapid dissemination of new antibiotic resistance mechanisms via economic globalization. The example of NDM-1 has also magnified the desperate need for a publicly funded global antibiotic surveillance system rather than just national or regional systems. Furthermore, there is a pressing need to establish a global task force to enforce international transparency and accountability on antibiotic stewardship and the implementation of measures to curb antibiotic resistance. An international antibiotic stewardship index should be established that is related to each country's gross domestic product (GDP) and assesses how much of their GDP is committed to publically funded health initiatives aimed at controlling antibiotic resistance.

Preserving Open Space via Community Stewardship.

ERIC Educational Resources Information Center

Lopez, Stephen

1983-01-01

When community groups assume stewardship of underused properties and turn them into recreational spaces, park agencies can save money on overhead and construction. Three stewardship projects in New York State, involving a playing field, gardening areas, and a historical restoration, are described. Criteria for successful projects are included. (PP)

Is there an improvement of antibiotic use in China? Evidence from the usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals.

PubMed

Zhou, Wen-Juan; Luo, Zhen-Ni; Tang, Chang-Min; Zou, Xiao-Xu; Zhao, Lu; Fang, Peng-Qian

2016-10-01

The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children's hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed. Data were collected with regards to the implementation of the national antibiotic stewardship program (NASP), the overall usage and the prophylactic use of antibiotic for type I incisions. Univariate analysis was used for microbiological diagnosis rate before antimicrobial therapy, prophylactic use of antibiotics for type I incision operation, and so on. For multivariate analysis, the use of antibiotics was dichotomized according to the guidelines, and entered as binary values into logistic regression analysis. The results were compared with the corresponding criteria given by the guidelines of this campaign. The antibiotic stewardship in China was effective in that more than 80% of each kind of hospitals achieved the criteria of recommended antibiotics varieties. Hospital type appeared to be a factor statistically associated with stewardship outcome. The prophylactic use of antibiotics on type I incision operations decreased by 16.22% (P<0.05). The usage of combination antibiotic therapy for type I incisions was also decreased. Region and bed size were the main determinants on surgical prophylaxis for type I incision. This national analysis of hospitals on antibiotic use and stewardship allows relevant comparisons for bench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.

NOAA's Scientific Data Stewardship Program

NASA Astrophysics Data System (ADS)

Bates, J. J.

2004-12-01

The NOAA mission is to understand and predict changes in the Earth's environment and conserve and manage coastal and marine resources to meet the Nation's economic, social and environmental needs. NOAA has responsibility for long-term archiving of the United States environmental data and has recently integrated several data management functions into a concept called Scientific Data Stewardship. Scientific Data Stewardship a new paradigm in data management consisting of an integrated suite of functions to preserve and exploit the full scientific value of NOAA's, and the world's, environmental data These functions include careful monitoring of observing system performance for long-term applications, the generation of authoritative long-term climate records from multiple observing platforms, and the proper archival of and timely access to data and metadata. NOAA has developed a conceptual framework to implement the functions of scientific data stewardship. This framework has five objectives: 1) develop real-time monitoring of all satellite observing systems for climate applications, 2) process large volumes of satellite data extending up to decades in length to account for systematic errors and to eliminate artifacts in the raw data (referred to as fundamental climate data records, FCDRs), 3) generate retrieved geophysical parameters from the FCDRs (referred to as thematic climate data records TCDRs) including combining observations from all sources, 4) conduct monitoring and research by analyzing data sets to uncover climate trends and to provide evaluation and feedback for steps 2) and 3), and 5) provide archives of metadata, FCDRs, and TCDRs, and facilitate distribution of these data to the user community. The term `climate data record' and related terms, such as climate data set, have been used for some time, but the climate community has yet to settle on a concensus definition. A recent United States National Academy of Sciences report recommends using the following definition: a climate data record (CDR) is a time series of measurements of sufficient length, consistency, and continuity to determine climate variability and change.

What is urban environmental stewardship? Constructing a practitioner-derived framework

Treesearch

M. Romolini; W. Brinkley; K.L. Wolf

2012-01-01

Agencies and organizations deploy various strategies in response to environmental challenges, including the formulation of policy, programs, and regulations. Citizen-based environmental stewardship is increasingly seen as an innovative and important approach to improving and conserving landscape health. A new research focus on the stewardship of urban natural resources...

The Six Principles of Facilities Stewardship

ERIC Educational Resources Information Center

Kaiser, Harvey H.; Klein, Eva

2010-01-01

Facilities stewardship means high-level and pervasive commitment to optimize capital investments, in order to achieve a high-functioning and attractive campus. It includes a major commitment to capital asset preservation and quality. Stewardship is about the long view of an institution's past and future. It ultimately forms the backdrop for…

After the Bell: Developing an Awareness of Pet Stewardship

ERIC Educational Resources Information Center

Farenga, Stephen J.; Ness, Daniel; Hutchinson, Michael

2008-01-01

Given the commonness of pets in communities throughout the United States, Canada, and Australia, among other countries, pet stewardship should be a natural topic of study for the integration of science, mathematics, and technology. Therefore, the term "stewardship" will be examined by applying observation and research to shape our…

Becoming Rooted in the Stewardship Way of Life.

ERIC Educational Resources Information Center

Voboril, Bob

2003-01-01

Criticizes how Catholic schools have been forced to survive by adopting a purchase mentality. The solution is to embrace the stewardship way of life. Points out that stewardship takes a while to take effect, but once it does it will create a counter cultural attitude toward one's income and assets. (MZ)

Branching Out: The North Carolina Forest Stewardship Activity Guide.

ERIC Educational Resources Information Center

Chesson, Gail

Stewardship is the responsibility of individuals to maintain and improve their natural resources and surroundings. The Forest Stewardship Program (FSP) in North Carolina aims at enhancing the management of all forest resources on private lands. This activity guide is designed to help youth appreciate and understand forests and natural…

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

PubMed Central

Schwartz, David N.; Weinstein, Robert A.

2016-01-01

SUMMARY Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs. PMID:27974411

Challenges in building intelligent systems for space mission operations

NASA Technical Reports Server (NTRS)

Hartman, Wayne

1991-01-01

The purpose here is to provide a top-level look at the stewardship functions performed in space operations, and to identify the major issues and challenges that must be addressed to build intelligent systems that can realistically support operations functions. The focus is on decision support activities involving monitoring, state assessment, goal generation, plan generation, and plan execution. The bottom line is that problem solving in the space operations domain is a very complex process. A variety of knowledge constructs, representations, and reasoning processes are necessary to support effective human problem solving. Emulating these kinds of capabilities in intelligent systems offers major technical challenges that the artificial intelligence community is only beginning to address.

Impact of an antimicrobial stewardship program with multidisciplinary cooperation in a community public teaching hospital in Taiwan.

PubMed

Lin, Yu-Shiuan; Lin, I-Fen; Yen, Yung-Feng; Lin, Pei-Ching; Shiu, Yu-Chih; Hu, Hsing-Yi; Yang, Ying-Pi

2013-11-01

Reports of antimicrobial stewardship programs (ASPs) in community hospitals are limited, with the major focus on specific agents, small settings, or short time periods. Here we present the outcomes of cost control, consumption restraint, and quality of care after a 3-year multidisciplinary ASP in a 415-bed community public teaching hospital. Three strategies for improving antimicrobial stewardship were implemented: education, clinical pharmacists-based intervention, and regular outcome announcement. The steering panel of the program was a committee composed of infection specialists, attending physicians, clinical pharmacists, nurses, and medical laboratorists. Semiannual data from July 2009 to June 2012 was analyzed. Antibiotic costs declined from $21,464 to $12,146 per 1,000 patient-days (-43.4%). Approximately $2.5 million was saved in 3 years, and estimated labor cost was $3,935 per month. Defined daily dose per 1,000 patient-days were diminished from 906.7 to 717.5 (-20.9%). Significant reductions were found in the consumption of aminoglycosides, first-generation cephalosporins, and aminopenicillins. However, through comprehensive auditing, increasing consumption of fourth-generation cephalosporins and fluoroquinolones was noticed. No significant difference in the quality of care (ie, length of stay, incidence of health care associated infections, and mortality) was observed. The multidisciplinary ASP was beneficial to reduce antibiotic cost and consumption. The strategies were practical and worthy to be recommended to community health care settings. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Stewardship of the Evolving Scholarly Record: From the Invisible Hand to Conscious Coordination

ERIC Educational Resources Information Center

Lavoie, Brian; Malpas, Constance

2015-01-01

The long-term future of the scholarly record in its fullest expression cannot be effectively secured with stewardship strategies designed for print materials. The features of the evolving scholarly record suggest that traditional stewardship strategies, built on an "invisible hand" approach that relies on the uncoordinated,…

A Clostridium difficile infection (CDI) stewardship initiative improves adherence to practice guidelines for management of CDI.

PubMed

Jury, Lucy A; Tomas, Myreen; Kundrapu, Sirisha; Sitzlar, Brett; Donskey, Curtis J

2013-11-01

A Clostridium difficile infection (CDI) stewardship initiative reduced inappropriate prescription of empirical CDI therapy and improved timeliness of treatment and adherence to clinical practice guidelines for management of CDI. The initiative required minimal resources and could easily be incorporated into traditional antimicrobial stewardship programs.

Communicating the value and benefits of silviculture through partnerships and collaborative stewardship

Treesearch

1997-01-01

Opening comments to this session share observations on the current management climate within the USDA Forest Service. Partnerships and collaborative stewardship as agency philosophy are discussed. Silviculturists roles, as scientists and managers are compared, and the need for internal and external cooperation stressed as we strive to meet forest stewardship goals....

Regional Stewardship and the Redefinition of Higher Education

ERIC Educational Resources Information Center

Simpson, Timothy Leahy

2010-01-01

Inspired by the late John Gardner, in May 2000 the "Alliance for Regional Stewardship" (ARS) was formed as a "peer-to-peer network of regional leaders working across boundaries to solve tough community problems." According to the ARS, regional stewardship is the leadership needed to address the complex problems of one's time.…

Antibiotic stewardship in community-acquired pneumonia.

PubMed

Viasus, Diego; Vecino-Moreno, Milly; De La Hoz, Juan M; Carratalà, Jordi

2017-04-01

Community-acquired pneumonia (CAP) continues to be associated with significant mortality and morbidity. As with other infectious diseases, in recent years there has been a marked increase in resistance to the antibiotics commonly used against the pathogens that cause CAP. Antimicrobial stewardship denotes coordinated interventions to improve and measure the appropriate use of antibiotics by encouraging the selection of optimal drug regimens. Areas covered: Several elements can be applied to antibiotic stewardship strategies for CAP in order to maintain or improve patient outcomes. In this regard, antibiotic de-escalation, duration of antibiotic treatment, adherence to CAP guidelines recommendations about empirical treatment, and switching from intravenous to oral antibiotic therapy may each be relevant in this context. Antimicrobial stewardship strategies, such as prospective audit with intervention and feedback, clinical pathways, and dedicated multidisciplinary teams, that have included some of these elements have demonstrated improvements in antimicrobial use for CAP without negatively affecting clinical outcomes. Expert commentary: Although there are a limited number of randomized clinical studies addressing antimicrobial stewardship strategies in CAP, there is evidence that antibiotic stewardship initiatives can be securely applied, providing benefits to both healthcare systems and patients.

Barriers to and enablers of implementing antimicrobial stewardship programs in veterinary practices.

PubMed

Hardefeldt, Laura Y; Gilkerson, J R; Billman-Jacobe, H; Stevenson, M A; Thursky, K; Bailey, K E; Browning, G F

2018-03-23

Antimicrobial stewardship (AMS) programs are yet to be widely implemented in veterinary practice and medical programs are unlikely to be directly applicable to veterinary settings. To gain an in-depth understanding of the factors that influence effective AMS in veterinary practices in Australia. A concurrent explanatory mixed methods design was used. The quantitative phase of the study consisted of an online questionnaire to assess veterinarians' attitudes to antimicrobial resistance (AMR) and antimicrobial use in animals, and the extent to which AMS currently is implemented (knowingly or unknowingly). The qualitative phase used semi-structured interviews to gain an understanding of the barriers to and enablers of AMS in veterinary practices. Data were collected and entered into NVivo v.11, openly coded and analyzed according to mixed methods data analysis principles. Companion animal, equine, and bovine veterinarians participated in the study. Veterinary practices rarely had antimicrobial prescribing policies. The key barriers were a lack of AMS governance structures, client expectations and competition between practices, cost of microbiological testing, and lack of access to education, training and AMS resources. The enablers were concern for the role of veterinary antimicrobial use in development of AMR in humans, a sense of pride in the service provided, and preparedness to change prescribing practices. Our study can guide development and establishment of AMS programs in veterinary practices by defining the major issues that influence the prescribing behavior of veterinarians. © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

NASA FY 2000 Accountability Report

NASA Technical Reports Server (NTRS)

2000-01-01

This Accountability Report consolidates reports required by various statutes and summarizes NASA's program accomplishments and its stewardship over budget and financial resources. It is a culmination of NASA's management process, which begins with mission definition and program planning, continues with the formulation and justification of budgets for the President and Congress, and ends with scientific and engineering program accomplishments. The report covers activities from October 1, 1999, through September 30, 2000. Achievements are highlighted in the Statement of the Administrator and summarized in the Report.

Trends in Antimicrobial Prescription for Inpatients in Changsha, China, 2003 to 2014

PubMed Central

ZHANG, Yinhua; YUAN, Qun; YI, Xia; LIU, Honghua; PAN, Xiaoyan; LIU, Jingwei; XU, Yi; CHEN, Yang; HE, Guoping

2017-01-01

Background: China had implemented policies to limit antimicrobials prescription since 2004; we conducted this study to reflect the effect of these national policies by analyzing antimicrobial prescription trends of medical insurance in patients from 2003 to 2014 in Changsha city, China. Methods: The participants were inpatients of the medical insurance of urban workers (UEBMI). Data were extracted from medical insurance information system of Changsha Medical Insurance Institution, which directly connects with hospitals information systems. Results: Trend analysis showed great changes in antimicrobial prescription and inpatients’ cost on antimicrobials over the study period. Antimicrobial prescription rates gradually declined over the study period from 79.0% in 2003 to 43.5% in 2014 (adjusted OR0.205; 95%CI 0.198 to 0.213). There was a quicker decline from 2011 to 2014 (with implementing national antimicrobial stewardship action plan) than the period from 2003 to 2010 (with implementing antimicrobials use education and self-management strategies). The proportion of inpatients used one antimicrobial increased significantly from 25.6% in 2003 to 46.7% in 2014, while the proportion of inpatients used three or more antimicrobials gradually decreased. Bacterial culture rate increased from 20.4% in 2003 to 36.6% in 2014 (adjusted OR 2.248; 95% CI 2.149 to 2.352). The average costs on antimicrobials decreased significantly, from 277.43 US Dollar in 2003 to 91.05 US Dollar in 2014. Conclusion: National efforts to promote rational use of antimicrobials in clinical practice have had a positive effect over the past decade in China. PMID:29026788

Stockpile Stewardship at Los Alamos(U)

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

Webster, Robert B.

2012-06-29

Stockpile stewardship is the retention of nuclear weapons in the stockpile beyond their original design life. These older weapons have potential changes inconsistent with the original design intent and military specifications. The Stockpile Stewardship Program requires us to develop high-fidelity, physics-based capabilities to predict, assess, certify and design nuclear weapons without conducting a nuclear test. Each year, the Lab Directors are required to provide an assessment of the safety, security, and reliability our stockpile to the President of the United States. This includes assessing whether a need to return to testing exists. This is a talk to provide an overviewmore » of Stockpile Stewardship's scientific requirements and how stewardship has changed in the absence of nuclear testing. The talk is adapted from an HQ talk to the War college, and historical unclassified talks on weapon's physics.« less

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship.

PubMed

Morency-Potvin, Philippe; Schwartz, David N; Weinstein, Robert A

2017-01-01

Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs. Copyright © 2016 American Society for Microbiology.

STEWARDSHIP: A Conceptual Imperative For Managerial Effectiveness In The Nigerian Health System

PubMed Central

2007-01-01

Unacceptable health status indicators such as high infant and maternal mortality rates and low life expectancy have continued unabated inspite of government efforts to change it. This paper espouses the concept of stewardship as a selfless, ethical, cost effective and outcome oriented approach to governance. It is believed that through stewardship approach governments would improve the health status of their populations considerably. The paper implores not only government and health care managers but the Nigerian society also to imbibe the concept of stewardship to make the development of a result-oriented health system easy. PMID:25161436

STEWARDSHIP: A Conceptual Imperative For Managerial Effectiveness In The Nigerian Health System.

PubMed

2007-12-01

Unacceptable health status indicators such as high infant and maternal mortality rates and low life expectancy have continued unabated inspite of government efforts to change it. This paper espouses the concept of stewardship as a selfless, ethical, cost effective and outcome oriented approach to governance. It is believed that through stewardship approach governments would improve the health status of their populations considerably. The paper implores not only government and health care managers but the Nigerian society also to imbibe the concept of stewardship to make the development of a result-oriented health system easy.

Increasing Capacity for Stewardship of Oceans and Coasts: Findings of the National Research Council Report

NASA Astrophysics Data System (ADS)

Roberts, S. J.; Feeley, M. H.

2008-05-01

With the increasing stress on ocean and coastal resources, ocean resource management will require greater capacity in terms of people, institutions, technology and tools. Successful capacity-building efforts address the needs of a specific locale or region and include plans to maintain and expand capacity after the project ends. In 2008, the US National Research Council published a report that assesses past and current capacity-building efforts to identify barriers to effective management of coastal and marine resources. The report recommends ways that governments and organizations can strengthen marine conservation and management capacity. Capacity building programs instill the tools, knowledge, skills, and attitudes that address: ecosystem function and change; processes of governance that influence societal and ecosystem change; and assembling and managing interdisciplinary teams. Programs require efforts beyond traditional sector-by-sector planning because marine ecosystems range from the open ocean to coastal waters and land use practices. Collaboration among sectors, scaling from local community-based management to international ocean policies, and ranging from inland to offshore areas, will be required to establish coordinated and efficient governance of ocean and coastal ecosystems. Barriers Most capacity building activities have been initiated to address particular issues such as overfishing or coral reef degradation, or they target a particular region or country facing threats to their marine resources. This fragmentation inhibits the sharing of information and experience and makes it more difficult to design and implement management approaches at appropriate scales. Additional barriers that have limited the effectiveness of capacity building programs include: lack of an adequate needs assessment prior to program design and implementation; exclusion of targeted populations in decision- making efforts; mismanagement, corruption, or both; incomplete or inappropriate evaluation procedures; and, lack of a coordinated and strategic approach among donors. A New Framework Improving ocean stewardship and ending the fragmentation of current capacity building programs will require a new, broadly adopted framework for capacity building that emphasizes cooperation, sustainability, and knowledge transfer within and among communities. The report identifies four specific features of capacity building that would increase the effectiveness and efficiency of future programs: 1. Regional action plans based on periodic program assessments to guide investments in capacity and set realistic milestones and performance measures. 2. Long-term support to establish self-sustaining programs. Sustained capacity building programs require a diversity of sources and coordinated investments from local, regional, and international donors. 3. Development of leadership and political will. One of the most commonly cited reasons for failure and lack of progress in ocean and coastal governance initiatives is lack of political will. One strategy for strengthening support is to identify, develop, mentor, and reward leaders. 4. Establishment of networks and mechanisms for regional collaboration. Networks bring together those working in the same or similar ecosystems with comparable management or governance challenges to share information, pool resources, and learn from one another. The report also recommends the establishment of regional centers to encourage and support collaboration among neighboring countries.

Optimizability of OGC Standards Implementations - a Case Study

NASA Astrophysics Data System (ADS)

Misev, D.; Baumann, P.

2012-04-01

Why do we shop at Amazon? Because they have a unique offering that is nowhere else available? Certainly not. Rather, Amazon offers (i) simple, yet effective search; (ii) very simple payment; (iii) extremely rapid delivery. This is how scientific services will be distinguished in future: not for their data holding (there will be manifold choice), but for their service quality. We are facing the transition from data stewardship to service stewardship. One of the OGC standards which particularly enables flexible retrieval is the Web Coverage Processing Service (WCPS). It defines a high-level query language on large, multi-dimensional raster data, such as 1D timeseries, 2D EO imagery, 3D x/y/t image time series and x/y/z geophysical data, 4D x/y/z/t climate and ocean data. We have implemented WCPS based on an Array Database Management System, rasdaman, which is available in open source. In this demonstration, we study WCPS queries on 2D, 3D, and 4D data sets. Particular emphasis is placed on the computational load queries generate in such on-demand processing and filtering. We look at different techniques and their impact on performance, such as adaptive storage partitioning, query rewriting, and just-in-time compilation. Results show that there is significant potential for effective server-side optimization once a query language is sufficiently high-level and declarative.

Environmental stewardship: Pathways to community cohesion and cultivating meaningful engagement

Treesearch

Sachi Arakawa; Sonya Sachdeva; Vivek Shandas

2018-01-01

What pathways do people take on the journey to stewardship and what rewards do they reap? Numerous studies emphasize the underlying values, whether moral, spiritual, or religious, which provide the foundation for engaging in environmental behavior. Yet, many cases of stewardship are founded not on lofty environmental ideals but on pragmatic, localized ambitions. As...

Family forest stewardship: do owners need a financial incentive?

Treesearch

Michael A. Kilgore; Stephanie Snyder; Steven Taff; Joseph Schertz

2008-01-01

This study assessed family forest owner interest in formally committing to the types of land use and management practices that characterize good stewardship if compensated for doing so, using Minnesota's Sustainable Forest Incentives Act (SFIA) as a proxy measure of forest stewardship. The SFIA provides an annual payment in return for obtaining and using a forest...

Donor Relations: The Essential Guide to Stewardship Policies, Procedures, and Protocol. The Newcomer Series.

ERIC Educational Resources Information Center

Taylor, Karla, Ed.; Joyce, Shannon, Ed.

This book discusses various facets of stewardship as it applies specifically to philanthropy and donor relations for institutions of higher education. Stewardship is defined as a way of preserving opportunities for further support, as the legal and public relations protection of institutions, and as a "right" thing to do. Following an…

Urban ecological stewardship: understanding the structure, function and network of community-based urban land management

Treesearch

Erika s. Svendsen; Lindsay K. Campbell

2008-01-01

Urban environmental stewardship activities are on the rise in cities throughout the Northeast. Groups participating in stewardship activities range in age, size, and geography and represent an increasingly complex and dynamic arrangement of civil society, government and business sectors. To better understand the structure, function and network of these community-based...

Institutional plan FY 1999--FY 2004

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

NONE

1998-10-01

Los Alamos has a well-defined and nationally important mission: to reduce the global nuclear danger. This central national security mission consists of four main elements: stockpile stewardship, nuclear materials management, nonproliferation and arms control, and cleanup of the environmental legacy of nuclear weapons activities. The Laboratory provides support for and ensures confidence in the nation`s nuclear stockpile without nuclear testing. This challenge requires the Laboratory to continually hone its scientific acumen and technological capabilities to perform this task reliably using an interdisciplinary approach and advanced experimental and modeling techniques. In the last two National Defense Authorization Acts, Congress identified themore » need to protect the nation from the proliferation of weapons of mass destruction, which includes nuclear, chemical, and biological weapons, and their potential use by terrorists. Los Alamos is applying multidisciplinary science and engineering skills to address these problems. In addition, the Laboratory`s critical programmatic roles in stockpile stewardship and threat reduction are complemented by its waste management operations and environmental restoration work. Information on specific programs is available in Section 2 of this document.« less

Perceptions and Practices of Community Pharmacists towards Antimicrobial Stewardship in the State of Selangor, Malaysia.

PubMed

Khan, Muhammad Umair; Hassali, Mohamed Azmi Ahmad; Ahmad, Akram; Elkalmi, Ramadan Mohamed; Zaidi, Syed Tabish Razi; Dhingra, Sameer

2016-01-01

Increasing antimicrobial resistance is one of the pressing concerns globally. Injudicious use of antibiotics is one of the modifiable factors responsible for antimicrobial resistance. Given the widespread use of antimicrobials in community settings, pharmacists have an important role in ensuring appropriate use of antibiotics. The objective of this study was to assess the perception and self-reported practices of community pharmacists towards antimicrobial stewardship. A cross-sectional study was conducted among community pharmacists between March-April, 2015, using a self-administered, pre-tested questionnaire in the State of Selangor, Malaysia. A simple random sampling approach was used to select pharmacy sites. Descriptive and inferential statistical methods were used to analyse the data. A total of 188 pharmacists responded to the survey, giving a response rate of 83.5%. The majority of participants (n = 182, 96.8%) believed that antimicrobial stewardship program helps healthcare professionals to improve the quality of patient care. However, more than half of pharmacists were neutral in their opinion about the incorporation of antimicrobial stewardship programs in community pharmacies (n = 102, 54.2%). Though collaboration was often done by pharmacists with other health professionals over the use of antibiotics (n = 104, 55.3%), a significant proportion of participants (n = 102, 54.2%) rarely/occasionally participate in antimicrobial awareness campaigns. Pharmacists having postgraduate qualification were more likely to held positive perceptions of, and were engaged in, antimicrobial stewardship than their non-postgraduate counterpart (p<0.05). Similarly, more experienced pharmacists (> 10 years) held positive perceptions towards antimicrobial stewardship (p<0.05). The study highlighted some gaps in the perception and practices of community pharmacist towards antimicrobial stewardship. Development of customized interventions would be critical to bridging these gaps and improve their perception and practices towards antimicrobial stewardship.

Perceptions and Practices of Community Pharmacists towards Antimicrobial Stewardship in the State of Selangor, Malaysia

PubMed Central

Khan, Muhammad Umair; Hassali, Mohamed Azmi Ahmad; Ahmad, Akram; Elkalmi, Ramadan Mohamed; Zaidi, Syed Tabish Razi; Dhingra, Sameer

2016-01-01

Background Increasing antimicrobial resistance is one of the pressing concerns globally. Injudicious use of antibiotics is one of the modifiable factors responsible for antimicrobial resistance. Given the widespread use of antimicrobials in community settings, pharmacists have an important role in ensuring appropriate use of antibiotics. The objective of this study was to assess the perception and self-reported practices of community pharmacists towards antimicrobial stewardship. Methods A cross-sectional study was conducted among community pharmacists between March–April, 2015, using a self-administered, pre-tested questionnaire in the State of Selangor, Malaysia. A simple random sampling approach was used to select pharmacy sites. Descriptive and inferential statistical methods were used to analyse the data. Results A total of 188 pharmacists responded to the survey, giving a response rate of 83.5%. The majority of participants (n = 182, 96.8%) believed that antimicrobial stewardship program helps healthcare professionals to improve the quality of patient care. However, more than half of pharmacists were neutral in their opinion about the incorporation of antimicrobial stewardship programs in community pharmacies (n = 102, 54.2%). Though collaboration was often done by pharmacists with other health professionals over the use of antibiotics (n = 104, 55.3%), a significant proportion of participants (n = 102, 54.2%) rarely/occasionally participate in antimicrobial awareness campaigns. Pharmacists having postgraduate qualification were more likely to held positive perceptions of, and were engaged in, antimicrobial stewardship than their non-postgraduate counterpart (p<0.05). Similarly, more experienced pharmacists (> 10 years) held positive perceptions towards antimicrobial stewardship (p<0.05). Conclusion The study highlighted some gaps in the perception and practices of community pharmacist towards antimicrobial stewardship. Development of customized interventions would be critical to bridging these gaps and improve their perception and practices towards antimicrobial stewardship. PMID:26901404

Engaging Pharmacy Students, Residents, and Fellows in Antimicrobial Stewardship.

PubMed

Chahine, Elias B; El-Lababidi, Rania M; Sourial, Mariette

2015-12-01

Antimicrobial stewardship programs are mainly established by infectious diseases physicians and infectious diseases-trained clinical pharmacists with the goal of optimizing patients' outcomes while halting antimicrobial resistance, decreasing adverse events, and controlling health care cost. The role of the infectious diseases-trained clinical pharmacist in antimicrobial stewardship is well established; however, there are not enough formally trained pharmacists to assume the challenging responsibilities of the steward coordinator. The purpose of this article was to review the available literature and resources and propose a model to engage introductory pharmacy practice experience students, advanced pharmacy practice experience students, postgraduate year (PGY) 1 pharmacy residents, PGY2 infectious diseases pharmacy residents, and PGY2 or PGY3 infectious diseases pharmacy fellows in antimicrobial stewardship. Further studies are needed to assess and document the impact of pharmacy students and postgraduate trainees on antimicrobial stewardship programs. © The Author(s) 2013.

Antimicrobial stewardship

PubMed Central

Chung, Gladys W.; Wu, Jia En; Yeo, Chay Leng; Chan, Douglas; Hsu, Li Yang

2013-01-01

Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs. PMID:23302793

Antimicrobial stewardship: a review of prospective audit and feedback systems and an objective evaluation of outcomes.

PubMed

Chung, Gladys W; Wu, Jia En; Yeo, Chay Leng; Chan, Douglas; Hsu, Li Yang

2013-02-15

Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs.

Urban non-timber forest products stewardship practices among foragers in Seattle, Washington (USA)

Treesearch

R.J. McLain; Melissa R. Poe; Lauren S. Urgenson; Dale J. Blahna; Lita P. Buttolph

2017-01-01

Our research seeks to expand the concept of urban environmental stewardship to include the everyday stewardship practices of urban nontimber forest products foragers. Ethnographic data from 58 urban foragers and 18 land stewards in the city of Seattle (USA) revealed that foragers reported using a variety of practices to enhance and minimize negative desirable species...

2015 National Agenda for Digital Stewardship

DTIC Science & Technology

2014-09-01

tool and framework that explores the aspects of “benefit,” “risk,” “value,”’ “ quality ,” and “sustainability.” It is analyzing previous work on cost...evidence of the value of digital stewardship activities is needed. Improved and sharable metrics about the quality and success of digital stewardship...Significant Properties .................................. 38 5.3.4 Policy Research on Trust Frameworks

Integrating human and natural systems in community psychology: an ecological model of stewardship behavior.

PubMed

Moskell, Christine; Allred, Shorna Broussard

2013-03-01

Community psychology (CP) research on the natural environment lacks a theoretical framework for analyzing the complex relationship between human systems and the natural world. We introduce other academic fields concerned with the interactions between humans and the natural environment, including environmental sociology and coupled human and natural systems. To demonstrate how the natural environment can be included within CP's ecological framework, we propose an ecological model of urban forest stewardship action. Although ecological models of behavior in CP have previously modeled health behaviors, we argue that these frameworks are also applicable to actions that positively influence the natural environment. We chose the environmental action of urban forest stewardship because cities across the United States are planting millions of trees and increased citizen participation in urban tree planting and stewardship will be needed to sustain the benefits provided by urban trees. We used the framework of an ecological model of behavior to illustrate multiple levels of factors that may promote or hinder involvement in urban forest stewardship actions. The implications of our model for the development of multi-level ecological interventions to foster stewardship actions are discussed, as well as directions for future research to further test and refine the model.

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

Sherry, T D; Kohlhorst, D P; Little, S K

The accomplishments to date and the long-range planning of the Y-12 Energy Management and Sustainability and Stewardship programs support the DOE and the National Nuclear Security Administration (NNSA) vision for a commitment to energy efficiency and sustainability and to achievement of the Guiding Principles. Specifically, the Y-12 vision is to support the Environment, Safety and Health Policy and the DOE Strategic Sustainability Performance Plan (SSPP) while promoting overall sustainability and reduction of greenhouse gas (GHG) emissions. Table ES.2 gives a comprehensive overview of Y-12's performance status and planned actions. B&W Y-12's Energy Management mission is to incorporate renewable energy andmore » energy efficient technologies site-wide and to position Y-12 to meet NNSA energy requirement needs through 2025 and beyond. During FY 2011, the site formed a sustainability team (Fig. ES.1). The sustainability team provides a coordinated approach to meeting the various sustainability requirements and serves as a forum for increased communication and consistent implementation of sustainability activities at Y-12. The sustainability team serves as an information exchange mechanism to promote general awareness of sustainability information, while providing a system to document progress and to identify resources. These resources are necessary to implement activities that support the overall goals of sustainability, including reducing the use of resources and conserving energy. Additionally, the team's objectives include: (1) Foster a Y-12-wide philosophy to conserve resources; (2) Reduce the impacts of production operations in a cost-effective manner; (3) Increase materials recycling; (4) Use a minimum amount of energy and fuel; (5) Create a minimum of waste and pollution in achieving Y-12-strategic objectives; (6) Develop and implement techniques, technologies, process modifications, and programs that support sustainable acquisition; (7) Minimize the impacts to resources, including energy/fuel, water, waste, pesticides, and pollution generation; (8) Incorporate sustainable design principles into the design and construction of facility upgrades, new facilities, and infrastructure; and (9) Comply with federal and state regulations, executive orders, and DOE requirements. Y-12 is working to communicate its sustainment vision through procedural, engineering, operational, and management practices. The site will make informed decisions based on the application of the five Guiding Principles for HPSBs to the maximum extent possible.« less

Data governance and stewardship: designing data stewardship entities and advancing data access.

PubMed

Rosenbaum, Sara

2010-10-01

U.S. health policy is engaged in a struggle over access to health information, in particular, the conditions under which information should be accessible for research when appropriate privacy protections and security safeguards are in place. The expanded use of health information-an inevitable step in an information age-is widely considered be essential to health system reform. Models exist for the creation of data-sharing arrangements that promote proper use of information in a safe and secure environment and with attention to ethical standards. Data stewardship is a concept with deep roots in the science and practice of data collection, sharing, and analysis. Reflecting the values of fair information practice, data stewardship denotes an approach to the management of data, particularly data that can identify individuals. The concept of a data steward is intended to convey a fiduciary (or trust) level of responsibility toward the data. Data governance is the process by which responsibilities of stewardship are conceptualized and carried out. As the concept of health information data stewardship advances in a technology-enabled environment, the question is whether legal barriers to data access and use will begin to give way. One possible answer may lie in defining the public interest in certain data uses, tying provider participation in federal health programs to the release of all-payer data to recognized data stewardship entities for aggregation and management, and enabling such entities to foster and enable the creation of knowledge through research. © Health Research and Educational Trust.

Data Governance and Stewardship: Designing Data Stewardship Entities and Advancing Data Access

PubMed Central

Rosenbaum, Sara

2010-01-01

U.S. health policy is engaged in a struggle over access to health information, in particular, the conditions under which information should be accessible for research when appropriate privacy protections and security safeguards are in place. The expanded use of health information—an inevitable step in an information age—is widely considered be essential to health system reform. Models exist for the creation of data-sharing arrangements that promote proper use of information in a safe and secure environment and with attention to ethical standards. Data stewardship is a concept with deep roots in the science and practice of data collection, sharing, and analysis. Reflecting the values of fair information practice, data stewardship denotes an approach to the management of data, particularly data that can identify individuals. The concept of a data steward is intended to convey a fiduciary (or trust) level of responsibility toward the data. Data governance is the process by which responsibilities of stewardship are conceptualized and carried out. As the concept of health information data stewardship advances in a technology-enabled environment, the question is whether legal barriers to data access and use will begin to give way. One possible answer may lie in defining the public interest in certain data uses, tying provider participation in federal health programs to the release of all-payer data to recognized data stewardship entities for aggregation and management, and enabling such entities to foster and enable the creation of knowledge through research. PMID:21054365

Fiscal Year 2015 Site Sustainability Plan

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

Witt, Monica Rene

Los Alamos National Laboratory is taking action to operate as a living laboratory for sustainable solutions in buildings, climate, energy, purchasing, transportation, waste, and water. LANL prepared the fiscal year (FY) 2015 Site Sustainability Plan (SSP) to describe progress towards the goals established in the SSPP. In addition, per the requirements of DOE Order 436.1, Departmental Sustainability, Los Alamos National Laboratory (LANL) uses its International Organization for Standardization (ISO) 14001:2004 certified Environmental Management System (EMS) to establish objectives to improve compliance, reduce environmental impacts, increase operational capacity, and meet long-term sustainability goals. The goals of the 2015 SSP are fullymore » integrated into LANL’s institutional environmental objectives under the EMS and its Long-Term Strategy for Environmental Stewardship & Sustainability (LTSESS).« less

Project FLOSSIE: Marine Data Stewardship at the Waterline

NASA Astrophysics Data System (ADS)

Bouchard, R. H.; Jensen, R. E.; Riley, R. E.

2016-02-01

There are more than 10 million wave records from platforms of the National Data Buoy Center (NDBC) that are archived by National Oceanic and Atmospheric Administration (NOAA). A considerable number of these were measured from the 61 NOMAD (Navy Oceanographic Meteorological Automatic Device) hulls that NDBC has used to make wave measurements since October 1979. Many of these measurements were made before the era of modern marine data stewardship. These long records lend themselves to investigations of climate trends and variability either directly by the measurements themselves, or indirectly by validating long-term numerical wave models or remote sensing applications. However studies (e.g., Gemmrich et al. 2011) indicate that discontinuities and increased variability of the measurements can arise from changing wave systems and platforms. The value of these records is undermined by the lack of understanding or documentation of technology changes - a critical component of data stewardship. To support its mission of long-term understanding of coastal waves and wave models, the U.S. Army Corps of Engineers, Coastal Hydraulics Laboratory (CHL) sponsored the FLOSSIE Project to gage the effects of technology changes on the long-term wave measurements from NOMAD hulls. On behalf of CHL, NDBC engineering and operations integrated old, new, and leading edge technologies on one NOMAD hull. The hull was successfully deployed in July 2015 at the Wave Evaluation and Testing area off of Monterey Bay, CA. The area hosts an NDBC 3-m hull with cross-generational-technologies and a reference standard in a Datawell Waverider buoy. Thus cross-generational and cross-platform inter-comparisons can be performed simultaneously to an accepted standard. The analysis goes beyond the bulk wave parameters. The analysis will examine the energy and directional distributions over the frequency range of wind-generated waves. The project is named in honor of the pioneering World War II Naval meteorologist, Commander Florence (Flossie) Van Straten (1913 - 1992), USNR, who coined the acronym for NOMAD. This paper will discuss the goals of the project, present preliminary data results and application to the long-term measurements, and outline the plans incorporating Best Practices of Marine Data Stewardship for the resulting datasets.

Enhancing Resident Safety by Preventing Healthcare-Associated Infection: A National Initiative to Reduce Catheter-Associated Urinary Tract Infections in Nursing Homes

PubMed Central

Mody, Lona; Meddings, Jennifer; Edson, Barbara S.; McNamara, Sara E.; Trautner, Barbara W.; Stone, Nimalie D.; Krein, Sarah L.; Saint, Sanjay

2015-01-01

Preventing healthcare-associated infection (HAI) is a key contributor to enhancing resident safety in nursing homes. In 2013, the U.S. Department of Health and Human Services approved a plan to enhance resident safety by reducing HAIs in nursing homes, with particular emphasis on reducing indwelling catheter use and catheter-associated urinary tract infection (CAUTI). Lessons learned from a recent multimodal Targeted Infection Prevention program in a group of nursing homes as well as a national initiative to prevent CAUTI in over 950 acute care hospitals called “On the CUSP: STOP CAUTI” will now be implemented in nearly 500 nursing homes in all 50 states through a project funded by the Agency for Healthcare Research and Quality (AHRQ). This “AHRQ Safety Program in Long-Term Care: HAIs/CAUTI” will emphasize professional development in catheter utilization, catheter care and maintenance, and antimicrobial stewardship as well as promoting patient safety culture, team building, and leadership engagement. We anticipate that an approach integrating technical and socio-adaptive principles will serve as a model for future initiatives to reduce other infections, multidrug resistant organisms, and noninfectious adverse events among nursing home residents. PMID:25814630

Knowledge translation in Iranian universities: need for serious interventions

PubMed Central

2013-01-01

Background The aim of this study was to assess the status of knowledge translation (KT) in Iranian medical science universities in order to assess the strengths and weaknesses of the most important organizations responsible for producing knowledge in the country. Methods The KT activities were assessed qualitatively and quantitatively in nine universities using the Self-Assessment Tool for Research Institutes. Results The strengths and weaknesses of universities were determined using seven main themes: priority setting; research quality and timeliness; researchers’ KT capacities; interaction with research users; the facilities and prerequisites of KT; the processes and regulations supporting KT; and promoting and evaluating the use of evidence. The quantitative and qualitative results showed that the Iranian universities did not have an appropriate context for KT. There were significant shortcomings in supportive regulations, facilities for KT activities, and the level of interaction between the researchers and research users. Conclusions The shortcomings in KT were mostly in the area of stewardship and policymaking (macro level), followed by planning and implementation at the universities. In order to strengthen KT in Iran, it should occupy a prominent and focused role in the strategies of the country’s health research system. PMID:24225146

Fifteen years of sector-wide approach (SWAp) in Bangladesh health sector: an assessment of progress.

PubMed

Ahsan, Karar Zunaid; Streatfield, Peter Kim; Ijdi, Rashida-E-; Escudero, Gabriela Maria; Khan, Abdul Waheed; Reza, M M

2016-06-01

The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh embarked on a sector-wide approach (SWAp) modality for the health, nutrition and population (HNP) sector in 1998. This programmatic shift initiated a different set of planning disciplines and practices along with institutional changes in the MOHFW. Over the years, the SWAp modality has evolved in Bangladesh as the MOHFW has learnt from its implementation and refined the program design. This article explores the progress made, both in terms of achievement of health outcomes and systems strengthening results, since the implementation of the SWAp for Bangladesh's health sector. Secondary analyses of survey data from 1993 to 2011 as well as a literature review of published and grey literature on health SWAp in Bangladesh was conducted for this assessment. Results of the assessment indicate that the MOHFW made substantial progress in health outcomes and health systems strengthening. SWAps facilitated the alignment of funding and technical support around national priorities, and improved the government's role in program design as well as in implementation and development partner coordination. Notable systemic improvements have taken place in the country systems with regards to monitoring and evaluation, procurement and service provision, which have improved functionality of health facilities to provide essential care. Implementation of the SWAp has, therefore, contributed to an accelerated improvement in key health outcomes in Bangladesh over the last 15 years. The health SWAp in Bangladesh offers an example of a successful adaptation of such an approach in a complex administrative structure. Based on the lessons learned from SWAp implementation in Bangladesh, the MOHFW needs to play a stronger stewardship and regulatory role to reap the full benefits of a SWAp in its subsequent programming. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention.

PubMed

Dela-Pena, Jennifer; Kerstenetzky, Luiza; Schulz, Lucas; Kendall, Ron; Lepak, Alexander; Fox, Barry

2017-03-01

OBJECTIVE To characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center and identify cost-effective intervention opportunities targeting high-cost antimicrobial utilization. DESIGN Retrospective cohort study. PATIENTS Top 1% of the antimicrobial budget from July 1 through December 31, 2014. METHODS Patients were identified through a pharmacy billing database. Baseline characteristics were collected through a retrospective medical chart review. Patients were presented to the antimicrobial stewardship team to determine appropriate utilization of high-cost antimicrobials and potential intervention opportunities. Appropriate use was defined as antimicrobial therapy that was effective, safe, and most cost-effective compared with alternative agents. RESULTS A total of 10,460 patients received antimicrobials in 6 months; 106 patients accounted for $889,543 (47.2%) of the antimicrobial budget with an antimicrobial cost per day of $219±$192 and antimicrobial cost per admission of $4,733±$7,614. Most patients were immunocompromised (75%) and were followed by the infectious disease consult service (80%). The most commonly prescribed antimicrobials for treatment were daptomycin, micafungin, liposomal amphotericin B, and meropenem. Posaconazole and valganciclovir accounted for most of the prophylactic therapy. Cost-effective opportunities (n=71) were present in 57 (54%) of 106 patients, which included dose optimization, de-escalation, dosage form conversion, and improvement in transitions of care. CONCLUSION Antimicrobial stewardship oversight is important in implementing cost-effective strategies, especially in complex and immunocompromised patients who require the use of high-cost antimicrobials. Infect Control Hosp Epidemiol 2017;38:259-265.

[Stewardship of public health surveillance in the health system in Colombia: a case study].

PubMed

López, Yolanda Lucía; González, Claudia; Gallego, Berta Natalia; Moreno, Ana Lida

2009-12-01

With the reform of the Colombian health system in 1993, public health surveillance continued to be a governmental responsibility under the stewardship of the Ministry of Social Protection along with state and local health authorities. The effectiveness of the development and organization of state and municipality public health surveillance programs will be studied as they have evolved under the general social security system in Colombia. Qualitative study and case-study method are applied to several institutions as they function in 5 states and 11 counties, ten years after the health system reforms. Public health authorities have reduced resources for providing advice, technical assistance, supervision and control of the process of the public health surveillance. Weaknesses in administrative control are common. Quantity and quality of human resources, as well as, staffing and financial resources are inadequate to meet the responsibilities that have been assigned to each state and county. The public health surveillance has prioritized the notification and registration of cases, and the strength of development of particular areas occasionally has been subject to the particular interests of officials in charge, particularly in the public hospitals. Little commitment or interest is shown by mayors, insurance companies, and institutions providing health services that are supposed to be involved with monitoring. A lack of cross-institutional collaboration is apparent in the development of health services surveillance. The implementation of public health surveillance at state and local levels is weak due to problems with the governmental stewardship. These weaknesses are manifested in the lack of regulation, financing and control of the health system.

A Pilot Study for Antimicrobial Stewardship Post-Discharge: Avoiding Pitfalls at the Transitions of Care.

PubMed

Jones, Justin M; Leedahl, Nathan D; Losing, Ashley; Carson, Paul J; Leedahl, David D

2018-04-01

Lack of patient follow-up is a major concern during care transitions, and the role of an antimicrobial stewardship program (ASP) in assessing antimicrobial regimens after hospital discharge is not well described. We implemented an expanded ASP to include patients recently discharged from the hospital and measured its impact on inappropriate antimicrobial therapy 72 hours after inpatient culture data were finalized. A prospective cohort study was conducted at a 583-bed tertiary care center in the Upper Midwest of America. All patients discharged from our facility on antimicrobial therapy with pending culture results between February 3, 2016, and March 2, 2016, were included for review. If a pathogen nonsusceptible to all prescribed antimicrobials was identified post-discharge, a recommendation for therapy modification was communicated to the prescriber. Thirty-eight patients discharged from our hospital on antimicrobial therapy with pending culture results were evaluated for intervention. When final culture susceptibilities were considered, 5 of 38 patients had been prescribed an inappropriate antimicrobial agent. An ASP pharmacist intervened on 4 of 5 patients, resulting in 3 of 5 patients transitioning to appropriate antimicrobial therapy. When compared to a historical cohort, our transitions-of-care ASP yielded a 3.6-fold increase in antimicrobial-related interventions among discharged patients while reducing inappropriate outpatient antimicrobial therapy by 39%. We believe this is the first pharmacist-driven ASP represented in the medical literature which evaluated all available inpatient culture data to serve patients discharged from the hospital. Antimicrobial stewardship for patients in care transitions may provide an opportunity to increase ASP interventions and reduce inappropriate antimicrobial therapy.

Natural climate solutions.

PubMed

Griscom, Bronson W; Adams, Justin; Ellis, Peter W; Houghton, Richard A; Lomax, Guy; Miteva, Daniela A; Schlesinger, William H; Shoch, David; Siikamäki, Juha V; Smith, Pete; Woodbury, Peter; Zganjar, Chris; Blackman, Allen; Campari, João; Conant, Richard T; Delgado, Christopher; Elias, Patricia; Gopalakrishna, Trisha; Hamsik, Marisa R; Herrero, Mario; Kiesecker, Joseph; Landis, Emily; Laestadius, Lars; Leavitt, Sara M; Minnemeyer, Susan; Polasky, Stephen; Potapov, Peter; Putz, Francis E; Sanderman, Jonathan; Silvius, Marcel; Wollenberg, Eva; Fargione, Joseph

2017-10-31

Better stewardship of land is needed to achieve the Paris Climate Agreement goal of holding warming to below 2 °C; however, confusion persists about the specific set of land stewardship options available and their mitigation potential. To address this, we identify and quantify "natural climate solutions" (NCS): 20 conservation, restoration, and improved land management actions that increase carbon storage and/or avoid greenhouse gas emissions across global forests, wetlands, grasslands, and agricultural lands. We find that the maximum potential of NCS-when constrained by food security, fiber security, and biodiversity conservation-is 23.8 petagrams of CO 2 equivalent (PgCO 2 e) y -1 (95% CI 20.3-37.4). This is ≥30% higher than prior estimates, which did not include the full range of options and safeguards considered here. About half of this maximum (11.3 PgCO 2 e y -1 ) represents cost-effective climate mitigation, assuming the social cost of CO 2 pollution is ≥100 USD MgCO 2 e -1 by 2030. Natural climate solutions can provide 37% of cost-effective CO 2 mitigation needed through 2030 for a >66% chance of holding warming to below 2 °C. One-third of this cost-effective NCS mitigation can be delivered at or below 10 USD MgCO 2 -1 Most NCS actions-if effectively implemented-also offer water filtration, flood buffering, soil health, biodiversity habitat, and enhanced climate resilience. Work remains to better constrain uncertainty of NCS mitigation estimates. Nevertheless, existing knowledge reported here provides a robust basis for immediate global action to improve ecosystem stewardship as a major solution to climate change.

[Impact of rational use of antibiotics in a third level clinic in Colombia].

PubMed

Pallares, Christian J; Cataño, Juan C

2017-06-01

The increasing resistance of bacteria to antibiotics threatens the survival of patients and health costs. To determine the impact of an antimicrobial stewardship program in bacterial resistance and antibiotic consumption. Quasi experimental study in a third level clinic in the city of Medellin, that evaluate in two time periods (pre-intervention between October 2012 and September 2013 and post intervention between October 2013 and September 2014) the impact of an antimicrobial stewardship program in terms of antibiotic consumption and bacterial ecology. Adherence to institutional guidelines for management of infections in the post-intervention period was 82%. Antibiotic consumption of meropenem, ceftriaxone, vancomycin and colistin decreased, and imipenem, daptomycin and linezolid was increased. A significant decrease in antibiotic resistance in Pseudomonas aeruginosa was observed, including carbapenems. An increase of extended spectrum beta lactamase production (ESBL) in Enterobacteriaceae (especially E. coli) and piperacillin/tazobactam resistance was observed. The construction and implementation of a strategy in hospitals with guidelines for managing infectious diseases, restrictions in antibiotic use, a permanent monitoring system for the formulation of antibiotics, achieved a positive impact on reducing antibiotic use and bacterial resistance.

Synergizing health and population in Pakistan.

PubMed

Nishtar, Sania; Amjad, Saba; Sheikh, Sobia; Ahmad, Mahbub

2009-09-01

The delivery of health and family planning services in Pakistan is the respective mandate of the Ministry of Health/departments of health and the Ministry of Population Welfare. This institutional separation creates issues due to marginalization of family planning and reproductive health as core health issues. The government of Pakistan has made several attempts in the past to merge both the institutional hierarchal arrangements. This study was conducted to examine if merger is a viable option and to explore a way forward to bridge the current population-health disconnect in the country. Qualitative survey methods, inclusive of review of published and grey literature, archival analysis, informant interviews and focus group discussions were used for the analysis. Findings outline both the imperatives for merging the ministries and the challenges inherent in doing so. Recommendations recognize that although not a sufficient step to improve health and population outcomes, creating synergies between the health and population sectors is an imperative. The sustainable long-term solution to the existing population-health disconnect centres on deep-rooted reform at several levels in both the institutional hierarchies, with transformation of the role of stewardship agencies and reengineering of service delivery arrangements as its hallmarks. Restructured service delivery arrangements are meant to allow the delivery of a set of MDG+ services, where family planning and reproductive health are grouped alongside and together with essential health services. The latter are envisaged to be a yardstick for public delivery of services and the basis of contractual relationships in new management arrangements, which involve a role for the private sector. The short to medium term strategies proposed in this paper centre on a range of specific collaborative measures with a view to building capacity for the broader systems transformation. Sustained political and institutional commitment will be needed to implement these recommendations.

Marine Spatial Planning Applied to the High Seas - Process and Results of an Exercise Focused on the Sargasso Sea

NASA Astrophysics Data System (ADS)

Siuda, A. N.; Smythe, T. C.

2016-12-01

The Sargasso Sea, at the center of the North Atlantic gyre, is recognized by the United Nations Convention on Biological Diversity as a globally unique ecosystem threatened by anthropogenic activity. In its stewardship capacity, the Sargasso Sea Commission works within the current system of international organizations and treaties to secure protection for particular species or areas. Without a single governing authority to implement and enforce protective measures across the region, a coordinated management plan for the region is lacking. A research team comprised of 20 advanced undergraduate scientists participating in the spring 2015 SEA Semester: Marine Biodiversity and Conservation program of Sea Education Association (Woods Hole, MA) engaged in a groundbreaking simulated high seas marine spatial planning process resulting in A Marine Management Proposal for the Sargasso Sea. Based on natural and social science research, the interdisciplinary Proposal outlines goals, objectives and realistic strategies that encompass ecological, economic, human use, and future use considerations. Notably, the Proposal is the product of a classroom-based simulation intended to improve emerging scientists' understanding of how research is integrated into the policy process and how organizations work across disciplinary boundaries to address complex ocean management problems. Student researchers identified several discrete management areas and associated policy recommendations for those areas, as well as strategies for coordinated management across the entire Sargasso Sea region. The latter include establishment of a United Nations Regional Ocean Management Organization as well as provisions for monitoring and managing high seas traffic. To make progress toward these strategies, significant attention to the importance of high seas regions for global-scale conservation will be necessary.

Marine Spatial Planning Applied to the High Seas - Process and Results of an Exercise Focused on the Sargasso Sea

NASA Astrophysics Data System (ADS)

Siuda, A. N.; Smythe, T. C.

2016-02-01

The Sargasso Sea, at the center of the North Atlantic gyre, is recognized by the United Nations Convention on Biological Diversity as a globally unique ecosystem threatened by anthropogenic activity. In its stewardship capacity, the Sargasso Sea Commission works within the current system of international organizations and treaties to secure protection for particular species or areas. Without a single governing authority to implement and enforce protective measures across the region, a coordinated management plan for the region is lacking. A research team comprised of 20 advanced undergraduate scientists participating in the spring 2015 SEA Semester: Marine Biodiversity and Conservation program of Sea Education Association (Woods Hole, MA) engaged in a groundbreaking simulated high seas marine spatial planning process resulting in A Marine Management Proposal for the Sargasso Sea. Based on natural and social science research, the interdisciplinary Proposal outlines goals, objectives and realistic strategies that encompass ecological, economic, human use, and future use considerations. Notably, the Proposal is the product of a classroom-based simulation intended to improve emerging scientists' understanding of how research is integrated into the policy process and how organizations work across disciplinary boundaries to address complex ocean management problems. Student researchers identified several discrete management areas and associated policy recommendations for those areas, as well as strategies for coordinated management across the entire Sargasso Sea region. The latter include establishment of a United Nations Regional Ocean Management Organization as well as provisions for monitoring and managing high seas traffic. To make progress toward these strategies, significant attention to the importance of high seas regions for global-scale conservation will be necessary.

Investigating the ways in which health information technology can promote antimicrobial stewardship: a conceptual overview.

PubMed

King, Abby; Cresswell, Kathrin M; Coleman, Jamie J; Pontefract, Sarah K; Slee, Ann; Williams, Robin; Sheikh, Aziz

2017-08-01

Antimicrobial resistance is now recognised as a threat to health worldwide. Antimicrobial stewardship aims to promote the responsible use of antibiotics and is high on international and national policy agendas. Health information technology has the potential to support antimicrobial stewardship in a number of ways, but this field is still poorly characterised and understood. Building on a recent systematic review and expert roundtable discussions, we take a lifecycle perspective of antibiotic use in hospitals and identify potential targets for health information technology-based interventions to support antimicrobial stewardship. We aim for this work to help chart a future research agenda in this critically important area.

Between land and sea: divergent data stewardship practices in deep-sea biosphere research

NASA Astrophysics Data System (ADS)

Cummings, R.; Darch, P.

2013-12-01

Data in deep-sea biosphere research often live a double life. While the original data generated on IODP expeditions are highly structured, professionally curated, and widely shared, the downstream data practices of deep-sea biosphere laboratories are far more localized and ad hoc. These divergent data practices make it difficult to track the provenance of datasets from the cruise ships to the laboratory or to integrate IODP data with laboratory data. An in-depth study of the divergent data practices in deep-sea biosphere research allows us to: - Better understand the social and technical forces that shape data stewardship throughout the data lifecycle; - Develop policy, infrastructure, and best practices to improve data stewardship in small labs; - Track provenance of datasets from IODP cruises to labs and publications; - Create linkages between laboratory findings, cruise data, and IODP samples. In this paper, we present findings from the first year of a case study of the Center for Dark Energy Biosphere Investigations (C-DEBI), an NSF Science and Technology Center that studies life beneath the seafloor. Our methods include observation in laboratories, interviews, document analysis, and participation in scientific meetings. Our research uncovers the data stewardship norms of geologists, biologists, chemists, and hydrologists conducting multi-disciplinary research. Our research team found that data stewardship on cruises is a clearly defined task performed by an IODP curator, while downstream it is a distributed task that develops in response to local need and to the extent necessary for the immediate research team. IODP data are expensive to collect and challenging to obtain, often costing $50,000/day and requiring researchers to work twelve hours a day onboard the ships. To maximize this research investment, a highly trained IODP data curator controls data stewardship on the cruise and applies best practices such as standardized formats, proper labeling, and centralized storage. In the laboratory, a scientist is his or her own curator. In contrast to the IODP research parties, laboratory research teams analyze diverse datasets, share them internally, implement ad hoc data management practices, optimize methods for their specific research questions, and release data on request through personal transactions. We discovered that while these workflows help small research teams retain flexibility and local control - crucial in exploratory deep-sea biosphere research - they also hinder data interoperability, discoverability, and consistency of methods from one research team to the next. Additional consequences of this contrast between IODP and lab practices are that it is difficult to track the provenance of data and to create linkages between laboratory findings, cruise data, and archived IODP samples. The ability to track provenance would add value to datasets and provide a clearer picture of the decisions made throughout the data lifecycle. Better linkages between the original data, laboratory data, and samples would allow secondary researchers to locate IODP data that may be useful to their research after laboratory findings are published. Our case study is funded by the Sloan Foundation and NSF.

Use of PNA FISH for blood cultures growing Gram-positive cocci in chains without a concomitant antibiotic stewardship intervention does not improve time to appropriate antibiotic therapy.

PubMed

Cosgrove, Sara E; Li, David X; Tamma, Pranita D; Avdic, Edina; Hadhazy, Eric; Wakefield, Teresa; Gherna, Michael; Carroll, Karen C

2016-09-01

Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) is a rapid diagnostic assay that can identify certain organisms growing in blood cultures 30-90 min from the time of positive Gram-stain. Existing studies have demonstrated a clinical utility with this assay when antibiotic stewardship programs assist clinicians with interpreting the results. However, the benefit of these rapid assays in the absence of concomitant antibiotic stewardship involvement is unclear. In this randomized study of 220 patients with enterococcal or streptococcal bacteremia, we found that PNA FISH, in the absence of concomitant input from an antibiotic stewardship program, had no impact on time to effective or optimal therapy, length of hospital stay, or in-hospital mortality. Our results suggest that in the absence of guidance from an antibiotic stewardship program, the clinical benefits of rapid diagnostic microbiological tools may be reduced. Copyright © 2016 Elsevier Inc. All rights reserved.

Optimizing adherence to advice from antimicrobial stewardship audit and feedback rounds.

PubMed

Rawlins, Matthew D M; Sanfilippo, Frank M; Ingram, Paul R; McLellan, Duncan G J; Crawford, Colin; D'Orsogna, Luca; Dyer, John

2018-02-01

We examined adherence to antimicrobial stewardship prospective audit and feedback rounds in a rehabilitation service compared with the remainder of the acute hospital, and explored the reasons for this. Between October 2014 and December 2015, we retrospectively assessed the rate of non-adherence to advice from antimicrobial stewardship prospective audit and feedback rounds between the rehabilitation service and the acute hospital, along with the source of the patient referral. Compared with the rehabilitation service, acute hospital medical staff were almost twice as likely to not adhere to advice provided on antimicrobial stewardship prospective audit and feedback rounds (13.8% vs. 7.6%, p < 0.0001, relative risk 1.8 [95% confidence interval 1.3, 2.5]). In the rehabilitation service, referrals were more likely to come from medical staff (61.9% vs. 16.3%, p < 0.0001). These findings may be explained by regular, direct engagement of the antimicrobial stewardship team with the rehabilitation service clinical team, a model potentially applicable to other settings.

Impact of China's essential medicines scheme and zero-mark-up policy on antibiotic prescriptions in county hospitals: a mixed methods study.

PubMed

Wei, Xiaolin; Yin, Jia; Walley, John D; Zhang, Zhitong; Hicks, Joseph P; Zhou, Yu; Sun, Qiang; Zeng, Jun; Lin, Mei

2017-09-01

To evaluate the impact of the national essential medicines scheme and zero-mark-up policy on antibiotic prescribing behaviour. In rural Guangxi, a natural experiment compared one county hospital which implemented the policy with a comparison hospital which did not. All outpatient and inpatient records in 2011 and 2014 were extracted from the two hospitals. Primary outcome indicator was antibiotic prescribing rate (APR) among children aged 2-14 presenting in outpatients with a primary diagnosis of upper respiratory tract infection (URTI). We organised independent physician reviews to determine inappropriate prescribing for inpatients. Difference-in-difference analyses based on multivariate regressions were used to compare APR over time after adjusting potential confounders. We conducted 12 in-depth interviews with paediatricians, hospital directors and health officials. A total of 8219 and 4142 outpatient prescriptions of childhood URTIs were included in the intervention and comparison hospitals, respectively. In 2011, APR was 30% in the intervention and 88% in the comparison hospital. In 2014, the intervention hospital significantly reduced outpatient APR by 21% (95% CI:-23%, -18%), intravenous infusion by 58% (95% CI: -64%, -52%) and prescription cost by 31 USD (95% CI: -35, -28), compared with the controls. We collected 251 inpatient records, but did not find reductions in inappropriate antibiotic use. Interviews revealed that the intervention hospital implemented a thorough antibiotics stewardship programme containing training, peer review of prescriptions and restrictions for overprescribing. The national essential medicines scheme and zero-mark-up policy, when implemented with an antimicrobial stewardship programme, may be associated with reductions in outpatient antibiotic prescribing and intravenous infusions. © 2017 John Wiley & Sons Ltd.

The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey.

PubMed

Sartelli, Massimo; Labricciosa, Francesco M; Barbadoro, Pamela; Pagani, Leonardo; Ansaloni, Luca; Brink, Adrian J; Carlet, Jean; Khanna, Ashish; Chichom-Mefire, Alain; Coccolini, Federico; Di Saverio, Salomone; May, Addison K; Viale, Pierluigi; Watkins, Richard R; Scudeller, Luigia; Abbo, Lilian M; Abu-Zidan, Fikri M; Adesunkanmi, Abdulrashid K; Al-Dahir, Sara; Al-Hasan, Majdi N; Alis, Halil; Alves, Carlos; Araujo da Silva, André R; Augustin, Goran; Bala, Miklosh; Barie, Philip S; Beltrán, Marcelo A; Bhangu, Aneel; Bouchra, Belefquih; Brecher, Stephen M; Caínzos, Miguel A; Camacho-Ortiz, Adrian; Catani, Marco; Chandy, Sujith J; Jusoh, Asri Che; Cherry-Bukowiec, Jill R; Chiara, Osvaldo; Colak, Elif; Cornely, Oliver A; Cui, Yunfeng; Demetrashvili, Zaza; De Simone, Belinda; De Waele, Jan J; Dhingra, Sameer; Di Marzo, Francesco; Dogjani, Agron; Dorj, Gereltuya; Dortet, Laurent; Duane, Therese M; Elmangory, Mutasim M; Enani, Mushira A; Ferrada, Paula; Esteban Foianini, J; Gachabayov, Mahir; Gandhi, Chinmay; Ghnnam, Wagih Mommtaz; Giamarellou, Helen; Gkiokas, Georgios; Gomi, Harumi; Goranovic, Tatjana; Griffiths, Ewen A; Guerra Gronerth, Rosio I; Haidamus Monteiro, Julio C; Hardcastle, Timothy C; Hecker, Andreas; Hodonou, Adrien M; Ioannidis, Orestis; Isik, Arda; Iskandar, Katia A; Kafil, Hossein S; Kanj, Souha S; Kaplan, Lewis J; Kapoor, Garima; Karamarkovic, Aleksandar R; Kenig, Jakub; Kerschaever, Ivan; Khamis, Faryal; Khokha, Vladimir; Kiguba, Ronald; Kim, Hong B; Ko, Wen-Chien; Koike, Kaoru; Kozlovska, Iryna; Kumar, Anand; Lagunes, Leonel; Latifi, Rifat; Lee, Jae G; Lee, Young R; Leppäniemi, Ari; Li, Yousheng; Liang, Stephen Y; Lowman, Warren; Machain, Gustavo M; Maegele, Marc; Major, Piotr; Malama, Sydney; Manzano-Nunez, Ramiro; Marinis, Athanasios; Martinez Casas, Isidro; Marwah, Sanjay; Maseda, Emilio; McFarlane, Michael E; Memish, Ziad; Mertz, Dominik; Mesina, Cristian; Mishra, Shyam K; Moore, Ernest E; Munyika, Akutu; Mylonakis, Eleftherios; Napolitano, Lena; Negoi, Ionut; Nestorovic, Milica D; Nicolau, David P; Omari, Abdelkarim H; Ordonez, Carlos A; Paiva, José-Artur; Pant, Narayan D; Parreira, Jose G; Pędziwiatr, Michal; Pereira, Bruno M; Ponce-de-Leon, Alfredo; Poulakou, Garyphallia; Preller, Jacobus; Pulcini, Céline; Pupelis, Guntars; Quiodettis, Martha; Rawson, Timothy M; Reis, Tarcisio; Rems, Miran; Rizoli, Sandro; Roberts, Jason; Pereira, Nuno Rocha; Rodríguez-Baño, Jesús; Sakakushev, Boris; Sanders, James; Santos, Natalia; Sato, Norio; Sawyer, Robert G; Scarpelini, Sandro; Scoccia, Loredana; Shafiq, Nusrat; Shelat, Vishalkumar; Sifri, Costi D; Siribumrungwong, Boonying; Søreide, Kjetil; Soto, Rodolfo; de Souza, Hamilton P; Talving, Peep; Trung, Ngo Tat; Tessier, Jeffrey M; Tumbarello, Mario; Ulrych, Jan; Uranues, Selman; Van Goor, Harry; Vereczkei, Andras; Wagenlehner, Florian; Xiao, Yonghong; Yuan, Kuo-Ching; Wechsler-Fördös, Agnes; Zahar, Jean-Ralph; Zakrison, Tanya L; Zuckerbraun, Brian; Zuidema, Wietse P; Catena, Fausto

2017-01-01

Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p  < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.

A survey to optimize the design of an antimicrobial stewardship smartphone app at an academic medical center.

PubMed

Markley, J Daniel; Pakyz, Amy; Bernard, Shaina; Lee, Kimberly; Appelbaum, Nital; Bearman, Gonzalo; Stevens, Michael P

2017-03-01

Mobile medical apps are commonly used by health care professionals and could be used by antimicrobial stewardship programs to enhance adherence to local recommendations. We conducted a survey of health care workers to inform the design of an antimicrobial stewardship smartphone app. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.

PubMed

Heath, Barbara; Bernhardt, Jaime; Michalski, Thomas J; Crnich, Christopher J; Moehring, Rebekah; Schmader, Kenneth E; Olds, Danielle; Higgins, Patricia A; Jump, Robin L P

2016-03-01

We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Our outcomes suggest opportunities to engage nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting. Published by Elsevier Inc.

Social Network Analysis Identifies Key Participants in Conservation Development.

PubMed

Farr, Cooper M; Reed, Sarah E; Pejchar, Liba

2018-05-01

Understanding patterns of participation in private lands conservation, which is often implemented voluntarily by individual citizens and private organizations, could improve its effectiveness at combating biodiversity loss. We used social network analysis (SNA) to examine participation in conservation development (CD), a private land conservation strategy that clusters houses in a small portion of a property while preserving the remaining land as protected open space. Using data from public records for six counties in Colorado, USA, we compared CD participation patterns among counties and identified actors that most often work with others to implement CDs. We found that social network characteristics differed among counties. The network density, or proportion of connections in the network, varied from fewer than 2 to nearly 15%, and was higher in counties with smaller populations and fewer CDs. Centralization, or the degree to which connections are held disproportionately by a few key actors, was not correlated strongly with any county characteristics. Network characteristics were not correlated with the prevalence of wildlife-friendly design features in CDs. The most highly connected actors were biological and geological consultants, surveyors, and engineers. Our work demonstrates a new application of SNA to land-use planning, in which CD network patterns are examined and key actors are identified. For better conservation outcomes of CD, we recommend using network patterns to guide strategies for outreach and information dissemination, and engaging with highly connected actor types to encourage widespread adoption of best practices for CD design and stewardship.

An Interprofessional Curriculum on Antimicrobial Stewardship Improves Knowledge and Attitudes Toward Appropriate Antimicrobial Use and Collaboration

PubMed Central

Schwartz, Brian S.; Kim, Lisa; Nanamori, Mari; Shekarchian, Sharmin; Chin-Hong, Peter V.

2017-01-01

Abstract Background. Inappropriate antimicrobial use can threaten patient safety and is the focus of collaborative physician and pharmacist antimicrobial stewardship teams. However, antimicrobial stewardship is not comprehensively taught in medical or pharmacy school curricula. Addressing this deficiency can teach an important concept as well as model interprofessional healthcare. Methods. We created an antimicrobial stewardship curriculum consisting of an online learning module and workshop session that combined medical and pharmacy students, with faculty from both professions. Learners worked through interactive, branched-logic clinical cases relating to appropriate antimicrobial use. We surveyed participants before and after the curriculum using validated questions to assess knowledge and attitudes regarding antimicrobial stewardship and interprofessional collaboration. Results were analyzed using paired χ2 and t tests and mixed-effects logistic regression. Results. Analysis was performed with the 745 students (425 medical students, 320 pharmacy students) who completed both pre- and postcurriculum surveys over 3 years. After completing the curriculum, significantly more students perceived that they were able to describe the role of each profession in appropriate antimicrobial use (34% vs 82%, P < .001), communicate in a manner that engaged the interprofessional team (75% vs 94%, P < .001), and describe collaborative approaches to appropriate antimicrobial use (49% vs 92%, P < .001). Student favorability ratings were high for the online learning module (85%) and small group workshop (93%). Conclusions. A curriculum on antimicrobial stewardship consisting of independent learning and an interprofessional workshop significantly increased knowledge and attitudes towards collaborative antimicrobial stewardship among preclinical medical and pharmacy students. PMID:28480231

An Interprofessional Curriculum on Antimicrobial Stewardship Improves Knowledge and Attitudes Toward Appropriate Antimicrobial Use and Collaboration.

PubMed

MacDougall, Conan; Schwartz, Brian S; Kim, Lisa; Nanamori, Mari; Shekarchian, Sharmin; Chin-Hong, Peter V

2017-01-01

Inappropriate antimicrobial use can threaten patient safety and is the focus of collaborative physician and pharmacist antimicrobial stewardship teams. However, antimicrobial stewardship is not comprehensively taught in medical or pharmacy school curricula. Addressing this deficiency can teach an important concept as well as model interprofessional healthcare. We created an antimicrobial stewardship curriculum consisting of an online learning module and workshop session that combined medical and pharmacy students, with faculty from both professions. Learners worked through interactive, branched-logic clinical cases relating to appropriate antimicrobial use. We surveyed participants before and after the curriculum using validated questions to assess knowledge and attitudes regarding antimicrobial stewardship and interprofessional collaboration. Results were analyzed using paired χ 2 and t tests and mixed-effects logistic regression. Analysis was performed with the 745 students (425 medical students, 320 pharmacy students) who completed both pre- and postcurriculum surveys over 3 years. After completing the curriculum, significantly more students perceived that they were able to describe the role of each profession in appropriate antimicrobial use (34% vs 82%, P < .001), communicate in a manner that engaged the interprofessional team (75% vs 94%, P < .001), and describe collaborative approaches to appropriate antimicrobial use (49% vs 92%, P < .001). Student favorability ratings were high for the online learning module (85%) and small group workshop (93%). A curriculum on antimicrobial stewardship consisting of independent learning and an interprofessional workshop significantly increased knowledge and attitudes towards collaborative antimicrobial stewardship among preclinical medical and pharmacy students. © The Author 2017. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

Evaluation of pharmacy generalists performing antimicrobial stewardship services.

PubMed

Carreno, Joseph J; Kenney, Rachel M; Bloome, Mary; McDonnell, Jane; Rodriguez, Jennifer; Weinmann, Allison; Kilgore, Paul E; Davis, Susan L

2015-08-01

Improvements in medication use achieved by pharmacy generalists using a care bundle approach to antimicrobial stewardship are reported. A six-month prospective, repeated-treatment, quasi-experimental study involving three month-long intervention periods and three month-long control periods was conducted in the setting of an existing antimicrobial stewardship program at a large hospital. The intervention involved prospective audit and feedback conducted by pharmacy generalists who were trained in an antimicrobial stewardship care bundle approach. During control months, a pharmacy generalist who was not trained in antimicrobial stewardship rounded with the multidisciplinary team and provided standard-of-care pharmacy services. The primary endpoint was compliance with a care bundle of four antimicrobial stewardship metrics: documentation of indication for therapy in the medical record, selection of empirical therapy according to institutional guidelines, documented performance of indicated culture testing, and deescalation of therapy when indicated. Two-hundred eighty-six patients were enrolled in the study: 124 in the intervention group and 162 in the control group. The cumulative rate of full compliance with all care bundle components during the six-month study was significantly greater during intervention months than during control months (68.5% versus 45.7%, p < 0.001). After adjusting for infection type, antimicrobial stewardship provided by an intervention-group pharmacist was associated with improved care bundle compliance (adjusted odds ratio, 2.70; p < 0.001). No significant differences in patient outcomes during intervention and control months were detected. Pharmacy generalists trained to comply with a systematic care bundle approach enhanced the quality of antimicrobial management. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Protocol to disseminate a hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of asymptomatic bacteriuria.

PubMed

Trautner, Barbara W; Prasad, Pooja; Grigoryan, Larissa; Hysong, Sylvia J; Kramer, Jennifer R; Rajan, Suja; Petersen, Nancy J; Rosen, Tracey; Drekonja, Dimitri M; Graber, Christopher; Patel, Payal; Lichtenberger, Paola; Gauthier, Timothy P; Wiseman, Steve; Jones, Makoto; Sales, Anne; Krein, Sarah; Naik, Aanand Dinkar

2018-01-19

Antimicrobial stewardship to combat the spread of antibiotic-resistant bacteria has become a national priority. This project focuses on reducing inappropriate use of antimicrobials for asymptomatic bacteriuria (ASB), a very common condition that leads to antimicrobial overuse in acute and long-term care. We previously conducted a successful intervention, entitled "Kicking Catheter Associated Urinary Tract Infection (CAUTI): the No Knee-Jerk Antibiotics Campaign," to decrease guideline-discordant ordering of urine cultures and antibiotics for ASB. The current objective is to facilitate implementation of a scalable version of the Kicking CAUTI campaign across four geographically diverse Veterans Health Administration facilities while assessing what aspects of an antimicrobial stewardship intervention are essential to success and sustainability. This project uses an interrupted time series design with four control sites. The two main intervention tools are (1) an evidence-based algorithm that distills the guidelines into a streamlined clinical pathway and (2) case-based audit and feedback to train clinicians to use the algorithm. Our conceptual framework for the development and implementation of this intervention draws on May's General Theory of Implementation. The intervention is directed at providers in acute and long-term care, and the goal is to reduce inappropriate screening for and treatment of ASB in all patients and residents, not just those with urinary catheters. The start-up for each facility consists of centrally-led phone calls with local site champions and baseline surveys. Case-based audit and feedback will begin at a given site after the start-up period and continue for 12 months, followed by a sustainability assessment. In addition to the clinical outcomes, we will explore the relationship between the dose of the intervention and clinical outcomes. This project moves from a proof-of-concept effectiveness study to implementation involving significantly more sites, and uses the General Theory of Implementation to embed the intervention into normal processes of care with usual care providers. Aspects of implementation that will be explored include dissemination, internal and external facilitation, and organizational partnerships. "Less is More" is the natural next step from our prior successful Kicking CAUTI intervention, and has the potential to improve patient care while advancing the science of implementation.

[The health system of Dominican Republic].

PubMed

Rathe, Magdalena; Moliné, Alejandro

2011-01-01

This paper describes the health conditions in Dominican Republic and the characteristics of the Dominican health system, including its structure and coverage, its financial sources, the health expenditure, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health and the generation of health information. The participation of health care users in the operation and evaluation of the system and the most recent policy innovations, including the new General Health Law, the new Social Security Law and the Decennial Health Plan are also discussed.

Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.

PubMed

Perez, Katherine K; Olsen, Randall J; Musick, William L; Cernoch, Patricia L; Davis, James R; Peterson, Leif E; Musser, James M

2014-09-01

An intervention for Gram-negative bloodstream infections that integrated mass spectrometry technology for rapid diagnosis with antimicrobial stewardship oversight significantly improved patient outcomes and reduced hospital costs. As antibiotic resistance rates continue to grow at an alarming speed, the current study was undertaken to assess the impact of this intervention in a challenging patient population with bloodstream infections caused by antibiotic-resistant Gram-negative bacteria. A total of 153 patients with antibiotic-resistant Gram-negative bacteremia hospitalized prior to the study intervention were compared to 112 patients treated post-implementation. Outcomes assessed included time to optimal antibiotic therapy, time to active treatment when inactive, hospital and intensive care unit length of stay, all-cause 30-day mortality, and total hospital expenditures. Integrating rapid diagnostics with antimicrobial stewardship improved time to optimal antibiotic therapy (80.9 h in the pre-intervention period versus 23.2 h in the intervention period, P < 0.001) and effective antibiotic therapy (89.7 h versus 32 h, P < 0.001). Patients in the pre-intervention period had increased duration of hospitalization compared to those in the intervention period (23.3 days versus 15.3 days, P = 0.0001) and longer intensive care unit length of stay (16 days versus 10.7 days, P = 0.008). Mortality among patients during the intervention period was lower (21% versus 8.9%, P = 0.01) and our study intervention remained a significant predictor of survival (OR, 0.3; 95% confidence interval [CI], 0.12-0.79) after multivariate logistic regression. Mean hospital costs for each inpatient survivor were reduced $26,298 in the intervention cohort resulting in an estimated annual cost savings of $2.4 million (P = 0.002). Integration of rapid identification and susceptibility techniques with antimicrobial stewardship resulted in significant improvements in clinical and financial outcomes for patients with bloodstream infections caused by antibiotic-resistant Gram-negatives. The intervention decreased hospital and intensive care unit length of stay, total hospital costs, and reduced all-cause 30-day mortality. Copyright © 2014. Published by Elsevier Ltd.

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

Nelson, Jody K.

Land stewardship is one of nine sustainability programs in the U.S. Department of Energy's Environmental Management System. Land stewardship includes maintaining and improving ecosystem health. At the Rocky Flats Site near Westminster, Colorado, land stewardship is an integral component of the Office of Legacy Management's post-closure monitoring and management at the site. Nearly 263 hectares (650 acres) were disturbed and re-vegetated during site cleanup and closure operations. Proactive management of revegetation areas is critical to the successful reestablishment of native grasslands, wetlands, and riparian communities. The undisturbed native plant communities that occur at the site also require active management tomore » maintain the high-quality wetlands and other habitats that are home to numerous species of birds and other wildlife such as elk and deer, rare plant communities, and the federally listed threatened Preble's meadow jumping mouse. Over the past several decades, an increase of Noxious weeds has impacted much of Colorado's Front Range. As a result, weed control is a key component of the land stewardship program at Rocky Flats. Thirty-three species of state-listed Noxious weeds are known to occur in the Central and Peripheral Operable Units at Rocky Flats, along with another five species that are considered invasive at the site. Early detection and rapid response to control new invasive species is crucial to the program. An integrated weed control/vegetation management approach is key to maintaining healthy, sustainable plant communities that are able to resist Noxious weed invasions. Weed mapping, field surveys, and field-staff training sessions (to learn how to identify new potential problem species) are conducted to help detect and prevent new weed problems. The integrated approach at Rocky Flats includes administrative and cultural techniques (prevention), mechanical controls, biological controls, and chemical controls. Several species of biocontrol insects have been released to assist with control of different target weed species. Monitoring is conducted to evaluate the effectiveness of control efforts and to provide information for future control efforts. The effective implementation of this integrated approach has reduced the infestation levels of many species and has kept several newly discovered invasive species from spreading and becoming larger problems at the site. (authors)« less

Addressing the social dimensions of citizen observatories: The Ground Truth 2.0 socio-technical approach for sustainable implementation of citizen observatories

NASA Astrophysics Data System (ADS)

Wehn, Uta; Joshi, Somya; Pfeiffer, Ellen; Anema, Kim; Gharesifard, Mohammad; Momani, Abeer

2017-04-01

Owing to ICT-enabled citizen observatories, citizens can take on new roles in environmental monitoring, decision making and co-operative planning, and environmental stewardship. And yet implementing advanced citizen observatories for data collection, knowledge exchange and interactions to support policy objectives is neither always easy nor successful, given the required commitment, trust, and data reliability concerns. Many efforts are facing problems with the uptake and sustained engagement by citizens, limited scalability, unclear long-term sustainability and limited actual impact on governance processes. Similarly, to sustain the engagement of decision makers in citizen observatories, mechanisms are required from the start of the initiative in order to have them invest in and, hence, commit to and own the entire process. In order to implement sustainable citizen observatories, these social dimensions therefore need to be soundly managed. We provide empirical evidence of how the social dimensions of citizen observatories are being addressed in the Ground Truth 2.0 project, drawing on a range of relevant social science approaches. This project combines the social dimensions of citizen observatories with enabling technologies - via a socio-technical approach - so that their customisation and deployment is tailored to the envisaged societal and economic impacts of the observatories. The projects consists of the demonstration and validation of six scaled up citizen observatories in real operational conditions both in the EU and in Africa, with a specific focus on flora and fauna as well as water availability and water quality for land and natural resources management. The demonstration cases (4 EU and 2 African) cover the full 'spectrum' of citizen-sensed data usage and citizen engagement, and therefore allow testing and validation of the socio-technical concept for citizen observatories under a range of conditions.

Development and Implementation of Collaborative e-Infrastructures and Data Management for Global Change Research

NASA Astrophysics Data System (ADS)

Allison, M. Lee; Davis, Rowena

2016-04-01

An e-infrastructure that supports data-intensive, multidisciplinary research is needed to accelerate the pace of science to address 21st century global change challenges. Data discovery, access, sharing and interoperability collectively form core elements of an emerging shared vision of e-infrastructure for scientific discovery. The pace and breadth of change in information management across the data lifecycle means that no one country or institution can unilaterally provide the leadership and resources required to use data and information effectively, or needed to support a coordinated, global e-infrastructure. An 18-month long process involving ~120 experts in domain, computer, and social sciences from more than a dozen countries resulted in a formal set of recommendations that were adopted in fall, 2015 by the Belmont Forum collaboration of national science funding agencies and international bodies on what they are best suited to implement for development of an e-infrastructure in support of global change research, including: • adoption of data principles that promote a global, interoperable e-infrastructure, that can be enforced • establishment of information and data officers for coordination of global data management and e-infrastructure efforts • promotion of effective data planning and stewardship • determination of international and community best practices for adoption • development of a cross-disciplinary training curriculum on data management and curation The implementation plan is being executed under four internationally-coordinated Action Themes towards a globally organized, internationally relevant e-infrastructure and data management capability drawn from existing components, protocols, and standards. The Belmont Forum anticipates opportunities to fund additional projects to fill key gaps and to integrate best practices into an e-infrastructure to support their programs but that can also be scaled up and deployed more widely. Background The Belmont Forum is a global consortium established in 2009 to build on the work of the International Group of Funding Agencies for Global Change Research toward furthering collaborative efforts to deliver knowledge needed for action to avoid and adapt to detrimental environmental change, including extreme hazardous events.

Improved Clinical Outcomes in Patients with Positive Blood Culture by Proactive Intervention of Antimicrobial Use-Impact of Antimicrobial Stewardship Program Implementation on Clinical Practice.

PubMed

Yamada, Takehiro; Kagami, Keisuke; Imai, Shungo; Akizawa, Koji; Iwasaki, Sumio; Fukumoto, Tatsuya; Ishiguro, Nobuhisa; Iseki, Ken

2017-01-01

Bacteremia is one of the most serious infectious illness resulting from nosocomial infection. Therefore, appropriate antimicrobial chemotherapy should be provided as soon as possible to patients exhibiting symptoms of infectious disease and having positive blood culture results. Antimicrobial stewardship (AS) guidelines were recently released by the Infectious Diseases Society of America. The guidelines recommend "proactive intervention and feedback" as one of the core strategies for implementing optimal antimicrobial drug use to improve patient outcomes in clinical settings. We began using the AS program for optimizing antimicrobial chemotherapy in patients with positive blood culture results. The results of blood cultures and antimicrobial prescriptions for the corresponding patients were daily reviewed by a pharmacist and a physician, members of the infection control team (ICT). If the antimicrobial agents selected were inappropriate, ICT made a recommendation to the attending physicians who prescribed the antibiotics. To evaluate the outcomes of this program, we conducted a single-center, retrospective investigation for near a hundred of patients who underwent intervention by infection-control physician and pharmacist. Resolution of bacteremia (determined by blood culture results) was 96.3% in the group that accepted intervention, whereas only 16.7% of the cases resolved in the group that did not accept intervention. These results strongly suggest the importance of the infection disease-specialist team intervention. This program could become an important method for improving clinical outcomes in patients with bacteremia.

LANL continuity of operations plan

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

Senutovitch, Diane M

2010-12-22

The Los Alamos National Laboratory (LANL) is a premier national security research institution, delivering scientific and engineering solutions for the nation's most crucial and complex problems. Our primary responsibility is to ensure the safety, security, and reliability of the nation's nuclear stockpile. LANL emphasizes worker safety, effective operational safeguards and security, and environmental stewardship, outstanding science remains the foundation of work at the Laboratory. In addition to supporting the Laboratory's core national security mission, our work advances bioscience, chemistry, computer science, earth and environmental sciences, materials science, and physics disciplines. To accomplish LANL's mission, we must ensure that the Laboratorymore » EFs continue to be performed during a continuity event, including localized acts of nature, accidents, technological or attack-related emergencies, and pandemic or epidemic events. The LANL Continuity of Operations (COOP) Plan documents the overall LANL COOP Program and provides the operational framework to implement continuity policies, requirements, and responsibilities at LANL, as required by DOE 0 150.1, Continuity Programs, May 2008. LANL must maintain its ability to perform the nation's PMEFs, which are: (1) maintain the safety and security of nuclear materials in the DOE Complex at fixed sites and in transit; (2) respond to a nuclear incident, both domestically and internationally, caused by terrorist activity, natural disaster, or accident, including mobilizing the resources to support these efforts; and (3) support the nation's energy infrastructure. This plan supports Continuity of Operations for Los Alamos National Laboratory (LANL). This plan issues LANL policy as directed by the DOE 0 150.1, Continuity Programs, and provides direction for the orderly continuation of LANL EFs for 30 days of closure or 60 days for a pandemic/epidemic event. Initiation of COOP operations may be required to support an allhazards event, including a national security emergency, major fire, catastrophic natural disaster, man-made disaster, terrorism event, or technological disaster by rendering LANL buildings, infrastructure, or Technical Areas unsafe, temporarily unusable, or inaccessible.« less

Use of North American Breeding Bird Survey data in avian conservation assessments

USGS Publications Warehouse

Rosenberg, Kenneth V.; Blancher, Peter J.; Stanton, Jessica C.; Panjabi, Arvind O.

2017-01-01

Conservation resources are limited, and prioritizing species based on their relative vulnerability and risk of extinction is a fundamental component of conservation planning. In North America, the conservation consortium Partners in Flight (PIF) has developed and implemented a data-driven species assessment process, at global and regional scales, based on quantitative vulnerability criteria. This species assessment process has formed the biological basis for PIF's continental and regional planning and has informed the ranking and legal listing of bird species for conservation protection by state, provincial, and national agencies in Canada, the U.S., and Mexico. Because of its long time series, extensive geographic and species coverage, standardized survey methods, and prompt availability of results, the North American Breeding Bird Survey (BBS) has been an invaluable source of data, allowing PIF to assign objective vulnerability scores calibrated across more than 460 landbird species. BBS data have been most valuable for assessing long-term population trends (PT score). PIF has also developed methods for estimating population size by extrapolating from BBS abundance indices, allowing the assignment of categorical population size (PS) scores for landbird species. At regional scales, BBS relative abundance indices have allowed PIF to assess the area importance (i.e. stewardship responsibility) of each Bird Conservation Region (BCR) for each species, using measures of both relative density and percent of total population in each BCR. Besides direct applicability to assessment scores, PIF has recently used BBS trend data to create new metrics of conservation urgency (e.g., ‘half-life'), as well as for setting population objectives for tracking progress toward meeting conservation goals. Future directions include integrating BBS data with other sources (e.g., eBird) to assess additional species and nonbreeding season measures, working closely with BBS coordinators to expand surveys into Mexico, and providing assessment scores at implementation-relevant scales, such as for migratory bird joint ventures.

Stockpile Stewardship: Los Alamos

ScienceCinema

McMillan, Charlie; Morgan, Nathanial; Goorley, Tom; Merrill, Frank; Funk, Dave; Korzekwa, Deniece; Laintz, Ken

2018-01-16

"Heritage of Science" is a short video that highlights the Stockpile Stewardship program at Los Alamos National Laboratory. Stockpile Stewardship was conceived in the early 1990s as a national science-based program that could assure the safety, security, and effectiveness of the U.S. nuclear deterrent without the need for full-scale underground nuclear testing. This video was produced by Los Alamos National Laboratory for screening at the Lab's Bradbury Science Museum in Los Alamos, NM and is narrated by science correspondent Miles O'Brien.

Without Testing: Stockpile Stewardship in the Second Nuclear Age

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

Martz, Joseph C.

2014-01-07

Stockpile stewardship is a topic dear to my heart. I’ve been fascinated by it, and I’ve lived it—mostly on the technical side but also on the policy side from 2009 to 2010 at Stanford University as a visiting scholar and the inaugural William J. Perry Fellow. At Stanford I worked with Perry, former secretary of defense, and Sig Hecker, former Los Alamos Lab director (1986–1997), looking at nuclear deterrence, nuclear policy, and stockpile stewardship and at where all this was headed.

Antimicrobial Stewardship in Inpatient Settings in the Asia Pacific Region: A Systematic Review and Meta-analysis.

PubMed

Honda, Hitoshi; Ohmagari, Norio; Tokuda, Yasuharu; Mattar, Caline; Warren, David K

2017-05-15

An antimicrobial stewardship program (ASP) is one of the core elements needed to optimize antimicrobial use. Although collaboration at the national level to address the importance of ASPs and antimicrobial resistance has occurred in the Asia Pacific region, hospital-level ASP implementation in this region has not been comprehensively evaluated. We conducted a systematic review and meta-analysis to assess the efficacy of ASPs in inpatient settings in the Asia Pacific region from January 2005 through March 2016. The impact of ASPs on various outcomes, including patient clinical outcomes, antimicrobial prescription outcomes, microbiological outcomes, and expenditure were assessed. Forty-six studies were included for a systematic review and meta-analysis. The pooled risk ratio for mortality from ASP before-after trials and 2-group comparative studies were 1.03 (95% confidence interval [CI], .88-1.19) and 0.69 (95% CI, .56-.86), respectively. The pooled effect size for change in overall antimicrobial and carbapenem consumption (% difference) was -9.74% (95% CI, -18.93% to -.99%) and -10.56% (95% CI, -19.99% to -3.03%), respectively. Trends toward decreases in the incidence of multidrug-resistant organisms and antimicrobial expenditure (range, 9.7%-58.1% reduction in cost in the intervention period/arm) were also observed. ASPs in inpatient settings in the Asia Pacific region appear to be safe and effective to reduce antimicrobial consumption and improve outcomes. However, given the significant variations in assessing the efficacy of ASPs, high-quality studies using standardized surveillance methodology for antimicrobial consumption and similar metrics for outcome measurement are needed to further promote antimicrobial stewardship in this region. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists.

PubMed

Hand, Kieran S; Cumming, Debbie; Hopkins, Susan; Ewings, Sean; Fox, Andy; Theminimulle, Sandya; Porter, Robert J; Parker, Natalie; Munns, Joanne; Sheikh, Adel; Keyser, Taryn; Puleston, Richard

2017-04-01

The implementation of electronic prescribing and medication administration (EPMA) systems is a priority for hospitals and a potential component of antimicrobial stewardship (AMS). To identify software features within EPMA systems that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features. A questionnaire was developed using nominal group technique and transmitted via email links through professional networks. The questionnaire collected demographic data, information on priority areas and anticipated impact of EPMA. Responses from different respondent groups were compared using the Mann-Whitney U -test. Responses were received from 164 individuals (142 analysable). Respondents were predominantly specialist infection pharmacists (48%) or medical microbiologists (37%). Of the pharmacists, 59% had experience of EPMA in their hospitals compared with 35% of microbiologists. Pharmacists assigned higher priority to indication prompt ( P  <   0.001), allergy checker ( P  =   0.003), treatment protocols ( P  =   0.003), drug-indication mismatch alerts ( P  =   0.031) and prolonged course alerts ( P  =   0.041) and lower priority to a dose checker for adults ( P  =   0.02) and an interaction checker ( P  <   0.05) than microbiologists. A 'soft stop' functionality was rated essential or high priority by 89% of respondents. Potential EPMA software features were expected to have the greatest impact on stewardship, treatment efficacy and patient safety outcomes with lowest impact on Clostridium difficile infection, antimicrobial resistance and drug expenditure. The survey demonstrates key differences in health professionals' opinions of potential healthcare benefits of EPMA, but a consensus of anticipated positive impact on patient safety and AMS. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The cost-benefit of federal investment in preventing Clostridium difficile infections through the use of a multifaceted infection control and antimicrobial stewardship program.

PubMed

Slayton, Rachel B; Scott, R Douglas; Baggs, James; Lessa, Fernanda C; McDonald, L Clifford; Jernigan, John A

2015-06-01

To determine the potential epidemiologic and economic value of the implementation of a multifaceted Clostridium difficile infection (CDI) control program at US acute care hospitals Markov model with a 5-year time horizon Patients whose data were used in our simulations were limited to hospitalized Medicare beneficiaries ≥65 years old. CDI is an important public health problem with substantial associated morbidity, mortality, and cost. Multifaceted national prevention efforts in the United Kingdom, including antimicrobial stewardship, patient isolation, hand hygiene, environmental cleaning and disinfection, and audit, resulted in a 59% reduction in CDI cases reported from 2008 to 2012. Our analysis was conducted from the federal perspective. The intervention we modeled included the following components: antimicrobial stewardship utilizing the Antimicrobial Use and Resistance module of the National Healthcare Safety Network (NHSN), use of contact precautions, and enhanced environmental cleaning. We parameterized our model using data from CDC surveillance systems, the AHRQ Healthcare Cost and Utilization Project, and literature reviews. To address uncertainty in our parameter estimates, we conducted sensitivity analyses for intervention effectiveness and cost, expenditures by other federal partners, and discount rate. Each simulation represented a cohort of 1,000 hospitalized patients over 1,000 trials. RESULTS In our base case scenario with 50% intervention effectiveness, we estimated that 509,000 CDI cases and 82,000 CDI-attributable deaths would be prevented over a 5-year time horizon. Nationally, the cost savings across all hospitalizations would be $2.5 billion (95% credible interval: $1.2 billion to $4.0 billion). The potential benefits of a multifaceted national CDI prevention program are sizeable from the federal perspective.

Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A 3-Year, Multiphase Study.

PubMed

Zucker, Jason; Mittal, Jaimie; Jen, Shin-Pung; Cheng, Lucy; Cennimo, David

2016-03-01

There is a high prevalence of HIV infection in Newark, New Jersey, with University Hospital admitting approximately 600 HIV-infected patients per year. Medication errors involving antiretroviral therapy (ART) could significantly affect treatment outcomes. The goal of this study was to evaluate the effectiveness of various stewardship interventions in reducing the prevalence of prescribing errors involving ART. This was a retrospective review of all inpatients receiving ART for HIV treatment during three distinct 6-month intervals over a 3-year period. During the first year, the baseline prevalence of medication errors was determined. During the second year, physician and pharmacist education was provided, and a computerized order entry system with drug information resources and prescribing recommendations was implemented. Prospective audit of ART orders with feedback was conducted in the third year. Analyses and comparisons were made across the three phases of this study. Of the 334 patients with HIV admitted in the first year, 45% had at least one antiretroviral medication error and 38% had uncorrected errors at the time of discharge. After education and computerized order entry, significant reductions in medication error rates were observed compared to baseline rates; 36% of 315 admissions had at least one error and 31% had uncorrected errors at discharge. While the prevalence of antiretroviral errors in year 3 was similar to that of year 2 (37% of 276 admissions), there was a significant decrease in the prevalence of uncorrected errors at discharge (12%) with the use of prospective review and intervention. Interventions, such as education and guideline development, can aid in reducing ART medication errors, but a committed stewardship program is necessary to elicit the greatest impact. © 2016 Pharmacotherapy Publications, Inc.

Polishing the tarnished silver bullet: the quest for new antibiotics

PubMed Central

Blaskovich, Mark A.T.; Butler, Mark S.; Cooper, Matthew A.

2017-01-01

We are facing a potential catastrophe of untreatable bacterial infections, driven by the inexorable rise of extensively drug-resistant bacteria, coupled with a market failure of pharmaceutical and biotech companies to deliver new therapeutic options. While global recognition of the problem is finally apparent, solutions are still a long way from being implemented. In addition to drug stewardship programmes and better diagnostics, new antibiotics are desperately needed. The question remains as to how to achieve this goal. This review will examine the different strategies being applied to discover new antibiotics. PMID:28258234

Pesticide Environmental Stewardship Program Member Handbook

EPA Pesticide Factsheets

This Pesticide Environmental Stewardship Program (PESP) handbook is a resource with information to help prospective members to learn about PESP, to understand how the program works, and to assist in applying for membership.

Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.

PubMed

Schneider, Helen; Nxumalo, Nonhlanhla

2017-09-15

National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa's community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Four key roles are identified and discussed: 1. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services 2. Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs 3. Revising and developing new aligned and integrated planning, human resource, financing and information systems 4. Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles.

Department of the Interior

MedlinePlus

... American Indians Other Interior Offices Priorities American Energy Climate Change Jobs Regulatory Reform Stewardship Tribal Nations Join Jobs ... Secretary Bureaus For Employees Our Priorities American Energy Climate Change Jobs Regulatory Reform Stewardship Tribal Nations Resources Cobell / ...

Lockport Sewage Lagoon.

ERIC Educational Resources Information Center

Perry, John

1995-01-01

Describes a student initiated stewardship project that resulted in the transformation of a sewage lagoon near the school into a place to study nature. Contains a list of 20 things that discourage a successful stewardship project. (LZ)

H. R. 2594: This Act may be cited as the Wetlands Stewardship Trusts Act of 1991, introduced in the US House of Representatives, One Hundred Second Congress, First Session, June 7, 1991

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

Not Available

1991-01-01

This bill was introduced into the US House of Representatives on June 7, 1991 to provide for the designation of Wetlands Stewardship Trusts. This legislation amended the Internal Revenue Code of 1986 to establish special rules for contributions of wetlands and riparian lands to Wetlands Stewardship Trusts. Key features of the bill address the following: tax treatment of donations of wetlands and riparian lands to Wetlands Stewardship Trusts; amortization of expenditures to restore wetlands and riparian lands; expenditures for restoring wetlands and riparian lands; exclusion from gross income for amounts received from compatible uses of wetlands or riparian lands; andmore » income from compatible uses of wetlands or riparian lands.« less

2015 Stewardship Science Academic Programs Annual

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

Stone, Terri; Mischo, Millicent

The Stockpile Stewardship Academic Programs (SSAP) are essential to maintaining a pipeline of professionals to support the technical capabilities that reside at the National Nuclear Security Administration (NNSA) national laboratories, sites, and plants. Since 1992, the United States has observed the moratorium on nuclear testing while significantly decreasing the nuclear arsenal. To accomplish this without nuclear testing, NNSA and its laboratories developed a science-based Stockpile Stewardship Program to maintain and enhance the experimental and computational tools required to ensure the continued safety, security, and reliability of the stockpile. NNSA launched its academic program portfolio more than a decade ago tomore » engage students skilled in specific technical areas of relevance to stockpile stewardship. The success of this program is reflected by the large number of SSAP students choosing to begin their careers at NNSA national laboratories.« less

Improving antimicrobial prescribing: implementation of an antimicrobial i.v.-to-oral switch policy.

PubMed

McCallum, A D; Sutherland, R K; Mackintosh, C L

2013-01-01

Antimicrobial stewardship programmes reduce the risk of hospital associated infections (HAI) and antimicrobial resistance, and include early intravenous-to-oral switch (IVOS) as a key stewardship measure. We audited the number of patients on intravenous antimicrobials suitable for oral switch, assessed whether prescribing guidelines were followed and reviewed prescribing documentation in three clinical areas in the Western General Hospital, Edinburgh, in late 2012. Following this, the first cycle results and local guidelines were presented at a local level and at the hospital grand rounds, posters with recommendations were distributed, joint infection consult and antimicrobial rounds commenced and an alert antimicrobial policy was introduced before re-auditing in early 2013. We demonstrate suboptimal prescribing of intravenous antimicrobials, with 43.9% (43/98) of patients eligible for IVOS at the time of auditing. Only 56.1% (55/98) followed empiric prescribing recommendations. Documentation of antimicrobial prescribing was poor with stop dates recorded in 14.3%, indication on prescription charts in 18.4% and in the notes in 90.8%. The commonest reason for deferring IVOS was deteriorating clinical condition or severe sepsis. Further work to encourage prudent antimicrobial prescribing and earlier consideration of IVOS is required.

Occupational safety and health, green chemistry, and sustainability: a review of areas of convergence

PubMed Central

2013-01-01

With increasing numbers and quantities of chemicals in commerce and use, scientific attention continues to focus on the environmental and public health consequences of chemical production processes and exposures. Concerns about environmental stewardship have been gaining broader traction through emphases on sustainability and “green chemistry” principles. Occupational safety and health has not been fully promoted as a component of environmental sustainability. However, there is a natural convergence of green chemistry/sustainability and occupational safety and health efforts. Addressing both together can have a synergistic effect. Failure to promote this convergence could lead to increasing worker hazards and lack of support for sustainability efforts. The National Institute for Occupational Safety and Health has made a concerted effort involving multiple stakeholders to anticipate and identify potential hazards associated with sustainable practices and green jobs for workers. Examples of potential hazards are presented in case studies with suggested solutions such as implementing the hierarchy of controls and prevention through design principles in green chemistry and green building practices. Practical considerations and strategies for green chemistry, and environmental stewardship could benefit from the incorporation of occupational safety and health concepts which in turn protect affected workers. PMID:23587312

Occupational safety and health, green chemistry, and sustainability: a review of areas of convergence.

PubMed

Schulte, Paul A; McKernan, Lauralynn T; Heidel, Donna S; Okun, Andrea H; Dotson, Gary Scott; Lentz, Thomas J; Geraci, Charles L; Heckel, Pamela E; Branche, Christine M

2013-04-15

With increasing numbers and quantities of chemicals in commerce and use, scientific attention continues to focus on the environmental and public health consequences of chemical production processes and exposures. Concerns about environmental stewardship have been gaining broader traction through emphases on sustainability and "green chemistry" principles. Occupational safety and health has not been fully promoted as a component of environmental sustainability. However, there is a natural convergence of green chemistry/sustainability and occupational safety and health efforts. Addressing both together can have a synergistic effect. Failure to promote this convergence could lead to increasing worker hazards and lack of support for sustainability efforts. The National Institute for Occupational Safety and Health has made a concerted effort involving multiple stakeholders to anticipate and identify potential hazards associated with sustainable practices and green jobs for workers. Examples of potential hazards are presented in case studies with suggested solutions such as implementing the hierarchy of controls and prevention through design principles in green chemistry and green building practices. Practical considerations and strategies for green chemistry, and environmental stewardship could benefit from the incorporation of occupational safety and health concepts which in turn protect affected workers.

The ICSU World Data System: a Global System of Data Systems, Year 4

NASA Astrophysics Data System (ADS)

Minster, J. H.; Mokrane, M.

2012-12-01

The primary goals of the ICSU World Data System (ICSU-WDS, created in October 2008), are to ensure the long-term stewardship of quality-assessed data for research and education, and the provision of such data and related data services to the international science community and other stakeholders. New technological options opened by today's management, curation and on-line distribution of multi-disciplinary digital data sets make these goals achievable. The WDS is built as an international federated system of long-term data archives and data related services covering a wide spectrum of sciences. Since our last report, an International Program Office (IPO) was inaugurated, and is hosted by NICT in Tokyo, Japan. In the past two years, 160 organizations have formally requested membership, and 44 of these applications have been fully completed among which 38 are from Regular and Network member organizations dealing directly with data curation and data analysis services. Others include Partner and Associate members. ICSU-WDS fosters and enables interdisciplinary data activities, but recognizes that many disciplines (e.g. seismology, oceanography, astronomy, space sciences, biodiversity, health and social sciences) have already developed domain-specific efficient answers to their data challenges. WDS is evolving into a system of data systems wherein integration of interdisciplinary data depends on implementation of interoperability arrangements. Although the focus of WDS is on the long-term stewardship of scientific data—so that the value of data holdings might actually increase with time—WDS members must share some overarching principles to achieve this goal. This is realized through promotion of close collaboration between members but more importantly through a formal accreditation process based on well-defined certification criteria. These include, for example, the development and adoption of standards and quality control practices, analysis and metadata services, and data publication services that can be recognized across domain boundaries. The latter requires a strong relationship with science publishers and libraries, and we will report on initial steps in that direction. Another focus point is to establish a framework and tools to help scientists develop a workable data management plan from the very inception of science projects and programs, particularly in interdisciplinary and international contexts.

Supporting Data Stewardship Throughout the Data Life Cycle in the Solid Earth Sciences

NASA Astrophysics Data System (ADS)

Ferrini, V.; Lehnert, K. A.; Carbotte, S. M.; Hsu, L.

2013-12-01

Stewardship of scientific data is fundamental to enabling new data-driven research, and ensures preservation, accessibility, and quality of the data, yet researchers, especially in disciplines that typically generate and use small, but complex, heterogeneous, and unstructured datasets are challenged to fulfill increasing demands of properly managing their data. The IEDA Data Facility (www.iedadata.org) provides tools and services that support data stewardship throughout the full life cycle of observational data in the solid earth sciences, with a focus on the data management needs of individual researchers. IEDA builds upon and brings together over a decade of development and experiences of its component data systems, the Marine Geoscience Data System (MGDS, www.marine-geo.org) and EarthChem (www.earthchem.org). IEDA services include domain-focused data curation and synthesis, tools for data discovery, access, visualization and analysis, as well as investigator support services that include tools for data contribution, data publication services, and data compliance support. IEDA data synthesis efforts (e.g. PetDB and Global Multi-Resolution Topography (GMRT) Synthesis) focus on data integration and analysis while emphasizing provenance and attribution. IEDA's domain-focused data catalogs (e.g. MGDS and EarthChem Library) provide access to metadata-rich long-tail data complemented by extensive metadata including attribution information and links to related publications. IEDA's visualization and analysis tools (e.g. GeoMapApp) broaden access to earth science data for domain specialist and non-specialists alike, facilitating both interdisciplinary research and education and outreach efforts. As a disciplinary data repository, a key role IEDA plays is to coordinate with its user community and to bridge the requirements and standards for data curation with both the evolving needs of its science community and emerging technologies. Development of IEDA tools and services is based first and foremost on the scientific needs of its user community. As data stewardship becomes a more integral component of the scientific workflow, IEDA investigator support services (e.g. Data Management Plan Tool and Data Compliance Reporting Tool) continue to evolve with the goal of lessening the 'burden' of data management for individual investigators by increasing awareness and facilitating the adoption of data management practices. We will highlight a variety of IEDA system components that support investigators throughout the data life cycle, and will discuss lessons learned and future directions.

Taimi Lynne Hoag Award for Environmental Stewardship

EPA Pesticide Factsheets

The Region 5 Tribal Operation Committee established this Award in the name of Taimi Hoag to recognize significant contributions in environmental management and/or environmental stewardship by a tribal government leader, program manager, or staff person.

Supporting local diversity of habitats and species on farmland: a comparison of three wildlife-friendly schemes.

PubMed

Hardman, Chloe J; Harrison, Dominic P G; Shaw, Pete J; Nevard, Tim D; Hughes, Brin; Potts, Simon G; Norris, Ken

2016-02-01

Restoration and maintenance of habitat diversity have been suggested as conservation priorities in farmed landscapes, but how this should be achieved and at what scale are unclear. This study makes a novel comparison of the effectiveness of three wildlife-friendly farming schemes for supporting local habitat diversity and species richness on 12 farms in England.The schemes were: (i) Conservation Grade (Conservation Grade: a prescriptive, non-organic, biodiversity-focused scheme), (ii) organic agriculture and (iii) a baseline of Entry Level Stewardship (Entry Level Stewardship: a flexible widespread government scheme). Conservation Grade farms supported a quarter higher habitat diversity at the 100-m radius scale compared to Entry Level Stewardship farms. Conservation Grade and organic farms both supported a fifth higher habitat diversity at the 250-m radius scale compared to Entry Level Stewardship farms. Habitat diversity at the 100-m and 250-m scales significantly predicted species richness of butterflies and plants. Habitat diversity at the 100-m scale also significantly predicted species richness of birds in winter and solitary bees. There were no significant relationships between habitat diversity and species richness for bumblebees or birds in summer.Butterfly species richness was significantly higher on organic farms (50% higher) and marginally higher on Conservation Grade farms (20% higher), compared with farms in Entry Level Stewardship. Organic farms supported significantly more plant species than Entry Level Stewardship farms (70% higher) but Conservation Grade farms did not (10% higher). There were no significant differences between the three schemes for species richness of bumblebees, solitary bees or birds. Policy implications . The wildlife-friendly farming schemes which included compulsory changes in management, Conservation Grade and organic, were more effective at increasing local habitat diversity and species richness compared with the less prescriptive Entry Level Stewardship scheme. We recommend that wildlife-friendly farming schemes should aim to enhance and maintain high local habitat diversity, through mechanisms such as option packages, where farmers are required to deliver a combination of several habitats.

The nuclear issue: where do we go from here?.

PubMed

Rotblat, Joseph

2003-01-01

The drive for the elimination of nuclear weapons is going badly and there is currently little support from the general public. The United States Nuclear Posture Review incorporates nuclear capability into conventional war planning. The Stockpile Stewardship Program is designed to maintain nuclear weapon capability. The US is planning an essentially new earth-penetrating nuclear weapon and is prepared to test this in the national interest if thought necessary. These policies could stimulate nuclear proliferation by others, do nothing to deter terrorism, promote persisting polarization of the world, are a clear breach of the Non-Proliferation Treaty and rest world security on a continued balance of terror. A renewed mass campaign to counteract all this, on legal and moral grounds in particular, is urgently needed. IPPNW and kindred organizations must restore sanity in our policies and humanity to our actions.

Research activities to improve the utilization of antibiotics in Africa.

PubMed

Massele, Amos; Tiroyakgosi, Celda; Matome, Matshediso; Desta, Abayneh; Muller, Arno; Paramadhas, Bene D Anand; Malone, Brighid; Kurusa, Gobuiwang; Didimalang, Thatayaone; Moyo, Mosana; Godman, Brian

2017-02-01

There is a need to improve the rational use of antibiotics across continents including Africa. This has resulted in initiatives in Botswana including treatment guidelines and the instigation of Antibiotic Stewardship Programs (ASPs). The next steps involve a greater understanding of current antibiotic utilization and resistance patterns (AMR). This resulted in a 2-day meeting involving key stakeholders principally from Botswana to discuss key issues including AMR rates as well as ASPs in both the public and private sectors. Following this, the findings will be used to plan future studies across Africa including point prevalence studies. The findings will be presented in July 2016 at the next Medicines Utilization Research in Africa meeting will ideally serve as a basis for planning future pertinent interventional studies to enhance the rational use of antibiotics in Botswana and wider.

Improving performance of HVAC systems to reduce exposure to aerosolized infectious agents in buildings; recommendations to reduce risks posed by biological attacks.

PubMed

Hitchcock, Penny J; Mair, Michael; Inglesby, Thomas V; Gross, Jonathan; Henderson, D A; O'Toole, Tara; Ahern-Seronde, Joa; Bahnfleth, William P; Brennan, Terry; Burroughs, H E Barney; Davidson, Cliff; Delp, William; Ensor, David S; Gomory, Ralph; Olsiewski, Paula; Samet, Jonathan M; Smith, William M; Streifel, Andrew J; White, Ronald H; Woods, James E

2006-01-01

The prospect of biological attacks is a growing strategic threat. Covert aerosol attacks inside a building are of particular concern. In the summer of 2005, the Center for Biosecurity of the University of Pittsburgh Medical Center convened a Working Group to determine what steps could be taken to reduce the risk of exposure of building occupants after an aerosol release of a biological weapon. The Working Group was composed of subject matter experts in air filtration, building ventilation and pressurization, air conditioning and air distribution, biosecurity, building design and operation, building decontamination and restoration, economics, medicine, public health, and public policy. The group focused on functions of the heating, ventilation, and air conditioning systems in commercial or public buildings that could reduce the risk of exposure to deleterious aerosols following biological attacks. The Working Group's recommendations for building owners are based on the use of currently available, off-the-shelf technologies. These recommendations are modest in expense and could be implemented immediately. It is also the Working Group's judgment that the commitment and stewardship of a lead government agency is essential to secure the necessary financial and human resources and to plan and build a comprehensive, effective program to reduce exposure to aerosolized infectious agents in buildings.

Clinical and economic outcomes from a community hospital's antimicrobial stewardship program.

PubMed

Malani, Anurag N; Richards, Patrick G; Kapila, Shikha; Otto, Michael H; Czerwinski, Jennifer; Singal, Bonita

2013-02-01

Data from community antimicrobial stewardship programs (ASPs) are limited. We describe clinical and economic outcomes from the first year of our hospital's ASP. The ASP team comprised 2 infectious disease physicians and 3 intensive care unit pharmacists. The team prospectively audited the new starts and weekly use of 8 target antimicrobials: aztreonam, caspofungin, daptomycin, ertapenem, linezolid, meropenem, tigecycline, and voriconazole. Using administrative data, outcomes from the first year of the program, including death within 30 days of hospitalization, readmission within 30 days of discharge, and development of Clostridium difficile infection (CDI), were compared with outcomes from a similar period before institution of the program. A total of 510 antimicrobial orders were reviewed, of which 323 (63%) were appropriate, 94 (18%) prompted deescalation, 61 (12%) were denied, and 27 (5%) led to formal consultation with an infectious disease physician. On multivariate analysis, implementation of the ASP was associated with an approximate 50% reduction in the odds of developing CDI (odds ratio, 0.46; 95% confidence interval, 0.25-0.82). The ASP was not associated with decreased mortality at 30 days after discharge or readmission rate. The antimicrobial cost per patient-day decreased by 13.3%, from $10.16 to $8.81. The antimicrobial budget decreased by 15.2%, resulting in a total savings of $228,911. There was a 25.4% decrease in defined daily doses of the target antimicrobials. Implementation of the ASP was associated with significant reductions in CDI rate, antimicrobial use, and pharmacy costs. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Urine Culture Follow-up and Antimicrobial Stewardship in a Pediatric Urgent Care Network.

PubMed

Saha, Dipanwita; Patel, Jimisha; Buckingham, Don; Thornton, David; Barber, Terry; Watson, Joshua R

2017-04-01

Empiric antibiotic therapy for presumed urinary tract infection (UTI) leads to unnecessary antibiotic exposure in many children whose urine culture results fail to confirm the diagnosis. The objective of this quality improvement study was to improve follow-up management of negative urine culture results in the off-campus urgent care network of Nationwide Children's Hospital to reduce inappropriate antibiotic exposure in children. A multidisciplinary task force developed and implemented a protocol for routine nurse and clinician follow-up of urine culture results, discontinuation of unnecessary antibiotics, and documentation in the electronic medical record. Monthly antibiotic discontinuation rates were tracked in empirically treated patients with negative urine culture results from July 2013 through December 2015. Statistical process control methods were used to track improvement over time. Fourteen-day return visits for UTIs were monitored as a balancing measure. During the study period, 910 patients received empiric antibiotic therapy for UTIs but had a negative urine culture result. The antibiotic discontinuation rate increased from 4% to 84%, avoiding 3429 (40%) of 8648 antibiotic days prescribed. Among patients with discontinued antibiotics, none was diagnosed with a UTI within 14 days of the initial urgent care encounter. Implementation of a standard protocol for urine culture follow-up and discontinuation of unnecessary antibiotics was both effective and safe in a high-volume pediatric urgent care network. Urine culture follow-up management is an essential opportunity for improved antimicrobial stewardship in the outpatient setting that will affect many patients by avoiding a substantial number of antibiotic days. Copyright © 2017 by the American Academy of Pediatrics.

Antimicrobial stewardship programs: interventions and associated outcomes.

PubMed

Patel, Dimple; Lawson, Wendy; Guglielmo, B Joseph

2008-04-01

Guidelines regarding antimicrobial stewardship programs recommend an infectious diseases-trained physician and an infectious diseases-trained pharmacist as core members. Inclusion of clinical microbiologists, infection-control practitioners, information systems experts and hospital epidemiologists is considered optimal. Recommended stewardship interventions include prospective audit and intervention, formulary restriction, education, guideline development, clinical pathway development, antimicrobial order forms and the de-escalation of therapy. The primary outcome associated with these interventions has been the associated cost savings; however, few published investigations have taken into account the overall cost of the intervention. Over the past 5 years, there has been an increased focus upon interventions intended to decrease bacterial resistance or reduce superinfection, including infections associated with Clostridium difficile colitis. Few programs have been associated with a reduction in antimicrobial drug adverse events. Antimicrobial stewardship programs are becoming increasingly associated with clear benefits and will be integral in the in-patient healthcare setting.

[Practical approach to infection control and antimicrobial stewardship by medical technologists].

PubMed

Komori, Toshiaki; Yamada, Yukiji; Kimura, Takeshi; Kosaka, Tadashi; Nakanishi, Masaki; Fujitomo, Yumiko; Fujita, Naohisa

2013-04-01

Since establishing an antimicrobial management team (AMT) in 2003, we have been promoting both appropriate diagnosis and treatment and improving the prognosis of hospitalized patients with infections. AMT is composed of 4 doctors, 2 nurses, 2 pharmacists and one medical technologist. AMT members meet twice a week and discuss patients with positive blood cultures, with prescribed anti-MRSA drugs and suspected infections. Antimicrobial prescription and clinical laboratory data are obtained from the database of electric medical records and microbiological data from the laboratory database system. The initial step in infection control and antimicrobial stewardship is an accurate diagnosis of infection. Clinical microbiology laboratories play a critical role in infection control and antimicrobial stewardship by reporting accurate and timely results of both bacterial identification and antimicrobial susceptibility tests. Medical technologists are required to develop better competency and proficiency about clinical microbiology in both infection control and antimicrobial stewardship.

Epidemiology of bacterial isolates among pediatric cancer patients from a tertiary care oncology center in North India.

PubMed

Kapoor, G; Sachdeva, N; Jain, S

2014-01-01

Infections are a major cause of morbidity and mortality in pediatric oncology. Resistance pattern of bacterial isolates determine empiric antibiotic therapy and influence outcome. This study was planned to determine profile of bacterial isolates and their antibiotic resistance pattern among pediatric cancer patients. It was a retrospective, single institutional study. The study was carried out in the department of pediatric hematology-oncology of a tertiary care cancer centre in north India over a period of 24 months (2012-2014). Microbiological data pertaining to pediatric cancer patients, less than 18 yrs of age was analysed. Hence, 238 bacterial isolates were cultured from among 1757 blood, urine and other specimens. Gram negative bacteria were the most common (74%) pathogens identified and E. coli and Klebsiella comprised 80% of them. A high incidence of extended spectrum beta lactamase producing organisms (84%), beta-lactam beta-lactamase inhibitor (78%) and carbapenem resistance was observed (29%). Blood stream infection with multi-drug resistant Klebsiella was associated with high mortality. The gram positive bacteria isolated were predominantly staphylococcus aureus and were antibiotic sensitive. Reduction in the number of culture positive isolates in the second year of our study was probably due to rigorous implementation of infection control measures. These results on microbiologic profile and antibiotic sensitivity pattern of the isolates will be extremely helpful in revision of antibiotic guidelines for our patients and in developing strategies for coping with high prevalence of multi-drug resistance. Antibiotic stewardship and strict implementation of infection control practices will be important components of this effort.

High priority needs for range-wide monitoring of North American landbirds

USGS Publications Warehouse

Dunn, Erica H.; Altman, B.L.; Bart, J.; Beardmore, C.J.; Berlanga, H.; Blancher, P.J.; Butcher, G.S.; Demarest, D.W.; Dettmers, R.; Hunter, W.C.; Iñigo-Elias, Eduardo E.; Panjabi, A.O.; Pashley, D.N.; Ralph, C.J.; Rich, T.D.; Rosenberg, K.V.; Rustay, C.M.; Ruth, J.M.; Will, T.C.

2005-01-01

This document is an extension of work done for the Partners in Flight North American Landbird Conservation Plan (Rich et al. 2004). The Continental Plan reviewed conservation status of the 448 native landbird species that regularly breed in the United States and Canada. Two groups of species were identified as having high conservation importance: the PIF Watch List, made up of species for which there is conservation concern, and Stewardship Spices that are particularly characteristic of regional avifaunas. In addition, continental scale monitoring needs were identified for all species. Here we extend the monitoring needs aspect of the Plan, providing additional detail and suggesting the best means of filling the gaps in broad-scale, long-term trend monitoring. This analysis and report was compiled by the Partners in Flight (PIF) Science Committee as a contribution to current work by the North American Bird Conservation Initiative to assess the status of bird population monitoring in North America and to make recommendations for improvements.

Sharing Responsibility for Data Stewardship Between Scientists and Curators

NASA Astrophysics Data System (ADS)

Hedstrom, M. L.

2012-12-01

Data stewardship is becoming increasingly important to support accurate conclusions from new forms of data, integration of and computation across heterogeneous data types, interactions between models and data, replication of results, data governance and long-term archiving. In addition to increasing recognition of the importance of data management, data science, and data curation by US and international scientific agencies, the National Academies of Science Board on Research Data and Information is sponsoring a study on Data Curation Education and Workforce Issues. Effective data stewardship requires a distributed effort among scientists who produce data, IT staff and/or vendors who provide data storage and computational facilities and services, and curators who enhance data quality, manage data governance, provide access to third parties, and assume responsibility for long-term archiving of data. The expertise necessary for scientific data management includes a mix of knowledge of the scientific domain; an understanding of domain data requirements, standards, ontologies and analytical methods; facility with leading edge information technology; and knowledge of data governance, standards, and best practices for long-term preservation and access that rarely are found in a single individual. Rather than developing data science and data curation as new and distinct occupations, this paper examines the set of tasks required for data stewardship. The paper proposes an alternative model that embeds data stewardship in scientific workflows and coordinates hand-offs between instruments, repositories, analytical processing, publishers, distributors, and archives. This model forms the basis for defining knowledge and skill requirements for specific actors in the processes required for data stewardship and the corresponding educational and training needs.

GIS for environmental stewardship and streamlining: an overview of state DOT practices

DOT National Transportation Integrated Search

2005-01-31

The Federal Highway Administration (FHWA) supports the adoption and development of Geographic Information System (GIS) technologies to promote environmental streamlining and stewardship (referred to as GIS4EST). While several States have already appl...

Using Watershed Stewardship to Build Sustainability and Resilience

EPA Science Inventory

This presentation is designed to help build understanding of how stewardship of water resources can help local communities develop sustainably and become more resilient; discuss how monitoring can engage communities and increase environmental awareness; and explore how monitoring...

Stockpile Stewardship's 20th Anniversary

ScienceCinema

Hecker, Siegfried; Gottemoeller, Rose; Reis, Victor H.; McMillan, Charles; Rohlfing, Joan; Hurricane, Omar; Hagengruber, Roger; Taylor, John

2018-06-22

A short oral history of the NNSA's Stockpile Stewardship Program, produced in association with the 20th anniversary of the program. It features Siegfried Hecker, Rose Gottemoeller, Victor Reis, Charles McMillan, Joan Rohlfing, Omar Hurricane, Roger Hagengruber, and John Taylor.

Critical interactions between Global Fund-supported programmes and health systems: a case study in Indonesia.

PubMed

Desai, Monica; Rudge, James W; Adisasmito, Wiku; Mounier-Jack, Sandra; Coker, Richard

2010-11-01

The Global Fund to Fight AIDS, Tuberculosis and Malaria has played an important role in financing the response to HIV/AIDS and tuberculosis (TB) in Indonesia. As part of a series of case studies, we assessed the nature and extent of integration of Global Fund portfolios into the national HIV and TB programmes, integration of the HIV and TB programmes within the general health system, and system-wide effects of Global Fund support on the health care system in Indonesia. The study relied on a literature review and interviews with 22 key informants using the Systemic Rapid Assessment Toolkit and thematic analysis. Global Fund programmes in Indonesia are highly vertical and centralized, in contrast with the decentralized nature of the Indonesian health system. Consequently, there is more integration of all functions at local levels than centrally. There is a high level of integration of planning of Global Fund HIV and TB portfolios into the National AIDS and TB programmes and some limited integration of these programmes with other disease programmes, through joint working groups. Other synergies include strengthening of stewardship and governance and increased staff recruitment encouraged by incentive payments and training. Monitoring and evaluation functions of the Global Fund programmes are not integrated with the disease programmes, with parallel indicators and reporting systems. System-wide effects include greater awareness of governance and stewardship in response to the temporary suspension of Global Fund funding in 2008, and increased awareness of the need to integrate programme planning, financing and service delivery. Global Fund investment has freed up resources for other programmes, particularly at local levels. However, this may hinder a robust exit strategy from Global Fund funding. Furthermore, Global Fund monetary incentives may result in staff shifting into HIV and TB programmes.

Memorandum of Understanding on Long-Term Stewardship at Federal Facilities in the United States

EPA Pesticide Factsheets

The purpose of this Memorandum of Understanding is to provide a common understanding and basis for discussion and coordination between the Environmental Council of the States and relevant federal agencies regarding Long-Term Stewardship.

Ecosystem stewardship: good idea, but how?

USDA-ARS?s Scientific Manuscript database

Ecosystem stewardship and resilience-based management are admirable concepts that remain largely conceptual. Beyond a suite of general ideas, including linkages among ecological models, monitoring, stakeholder engagement, and social learning, there is not a replicable method to use the ideas in the ...

Development of Antimicrobial Competencies and Training for Staff Hospital Pharmacists

PubMed Central

Crader, Marsha F.

2014-01-01

Antimicrobial stewardship is an important component in health care outcomes of all patients. Many institutions are seeking the best methods to incorporate antimicrobial stewardship strategies into their hospitals including pharmacy services. Multiple factors should be considered when beginning or expanding an antimicrobial stewardship program. The purpose of this article is to discuss the development of basic antibiotic competencies and training for staff pharmacists in a community hospital. The article includes an assessment of pharmacists’ knowledge pre education and post education, perception of benefits from an antibiotic education program, and learning needs and preferences. PMID:24421561

Organizational ethics in Catholic health care: honoring stewardship and the work environment.

PubMed

Magill, G

2001-04-01

Organizational ethics refers to the integration of values into decision making, policies, and behavior throughout the multi-disciplinary environment of a health care organization. Based upon Catholic social ethics, stewardship is at the heart of organizational ethics in health care in this sense: stewardship provides the hermeneutic filter that enables basic ethical principles to be realized practically, within the context of the Catholic theology of work, to concerns in health care. This general argument can shed light on the specific topic of non-executive compensation programs as an illustration of organizational ethics in health care.

``Just Another Hoop to Jump Through?'' Using Environmental Laws and Processes to Protect Indigenous Rights

NASA Astrophysics Data System (ADS)

Middleton, Beth Rose

2013-11-01

Protection of culturally important indigenous landscapes has become an increasingly important component of environmental management processes, for both companies and individuals striving to comply with environmental regulations, and for indigenous groups seeking stronger laws to support site protection and cultural/human rights. Given that indigenous stewardship of culturally important sites, species, and practices continues to be threatened or prohibited on lands out of indigenous ownership, this paper examines whether or not indigenous people can meaningfully apply mainstream environmental management laws and processes to achieve protection of traditional sites and associated stewardship activities. While environmental laws can provide a “back door” to protect traditional sites and practices, they are not made for this purpose, and, as such, require specific amendments to become more useful for indigenous practitioners. Acknowledging thoughtful critiques of the cultural incommensurability of environmental law with indigenous environmental stewardship of sacred sites, I interrogate the ability of four specific environmental laws and processes—the Uniform Conservation Easement Act; the National Environmental Policy Act and the California Environmental Quality Act; the Pacific Stewardship Council land divestiture process; and Senate Bill 18 (CA-2004)—to protect culturally important landscapes and practices. I offer suggestions for improving these laws and processes to make them more applicable to indigenous stewardship of traditional landscapes.

"Just another hoop to jump through?" using environmental laws and processes to protect indigenous rights.

PubMed

Middleton, Beth Rose

2013-11-01

Protection of culturally important indigenous landscapes has become an increasingly important component of environmental management processes, for both companies and individuals striving to comply with environmental regulations, and for indigenous groups seeking stronger laws to support site protection and cultural/human rights. Given that indigenous stewardship of culturally important sites, species, and practices continues to be threatened or prohibited on lands out of indigenous ownership, this paper examines whether or not indigenous people can meaningfully apply mainstream environmental management laws and processes to achieve protection of traditional sites and associated stewardship activities. While environmental laws can provide a "back door" to protect traditional sites and practices, they are not made for this purpose, and, as such, require specific amendments to become more useful for indigenous practitioners. Acknowledging thoughtful critiques of the cultural incommensurability of environmental law with indigenous environmental stewardship of sacred sites, I interrogate the ability of four specific environmental laws and processes-the Uniform Conservation Easement Act; the National Environmental Policy Act and the California Environmental Quality Act; the Pacific Stewardship Council land divestiture process; and Senate Bill 18 (CA-2004)-to protect culturally important landscapes and practices. I offer suggestions for improving these laws and processes to make them more applicable to indigenous stewardship of traditional landscapes.

Polishing the tarnished silver bullet: the quest for new antibiotics.

PubMed

Blaskovich, Mark A T; Butler, Mark S; Cooper, Matthew A

2017-02-28

We are facing a potential catastrophe of untreatable bacterial infections, driven by the inexorable rise of extensively drug-resistant bacteria, coupled with a market failure of pharmaceutical and biotech companies to deliver new therapeutic options. While global recognition of the problem is finally apparent, solutions are still a long way from being implemented. In addition to drug stewardship programmes and better diagnostics, new antibiotics are desperately needed. The question remains as to how to achieve this goal. This review will examine the different strategies being applied to discover new antibiotics. © 2017 The Author(s).

[The health system of Nicaragua].

PubMed

Muiser, Jorine; Sáenz, María del Rocío; Bermúdez, Juan Luis

2011-01-01

This paper describes the health conditions in Nicaragua and discusses the characteristics of its national health system including its structure and coverage, its financial sources its physical, material and human resources the stewardship functions developed by the Ministry of Health the participation of citizens in the operation and evaluation of the system and the level of satisfaction of health care users. It also discusses the most recent policy innovations, including the new General Health Law, the decentralization of the regulation of health facilities and the design and implementation of a new health care model known as Family and Community Health Model.

Improvement of Gram-negative Susceptibility to Fluoroquinolones After Implementation of a Pre-Authorization Policy for Fluoroquinolone Use: A Decade-Long Experience

PubMed Central

Lee, Rachael A; Scully, Morgan; Kunz, Danielle F; Jones, T Aaron; Camins, Bernard; McCarty, Todd P; Moser, Stephen; Hoesley, Craig J; Pappas, Peter G

2017-01-01

Abstract Background Antibiotic use is a well-known risk factor for acquisition of drug-resistant bacteria and community antibiotic prescribing can drive high rates of resistance within the hospital setting. Owing to concerns over increasing fluoroquinolone (FQ) resistance among Gram-negative organisms at UAB Hospital, our stewardship program implemented a pre-authorization policy. The goal of this study was to assess the relationship between hospital fluoroquinolone use and antibiotic resistance. Methods In 2006, the inpatient formulary was consolidated to only ciprofloxacin and moxifloxacin with implementation of guidelines for use to limit inpatient prescribing. Any use outside of these guidelines required approval from an infectious diseases physician. Organism-specific data were obtained from the clinical microbiology database and FQ use was obtained from the hospital database. Correlations were calculated using Pearson’s coefficient. Results From 1998 to 2004, FQ use peaked at 173 days of therapy (DOT)/1,000 patient-days, but has remained below 60 DOT/1,000 patient-days since restriction implementation (Figure 1). FQ susceptibility was documented for five common Gram-negative isolates, P. aeruginosa, Acinetobacter spp., Enterobacter cloacae, E. coli, and K. pneumoniae, over an 18-year period (1998–2016). Common hospital acquired pathogens, including Pseudomonas aeruginosa, Acinetobacter spp. and Enterobacter cloacae improved in their susceptibilities to fluoroquinolones. Acinetobacter went from 35% to over 50% susceptible in the preceding 10 years after the policy. Pseudomonas improved from 50% susceptible to over 70% and Enterobacter improved from less than 50% to over 90% susceptible. Interestingly this improvement was not seen for E. coli which continued to show a decline in susceptibility from over 90% to near 60% in 2016. Conclusion In a large academic hospital setting, FQ susceptibility for common hospital-acquired GNRS improved significantly with the introduction of a restricted use program. A continued decline in E. coli FQ susceptibility suggests resistance rates may be driven by outpatient and community antibiotic use and thus, outpatient stewardship programs are necessary to prevent further spread of FQ resistance. Disclosures All authors: No reported disclosures.

PFOA Stewardship Program Baseline Year Summary Report

EPA Pesticide Factsheets

In 2006, EPA and the eight major companies in the industry launched the 2010/15 PFOA Stewardship Program, in which companies committed to reduce global facility emissions and product content of PFOA and related chemicals by 95 percent by 2010, and to work

A Mixed-Methods Pilot Study to Assess Perceptions of Antimicrobial Stewardship in Nursing Homes

PubMed Central

Carter, Rebecca R.; Montpetite, Michelle M.; Jump, Robin L. P.

2016-01-01

Objectives Practicing antimicrobial stewardship in nursing homes faces many challenges, particularly in non-academic settings. We sought to identify features of community nursing home environments that are associated with lower rates of overall antibiotic use. Design In this pilot study, we used an explanatory sequential design that incorporated comparative feedback about antibiotic use to inform a discussion about antimicrobial stewardship practices among community nursing homes. Measurements For the quantitative phase, we measured the number of antibiotic prescriptions, length of therapy and days of therapy/1000 days of care at 6 nursing homes. For the qualitative phase, we conducted semi-structured interviews with healthcare workers in leadership positions at 5 community nursing homes. Transcripts from the recorded interviews were assessed using emergent thematic analysis. For the triangulation phase, we evaluated themes from the semi-structured interviews in the context of each NHs antibiotic use. Results The number of antibiotic prescriptions ranged from 172 to 1244, with 50% to 83% written for ≤ 7 days. All nursing homes reported a similar proportion of fluoroquinolone use (27–32% days of therapy). Triangulation yielded 6 themes for which the environment at each facility ranged from less to more supportive antimicrobial stewardship: practice patterns, external influences, infection control, leadership, communication and facility culture. All nursing homes reported pressure from well-intentioned family members to prescribe antibiotics. Nursing homes with shorter lengths of therapy and lower overall antibiotic use were consonant with an environment more supportive of antimicrobial stewardship. Conclusion Our findings suggest several features of nursing homes that are supportive of antimicrobial stewardship: practice patterns grounded in established diagnostic criteria, proactive infection control and prevention, open communication and interconnectedness among staff. PMID:28152171

Private-well stewardship among a general population based sample of private well-owners.

PubMed

Malecki, Kristen M C; Schultz, Amy A; Severtson, Dolores J; Anderson, Henry A; VanDerslice, James A

2017-12-01

Private well stewardship, including on-going testing and treatment, can ensure private well users are able to maintain source-water quality and prevent exposures to potentially harmful constituents in primary drinking water supplies. Unlike municipal water supplies, private well users are largely responsible for their own testing and treatment and well stewardship is often minimal. The importance of factors influencing regular testing, and treatment behaviors, including knowledge, risk perception, convenience and social norms, can vary by geography and population characteristics. The primary goals of this study were to survey a general statewide population of private well users in Wisconsin in order to quantify testing and treatment patterns and gather data on motivations and barriers to well stewardship. The majority of respondents reported using and drinking well water daily but only about one half of respondents reported testing their wells in the last ten years and of these, only 10% reported testing in the last 12months. Bacteria and nitrates were contaminants most often tested; and, a private laboratory most often conducted testing. The most commonly reported water treatment was a water softener. Living in a particular geographic region and income were the most significant predictors of water testing and treatment. Iron and hardness, which influence water aesthetics but not always safety, were the most commonly reported water quality problems. Health concerns or perceived lack thereof were, respectively, motivators and barriers to testing and treatment. Limited knowledge of testing and treatment options were also identified as barriers. Results confirm previous findings that well stewardship practices are minimal and often context specific. Understanding the target population's perceptions of risk and knowledge are important elements to consider in identifying vulnerable populations and developing education and policy efforts to improve well stewardship. Copyright © 2017 Elsevier B.V. All rights reserved.

Pharmacist-driven antimicrobial stewardship in intensive care units in East China: A multicenter prospective cohort study.

PubMed

Li, Zhongwang; Cheng, Baoli; Zhang, Kai; Xie, Guohao; Wang, Yan; Hou, Jinchao; Chu, Lihua; Zhao, Jialian; Xu, Zhijun; Lu, Zhongqiu; Sun, Huaqin; Zhang, Jian; Wang, Zhiyi; Wu, Haiya; Fang, Xiangming

2017-09-01

Antimicrobial stewardship programs, particularly pharmacist-driven programs, help reduce the unnecessary use of antimicrobial agents. The objective of this study was to assess the influence of pharmacist-driven antimicrobial stewardship on antimicrobial use, multidrug resistance, and patient outcomes in adult intensive care units in China. We conducted a multicenter prospective cohort study with a sample of 577 patients. A total of 353 patients were included under a pharmacist-driven antimicrobial stewardship program, whereas the remaining 224 patients served as controls. The primary outcome was all-cause hospital mortality. The pharmacist-driven antimicrobial stewardship program had a lower hospital mortality rate compared with the nonpharmacist program (19.3% vs 29.0%; P = .007). Furthermore, logistic regression analysis indicated that the pharmacist-driven program independently predicted hospital mortality (odds ratio, 0.57; 95% confidence interval, 0.36-0.91; P = .017) after adjustment. Meanwhile, this strategy had a lower rate of multidrug resistance (23.8% vs 31.7%; P = .037). Moreover, the strategy optimized antimicrobial use, such as having a shorter duration of empirical antimicrobial therapy (2.7 days; interquartile range [IQR], 1.7-4.6 vs 3.0; IQR, 1.9-6.2; P = .002) and accumulated duration of antimicrobial treatment (4.0; IQR, 2.0-7.0 vs 5.0; IQR, 3.0-9.5; P = .030). Pharmacist-driven antimicrobial stewardship in an intensive care unit decreased patient mortality and the emergence of multidrug resistance, and optimized antimicrobial agent use. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Risk perception, future land use and stewardship: comparison of attitudes about Hanford Site and Idaho National Engineering and Environmental Laboratory.

PubMed

Burger, J; Sanchez, J; Roush, D; Gochfeld, M

2001-04-01

With the ending of the Cold War, the Department of Energy (DOE) is evaluating mission, future land use and stewardship of departmental facilities. This paper compares the environmental concerns and future use preferences of 351 people interviewed at Lewiston, Idaho, about the Hanford Site and Idaho National Engineering and Environmental Laboratory (INEEL), two of DOE's largest sites. Although most subjects lived closer to Hanford than INEEL, most resided in the same state as INEEL. Therefore their economic interests might be more closely allied with INEEL, while their health concerns might be more related to Hanford. Few lived close enough to either site to be directly affected economically. We test the null hypotheses that there are no differences in environmental concerns and future land-use preferences as a function of DOE site, sex, age and education. When asked to list their major concerns about the sites, more people listed human health and safety, and environmental concerns about Hanford compared to INEEL. When asked to list their preferred future land uses, 49% of subjects did not have any for INEEL, whereas only 35% did not know for Hanford. The highest preferred land uses for both sites were as a National Environmental Research Park (NERP), and for camping, hunting, hiking, and fishing. Except for returning the land to the tribes and increased nuclear storage, subjects rated all future uses as more preferred at INEEL than Hanford. Taken together, these data suggest that the people interviewed know more about Hanford, are more concerned about Hanford, rate recreational uses and NERP as their highest preferred land use, and feel that INEEL is more suited for most land uses than Handford. Overall rankings for future land uses were remarkably similar between the sites, indicating that for these stakeholders, DOE lands should be preserved for research and recreation. These preferences should be taken into account when planning for long-term stewardship at these two DOE sites.

Monitoring habitat restoration projects: U.S. Fish and Wildlife Service Pacific Region Partners for Fish and Wildlife Program and Coastal Program Protocol

USGS Publications Warehouse

Woodward, Andrea; Hollar, Kathy

2011-01-01

The U.S. Fish and Wildlife Service's (FWS) Pacific Region (Region 1) includes more than 158 million acres (almost 247,000 square miles) of land base in Idaho, Oregon, Washington, Hawai`i, the Commonwealth of the Northern Mariana Islands, American Samoa, Guam, the Republic of Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands. Region 1 is ecologically diverse with landscapes that range from coral reefs, broadleaf tropical forests, and tropical savannahs in the Pacific Islands, to glacial streams and lakes, lush old-growth rainforests, inland fjords, and coastal shoreline in the Pacific Northwest, to the forested mountains, shrub-steppe desert, and native grasslands in the Inland Northwest. Similarly, the people of the different landscapes perceive, value, and manage their natural resources in ways unique to their respective regions and cultures. The Partners for Fish and Wildlife Program (Partners Program) and Coastal Program work with a variety of partners in Region 1 including individual landowners, watershed councils, land trusts, Soil and Water Conservation Districts, non-governmental organizations, Tribal governments, Native Hawaiian organizations, and local, State, and Federal agencies. The Partners Program is the FWS's vanguard for working with private landowners to voluntarily restore and conserve fish and wildlife habitat. Using non-regulatory incentives, the Partners Program engages willing partners to conserve and protect valuable fish and wildlife habitat on their property and in their communities. This is accomplished by providing the funding support and technical and planning tools needed to make on-the-ground conservation affordable, feasible, and effective. The primary goals of the Pacific Region Partners Program are to: Promote citizen and community-based stewardship efforts for fish and wildlife conservation Contribute to the recovery of at-risk species, Protect the environmental integrity of the National Wildlife Refuges, Contribute to the implementation of the State Comprehensive Wildlife Conservation Strategies, and Help achieve the objectives of the National Fish Habitat Partnerships and regionally based bird conservation plans (for example, North American Waterfowl Management Plan, U.S. Pacific Island Shorebird Conservation Plans, Intermountain West Regional Shorebird Plan, etc.). The Partners Program accomplishes these priorities by: Developing and maintaining strong partnerships, and delivering on-the-ground habitat restoration projects designed to reestablish habitat function and restore natural processes; Addressing key habitat limiting factors for declining species; Providing corridors for wildlife and decrease impediments to native fish and wildlife migration; and Enhancing native plant communities by reducing invasive species and improving native species composition. The Coastal Program is a voluntary fish and wildlife conservation program that focuses on watershed-scale, long-term collaborative resource planning and on-the-ground restoration projects in high-priority coastal areas. The Coastal Program conducts planning and restoration work on private, State, and Federal lands, and partnerships with other agencies-Native American Tribes, citizens, and organizations are emphasized. Coastal Program goals include restoring and protecting coastal habitat, providing technical and cost-sharing assistance where appropriate, supporting community-based restoration, collecting and developing information on the status of and threats to fish and wildlife, and using outreach to promote stewardship of coastal resources. The diversity of habitats and partners in Region 1 present many opportunities for conducting restoration projects. Faced with this abundance of opportunity, the Partners Program and Coastal Program must ensure that limited staffing and project dollars are allocated to benefit the highest priority resources and achieve the highest quality results for Federal trust species. In 2007, the Partners Program and Coastal Program developed a Strategic Plan to guide program operations and more efficiently conserve habitat by focusing partnership building and habitat improvement actions within 35 Partners Program Focus Areas and 9 Coastal Program Focus Areas (U.S. Fish and Wildlife Service, 2010). The Strategic Plan also contains four other goals: broaden and strengthen partnerships; improve information sharing and communications; enhance workforce; and increase accountability to ensure that program resources are used efficiently and effectively. This protocol will help achieve all goals of the Strategic Plan.

2010/2015 PFOA Stewardship Program - 2014 Annual Progress Reports

EPA Pesticide Factsheets

In 2006, EPA and the eight major companies in the industry launched the 2010/15 PFOA Stewardship Program, in which companies committed to reduce global facility emissions and product content of PFOA and related chemicals by 95 percent by 2010, and to work

77 FR 6820 - Proposed Information Collection; Comment Request: Creating Stewardship Through Biodiversity...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-09

... Information Collection; Comment Request: Creating Stewardship Through Biodiversity Discovery in National Parks... collection (IC) described below. This collection will survey participants of Biodiversity Discovery efforts... Biodiversity Discovery refers to a variety of efforts to discover living organisms through public involvement...

36 CFR 219.12 - Collaboration and cooperatively developed landscape goals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... others in the stewardship of National Forest System lands. To engage people in the stewardship of..., jurisdictions, and responsibilities of interested and affected organizations, groups, and individuals. The... it is the continuing responsibility of the Federal Government to use all practicable means...

36 CFR 219.12 - Collaboration and cooperatively developed landscape goals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... others in the stewardship of National Forest System lands. To engage people in the stewardship of..., jurisdictions, and responsibilities of interested and affected organizations, groups, and individuals. The... it is the continuing responsibility of the Federal Government to use all practicable means...

[The absence of stewardship in the Chilean health authority after the 2004 health reform].

PubMed

Herrera, Tania; Sánchez, Sergio

2014-11-26

Stewardship is the most important political function of a health system. It is a government responsibility carried out by the health authority. Among other dimensions, it is also a meta-function that includes conduction and regulation. The Health Authority and Management Act, which came about from the health reform of 2004, separated the functions of service provision and stewardship with the aim of strengthening the role of the health authority. However, the current structure of the health system contains overlapping functions between the different entities that leads to lack of coordination and inconsistencies, and a greater weight on individual health actions at the expense of collective ones. Consequently, a properly funded national health strategy to improve the health of the population is missing. Additionally, the components of citizen participation and governance are weak. It is necessary, therefore, to revisit the Chilean health structure in order to develop one that truly enables the exercise of the health authority’s stewardship role.

Data stewardship - a fundamental part of the scientific method (Invited)

NASA Astrophysics Data System (ADS)

Foster, C.; Ross, J.; Wyborn, L. A.

2013-12-01

This paper emphasises the importance of data stewardship as a fundamental part of the scientific method, and the need to effect cultural change to ensure engagement by earth scientists. It is differentiated from the science of data stewardship per se. Earth System science generates vast quantities of data, and in the past, data analysis has been constrained by compute power, such that sub-sampling of data often provided the only way to reach an outcome. This is analogous to Kahneman's System 1 heuristic, with its simplistic and often erroneous outcomes. The development of HPC has liberated earth sciences such that the complexity and heterogeneity of natural systems can be utilised in modelling at any scale, global, or regional, or local; for example, movement of crustal fluids. Paradoxically, now that compute power is available, it is the stewardship of the data that is presenting the main challenges. There is a wide spectrum of issues: from effectively handling and accessing acquired data volumes [e.g. satellite feeds per day/hour]; through agreed taxonomy to effect machine to machine analyses; to idiosyncratic approaches by individual scientists. Except for the latter, most agree that data stewardship is essential. Indeed it is an essential part of the science workflow. As science struggles to engage and inform on issues of community importance, such as shale gas and fraccing, all parties must have equal access to data used for decision making; without that, there will be no social licence to operate or indeed access to additional science funding (Heidorn, 2008). The stewardship of scientific data is an essential part of the science process; but often it is regarded, wrongly, as entirely in the domain of data custodians or stewards. Geoscience Australia has developed a set of six principles that apply to all science activities within the agency: Relevance to Government Collaborative science Quality science Transparent science Communicated science Sustained science capability Every principle includes data stewardship: this is to effect cultural change at both collective and individual levels to ensure that our science outcomes and technical advice are effective for the Government and community.

Critical Infrastructure for Ocean Research and Societal Needs in 2030

NASA Astrophysics Data System (ADS)

Glickson, D.; Barron, E. J.; Fine, R. A.; Bellingham, J. G.; Boss, E.; Boyle, E. A.; Edwards, M.; Johnson, K. S.; Kelley, D. S.; Kite-Powell, H.; Ramberg, S. E.; Rudnick, D. L.; Schofield, O.; Tamburri, M.; Wiebe, P. H.; Wright, D. J.; Committee on an Ocean Infrastructure StrategyU. S. Ocean Research in 2030

2011-12-01

At the request of the Subcommittee on Ocean Science and Technology, an expert committee was convened by the National Research Council to identify major research questions anticipated to be at the forefront of ocean science in 2030, define categories of infrastructure that should be included in planning, provide advice on criteria and processes that could be used to set priorities, and recommend ways to maximize the value of investments in ocean infrastructure. The committee identified 32 future ocean research questions in four themes: enabling stewardship of the environment, protecting life and property, promoting economic vitality, and increasing fundamental scientific understanding. Many of the questions reflect challenging, multidisciplinary science questions that are clearly relevant now and are likely to take decades to solve. U.S. ocean research will require a growing suite of ocean infrastructure for a range of activities, such as high quality, sustained time series observations and autonomous monitoring at a broad range of spatial and temporal scales. A coordinated national plan for making future strategic investments will be needed and should be based upon known priorities and reviewed every 5-10 years. After assessing trends in ocean infrastructure and technology development, the committee recommended implementing a comprehensive, long-term research fleet plan in order to retain access to the sea; continuing U.S. capability to access fully and partially ice-covered seas; supporting innovation, particularly the development of biogeochemical sensors; enhancing computing and modeling capacity and capability; establishing broadly accessible data management facilities; and increasing interdisciplinary education and promoting a technically-skilled workforce. They also recommended that development, maintenance, or replacement of ocean research infrastructure assets should be prioritized in terms of societal benefit. Particular consideration should be given to usefulness for addressing important science questions; affordability, efficiency, and longevity; and ability to contribute to other missions or applications. Estimating the economic costs and benefits of each potential infrastructure investment using these criteria would allow funding of investments that produce the largest expected net benefit over time.

Geospatial Analysis and Remote Sensing from Airplanes and Satellites for Cultural Resources Management

NASA Technical Reports Server (NTRS)

Giardino, Marco J.; Haley, Bryan S.

2005-01-01

Cultural resource management consists of research to identify, evaluate, document and assess cultural resources, planning to assist in decision-making, and stewardship to implement the preservation, protection and interpretation of these decisions and plans. One technique that may be useful in cultural resource management archaeology is remote sensing. It is the acquisition of data and derivative information about objects or materials (targets) located on the Earth's surface or in its atmosphere by using sensor mounted on platforms located at a distance from the targets to make measurements on interactions between the targets and electromagnetic radiation. Included in this definition are systems that acquire imagery by photographic methods and digital multispectral sensors. Data collected by digital multispectral sensors on aircraft and satellite platforms play a prominent role in many earth science applications, including land cover mapping, geology, soil science, agriculture, forestry, water resource management, urban and regional planning, and environmental assessments. Inherent in the analysis of remotely sensed data is the use of computer-based image processing techniques. Geographical information systems (GIS), designed for collecting, managing, and analyzing spatial information, are also useful in the analysis of remotely sensed data. A GIS can be used to integrate diverse types of spatially referenced digital data, including remotely sensed and map data. In archaeology, these tools have been used in various ways to aid in cultural resource projects. For example, they have been used to predict the presence of archaeological resources using modern environmental indicators. Remote sensing techniques have also been used to directly detect the presence of unknown sites based on the impact of past occupation on the Earth's surface. Additionally, remote sensing has been used as a mapping tool aimed at delineating the boundaries of a site or mapping previously unknown features. All of these applications are pertinent to the goals of site discovery and assessment in cultural resource management.

Improving Wellbeing and Environmental Stewardship Through Volunteering in Nature.

PubMed

Molsher, Robyn; Townsend, Mardie

2016-03-01

Environmental volunteering (EV) can provide a unique way to optimise the wellbeing of participants while fostering environmental stewardship. However, the potential of EV to create human health benefits remains an under-researched area. This study provides evidence for improved wellbeing and mood state for 32 participants from diverse backgrounds undertaking EV activities. Most participants also reported improved environmental stewardship with a greatly improved understanding of the environment and the need to conserve it. Other benefits included: 31% of those seeking work obtained it; and 50% joined a volunteer group at program completion. EV provides a unique mechanism to enhance the wellbeing of the participants, while conserving the environment.

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Mathematical Modeling.

PubMed

Barnes, Sean L; Kasaie, Parastu; Anderson, Deverick J; Rubin, Michael

2016-11-01

Mathematical modeling is a valuable methodology used to study healthcare epidemiology and antimicrobial stewardship, particularly when more traditional study approaches are infeasible, unethical, costly, or time consuming. We focus on 2 of the most common types of mathematical modeling, namely compartmental modeling and agent-based modeling, which provide important advantages-such as shorter developmental timelines and opportunities for extensive experimentation-over observational and experimental approaches. We summarize these advantages and disadvantages via specific examples and highlight recent advances in the methodology. A checklist is provided to serve as a guideline in the development of mathematical models in healthcare epidemiology and antimicrobial stewardship. Infect Control Hosp Epidemiol 2016;1-7.

Stewardship

ERIC Educational Resources Information Center

Canada, Benjamin O.

2005-01-01

In this article, the author found himself particularly drawn to a book he received in the mail--"Stewardship: Choosing Service Over Self-Interest" by Peter Block. Although the dictionary definition of steward is "one who manages another's property, finances or other affairs," from his vantage point as the first African-American superintendent in…

Predicting volunteer commitment in environmental stewardship programmes

Treesearch

Robert L. Ryan; Rachel Kaplan; Robert E. Grese

2001-01-01

The natural environment benefits greatly from the work of volunteers in environmental stewardship programmes. However, little is known about volunteers' motivations for continued participation in these programmes. This study looked at the relationship between volunteer commitment and motivation, as well as the effect that volunteering has on participants'...

Integration of Cloud Technologies for Data Stewardship at the NOAA National Centers for Environmental Information (NCEI)

NASA Astrophysics Data System (ADS)

Casey, K. S.; Hausman, S. A.

2016-02-01

In the last year, the NOAA National Oceanographic Data Center (NODC) and its siblings, the National Climatic Data Center and National Geophysical Data Center, were merged into one organization, the NOAA National Centers for Environmental Information (NCEI). Combining its expertise under one management has helped NCEI accelerate its efforts to embrace and integrate private, public, and hybrid cloud environments into its range of data stewardship services. These services span a range of tiers, from basic, long-term preservation and access, through enhanced access and scientific quality control, to authoritative product development and international-level services. Throughout these tiers of stewardship, partnerships and pilot projects have been launched to identify technological and policy-oriented challenges, to establish solutions to these problems, and to highlight success stories for emulation during operational integration of the cloud into NCEI's data stewardship activities. Some of these pilot activities including data storage, access, and reprocessing in Amazon Web Services, the OneStop data discovery and access framework project, and a set of Cooperative Research and Development Agreements under the Big Data Project with Amazon, Google, IBM, Microsoft, and the Open Cloud Consortium. Progress in these efforts will be highlighted along with a future vision of how NCEI could leverage hybrid cloud deployments and federated systems across NOAA to enable effective data stewardship for its oceanographic, atmospheric, climatic, and geophysical Big Data.

Examining the concept of convenient collection: an application to extended producer responsibility and product stewardship frameworks.

PubMed

Wagner, Travis P

2013-03-01

Increasingly, Extended Producer Responsibility (EPR) and Product Stewardship (PS) frameworks are being adopted as a preferred policy approach to promote cost-effective diversion and recovery of post-consumer solid waste. Because the application of EPR/PS generally requires the creation of a separate and often parallel collection and/or management system, key to increasing the amount of waste recovered is to maximize the convenience of the collection system to maximize consumer participation. Convenient collection is often mandated in EPR/PS laws, however it is not defined. Convenience is a subjective construct rendering it extremely difficult to define. However, based on a dissection of post-consumer collection efforts under a generic EPR/PS system, this paper identifies and examines five categories of convenience - knowledge requirements, proximity to a collection site, opportunity to drop-off materials, the draw of the collection site, and the ease of the process-and the various factors of convenience within each of these categories. By using a simplified multiple criteria decision analysis, this paper proposes a performance matrix of criteria of convenience. Stakeholders can use this matrix to assist in the design, assessment, and/or implementation of a convenient post-consumer collection system under an EPR/PS framework. Copyright © 2012 Elsevier Ltd. All rights reserved.

Environmental considerations related to mining of nonfuel minerals

USGS Publications Warehouse

Seal, Robert R.; Piatak, Nadine M.; Kimball, Bryn E.; Hammarstrom, Jane M.; Schulz, Klaus J.; DeYoung,, John H.; Seal, Robert R.; Bradley, Dwight C.

2017-12-19

Throughout most of human history, environmental stewardship during mining has not been a priority partly because of the lack of applicable laws and regulations and partly because of ignorance about the effects that mining can have on the environment. In the United States, the National Environmental Policy Act of 1969, in conjunction with related laws, codified a more modern approach to mining, including the responsibility for environmental stewardship, and provided a framework for incorporating environmental protection into mine planning. Today, similar frameworks are in place in the other developed countries of the world, and international mining companies generally follow similar procedures wherever they work in the world. The regulatory guidance has fostered an international effort among all stakeholders to identify best practices for environmental stewardship.The modern approach to mining using best practices involves the following: (a) establishment of a pre-mining baseline from which to monitor environmental effects during mining and help establish geologically reasonable closure goals; (b) identification of environmental risks related to mining through standardized approaches; and (c) formulation of an environmental closure plan before the start of mining. A key aspect of identifying the environmental risks and mitigating those risks is understanding how the risks vary from one deposit type to another—a concept that forms the basis for geoenvironmental mineral-deposit models.Accompanying the quest for best practices is the goal of making mining sustainable into the future. Sustainable mine development is generally considered to be development that meets the needs of the present generation without compromising the ability of future generations to meet their own needs. The concept extends beyond the availability of nonrenewable mineral commodities and includes the environmental and social effects of mine development.Global population growth, meanwhile, has decreased the percentage of inhabitable land available to support society’s material needs. Presently, the land area available to supply the mineral resources, energy resources, water, food, shelter, and waste disposal needs of all Earth’s inhabitants is estimated to be 135 square meters per person. Continued global population growth will only increase the challenges of sustainable mining.Current trends in mining are also expected to lead to new environmental challenges in the future, among which are mine-waste management issues related to mining larger deposits for lower ore grade; water-management issues related to both the mining of larger deposits and the changes in precipitation brought about by climate change; and greenhouse gas issues related to reducing the carbon footprint of larger, more energy-intensive mining operations.

Defense Experimentation and Stockpile Stewardship

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

None

2014-10-28

A primary mission of the site is to help ensure that the nation's nuclear weapon stockpile remains safe, secure and reliable. The stockpile stewardship program, working with the national weapons laboratories conducts a wide range of experiments using advanced diagnostic technologies, many of which were developed right here at the NNSS.

Watershed Stewardship Education Program--A Multidisciplinary Extension Education Program for Oregon's Watershed Councils.

ERIC Educational Resources Information Center

Conway, Flaxen D. L.; Godwin, Derek; Cloughesy, Mike; Nierenberg, Tara

2003-01-01

The Watershed Stewardship Education Program (WSEP) is a multidisciplinary Oregon Extension designed to help watershed councils, landowners, and others work effectively together on water management. Components include practical, easy-to-use educational materials, training in effective collaboration, a Master Watershed Stewards program, and advanced…

Defining Best Practices in Boating, Fishing, and Stewardship Education.

ERIC Educational Resources Information Center

Fedler, Anthony J., Ed.

The Recreational Boating and Fishing Foundation (RBFF) aims to increase participation in recreational boating and fishing and thereby increase public awareness, appreciation, and stewardship of aquatic natural resources. This document contains a summary and 11 commissioned papers from an RBFF workshop to create guidelines for best educational…

Place-Based Stewardship Education: Nurturing Aspirations to Protect the Rural Commons

ERIC Educational Resources Information Center

Gallay, Erin; Marckini-Polk, Lisa; Schroeder, Brandon; Flanagan, Constance

2016-01-01

In this mixed-methods study, we examine the potential of place-based stewardship education (PBSE) for nurturing rural students' community attachment and aspirations to contribute to the preservation of the environmental "commons." Analyzing pre- and post-experience surveys (n = 240) and open-ended responses (n = 275) collected from…

Defense Experimentation and Stockpile Stewardship

ScienceCinema

None

2018-01-16

A primary mission of the site is to help ensure that the nation's nuclear weapon stockpile remains safe, secure and reliable. The stockpile stewardship program, working with the national weapons laboratories conducts a wide range of experiments using advanced diagnostic technologies, many of which were developed right here at the NNSS.

Water, climate change, and forests: watershed stewardship for a changing climate

Treesearch

Michael J. Furniss; Brian P. Staab; Sherry Hazelhurst; Cathrine F. Clifton; Kenneth B. Roby; Bonnie L. Ilhadrt; Albert H. Todd; Leslie M. Reid; Sarah J. Hines; Karen A. Bennett; Charles H. Luce; Pamela J. Edwards

2010-01-01

Water from forested watersheds provides irreplaceable habitat for aquatic and riparian species and supports our homes, farms, industries, and energy production. Secure, high-quality water from forests is fundamental to our prosperity and our stewardship responsibility.Yet population pressures, land uses, and rapid climate change combine to seriously...

Mixed methods analysis of urban environmental stewardship networks

Treesearch

James J.T. Connolly; Erika S. Svendsen; Dana R. Fisher; Lindsay K. Campbell

2015-01-01

While mixed methods approaches to research have been accepted practice within the social sciences for several decades (Tashakkori and Teddlie 2003), the rising demand for cross-disciplinary analyses of socio-environmental processes has necessitated a renewed examination of this approach within environmental studies. Urban environmental stewardship is one area where it...

Stewardship, Learning, and Memory in Disaster Resilience

ERIC Educational Resources Information Center

Tidball, Keith G.; Krasny, Marianne E.; Svendsen, Erika; Campbell, Lindsay; Helphand, Kenneth

2010-01-01

In this contribution, we propose and explore the following hypothesis: civic ecology practices, including urban community forestry, community gardening, and other self-organized forms of stewardship of green spaces in cities, are manifestations of how memories of the role of greening in healing can be instrumentalized through social learning to…

Eco-Visualization: Promoting Environmental Stewardship in the Museum

ERIC Educational Resources Information Center

Holmes, Tiffany

2007-01-01

Eco-visualizations are artworks that reinterpret environmental data with custom software to promote stewardship. Eco-visualization technology offers a new way to dynamically picture environmental data and make it meaningful to a museum population. The questions are: How might museums create new projects and programs around place-based information?…

The challenge of wilderness stewardship

Treesearch

David J. Parsons; David N. Cole

2003-01-01

The 1964 Wilderness Act and subsequent wilderness legislation have resulted in the designation of over 106 million acres of the United States as wilderness. Charged with the responsibility of protecting a significant portion of federal lands as wilderness, the federal land management agencies with responsibility for wilderness stewardship (Bureau of Land Management,...

Antimicrobial stewardship through telemedicine and its impact on multi-drug resistance.

PubMed

Dos Santos, Rodrigo P; Dalmora, Camila H; Lukasewicz, Stephani A; Carvalho, Otávio; Deutschendorf, Caroline; Lima, Raquel; Leitzke, Tiago; Correa, Nilson C; Gambetta, Marcelo V

2018-01-01

Introduction Telemedicine technologies are increasingly being incorporated into infectious disease practice. We aimed to demonstrate the impact of antimicrobial stewardship through telemedicine on bacterial resistance rates. Methods We conducted a quasi-experimental study in a 220-bed hospital in southern Brazil. An antimicrobial stewardship program incorporating the use of telemedicine was implemented. Resistance and antimicrobial consumption rates were determined and analysed using a segmented regression model. Results After the intervention, the rate of appropriate antimicrobial prescription increased from 51.4% at baseline to 81.4%. Significant reductions in the consumption of fluoroquinolones (level change, β = -0.80; P < 0.01; trend change, β = -0.01; P = 0.98), first-generation cephalosporins (level change, β = -0.91; P < 0.01; trend change, β = +0.01; P = 0.96), vancomycin (level change, β = -0.47; P = 0.04; trend change, β = +0.17; P = 0.66) and polymyxins (level change, β = -0.15; P = 0.56; trend change, β = -1.75; P < 0.01) were identified. There was an increase in the consumption of amoxicillin + clavulanate (level change, β = +0.84; P < 0.01; trend change, β = +0.14; P = 0.41) and cefuroxime (level change, β = +0.21; P = 0.17; trend change, β = +0.66; P = 0.02). A significant decrease in the rate of carbapenem-resistant Acinetobacter spp. isolation (level change, β = +0.66; P = 0.01; trend change, β = -1.26; P < 0.01) was observed. Conclusions Telemedicine, which provides a tool for decision support and immediate access to experienced specialists, can promote better antibiotic selection and reductions in bacterial resistance.

A quality improvement programme to increase compliance with an anti-infective prescribing policy

PubMed Central

Thakkar, Kandarp; Gilchrist, Mark; Dickinson, Edward; Benn, Jonathan; Franklin, Bryony Dean; Jacklin, Ann; Adeniran, Shola; Ali, Alisha; Brannigan, Eimear; Bamford, Kathy; Lam-Chong, Kelly; Dickinson, Edward; Gilchrist, Mark; Jacklin, Ann; Lawson, Wendy; Mehta, Roopal; Newsholme, William; Rana, Ambreen; Reynolds, Sarah; Sanderson, Frances; Wei Tan, Xin; Thakkar, Kandarp; Bracey, Gemma

2011-01-01

Objectives The UK Department of Health has made recommendations on safe and appropriate prescribing of anti-infectives. In response, we reviewed our anti-infective policies to ensure they were in line with best practice. As a result, a new adult anti-infective policy was launched. To help facilitate its implementation, a quality improvement programme was established, with the aim of achieving >90% compliance with the new policy. Methods Patients under the care of the medical admissions teams who had been prescribed one or more systemic anti-infectives between January and November 2008 were included in the study. Study pharmacists collected data daily on all patients, including the anti-infective(s) prescribed and indication(s) documented on either the patient's drug prescription chart or health records. A definition of compliance was developed, which required documented indication(s) and associated anti-infectives to match the anti-infective policy. A baseline compliance level was established; we then implemented a series of interventions using the plan-do-study-act (‘PDSA’) approach to monitor and improve compliance. Three overlapping intervention phases were retrospectively identified: raising awareness; education; and weekly feedback of results in the form of run charts distributed to medical teams. Results Over the 11 month study period, compliance with the policy increased from 30% to 71%. Since 2008, we have seen the average compliance increase year-on-year to over 90% in 2010 using a sustainable once weekly data collection model. Conclusions This study shows that it is possible to use quality improvement methodology to support antimicrobial stewardship within existing resources and suggests that an improvement in policy compliance can be both achieved and sustained. PMID:21642650

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.

Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention.

PubMed

Pollack, Loria A; Srinivasan, Arjun

2014-10-15

The proven benefits of antibiotic stewardship programs (ASPs) for optimizing antibiotic use and minimizing adverse events, such as Clostridium difficile and antibiotic resistance, have prompted the Centers for Disease Control and Prevention (CDC) to recommend that all hospitals have an ASP. This article summarizes Core Elements of Hospital Antibiotic Stewardship Programs, a recently released CDC document focused on defining the infrastructure and practices of coordinated multidisciplinary programs to improve antibiotic use and patient care in US hospitals. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Antibiotic stewardship and empirical antibiotic treatment: How can they get along?

PubMed

Zuccaro, Valentina; Columpsi, Paola; Sacchi, Paolo; Lucà, Maria Grazia; Fagiuoli, Stefano; Bruno, Raffaele

2017-06-01

The aim of this review is to focus on the recent knowledge on antibiotic stewardship and empiric antibiotic treatment in cirrhotic patients. The application of antimicrobial stewardship (AMS) rules appears to be the most appropriate strategy to globally manage cirrhotic patients with infectious complications: indeed they represent a unique way to provide both early diagnosis and appropriate therapy in order to avoid not only antibiotic over-prescription but, more importantly, selection and spread of antimicrobial resistance. Moreover, cirrhotic patients must be considered "frail" and susceptible to healthcare associated infections: applying AMS policies would assure a cost reduction and thus contribute to the improvement of public health strategies. Copyright © 2017. Published by Elsevier Ltd.

Medical workforce education and training: A failed decentralisation attempt to reform organisation, financing, and planning in England.

PubMed

Ovseiko, Pavel V; Buchan, Alastair M

2015-12-01

The 2010-2015 Conservative and Liberal Democrat coalition government proposed introducing a radical decentralisation reform of the organisation, financing, and planning of medical workforce education and training in England. However, following public deliberation and parliamentary scrutiny of the government's proposals, it had to abandon and alter its original proposals to the extent that they failed to achieve their original decentralisation objectives. This failed decentralisation attempt provides important lessons about the policy process and content of both workforce governance and health system reforms in Europe and beyond. The organisation, financing, and planning of medical workforce education is as an issue of national importance and should remain in the stewardship of the national government. Future reform efforts seeking to enhance the skills of the workforce needed to deliver high-quality care for patients in the 21st century will have a greater chance of succeeding if they are clearly articulated through engagement with stakeholders, and focus on the delivery of undergraduate and postgraduate multi-professional education and training in universities and teaching hospitals. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

78 FR 28776 - Approval and Promulgation of Implementation Plans; Georgia; State Implementation Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... Section of this Federal Register, EPA is approving the State's implementation plan revision as a direct... Promulgation of Implementation Plans; Georgia; State Implementation Plan Miscellaneous Revisions AGENCY... State Implementation Plan (SIP) submitted by the Georgia Environmental Protection Division to EPA in...

Health sector operational planning and budgeting processes in Kenya—“never the twain shall meet”

PubMed Central

Molyneux, Sassy; Goodman, Catherine

2015-01-01

Summary Operational planning is considered an important tool for translating government policies and strategic objectives into day‐to‐day management activities. However, developing countries suffer from persistent misalignment between policy, planning and budgeting. The Medium Term Expenditure Framework (MTEF) was introduced to address this misalignment. Kenya adopted the MTEF in the early 2000s, and in 2005, the Ministry of Health adopted the Annual Operational Plan process to adapt the MTEF to the health sector. This study assessed the degree to which the health sector Annual Operational Plan process in Kenya has achieved alignment between planning and budgeting at the national level, using document reviews, participant observation and key informant interviews. We found that the Kenyan health sector was far from achieving planning and budgeting alignment. Several factors contributed to this problem including weak Ministry of Health stewardship and institutionalized separation between planning and budgeting processes; a rapidly changing planning and budgeting environment; lack of reliable data to inform target setting and poor participation by key stakeholders in the process including a top‐down approach to target setting. We conclude that alignment is unlikely to be achieved without consideration of the specific institutional contexts and the power relationships between stakeholders. In particular, there is a need for institutional integration of the planning and budgeting processes into a common cycle and framework with common reporting lines and for improved data and local‐level input to inform appropriate and realistic target setting. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd. PMID:25783862

Citizen monitoring and restoration: Volunteers and community involvement in wilderness stewardship

Treesearch

Laurie Yung

2007-01-01

Citizen monitoring and restoration is increasingly viewed as a means to involve local communities in wilderness stewardship. This paper examines research on volunteers participating in five monitoring and restoration programs in Western Montana. Volunteers reported that they gained valuable skills, felt more connected with local wilderness areas, and made an important...

Technical guide for monitoring selected conditions related to wilderness character

Treesearch

Peter Landres; Steve Boutcher; Liese Dean; Troy Hall; Tamara Blett; Terry Carlson; Ann Mebane; Carol Hardy; Susan Rinehart; Linda Merigliano; David N. Cole; Andy Leach; Pam Wright; Deb Bumpus

2009-01-01

The purpose of monitoring wilderness character is to improve wilderness stewardship by providing managers a tool to assess how selected actions and conditions related to wilderness character are changing over time. Wilderness character monitoring provides information to help answer two key questions about wilderness character and wilderness stewardship: 1. How is...

Aspen's Global 100: Beyond Grey Pinstripes 2009-2010--Preparing MBAs for Social and Environmental Stewardship

ERIC Educational Resources Information Center

Aspen Institute, 2009

2009-01-01

Beyond Grey Pinstripes is a research survey and alternative ranking of business schools that spotlights innovative full-time MBA programs leading the way in integrating social and environmental stewardship into their curriculum and scholarly research. These schools are preparing today's students--tomorrow's leaders--for future market realities by…

Stewardship, learning, and memory in disaster resilience

Treesearch

Keith G. Tidball; Marianne E. Krasny; Erika Svendsen; Lindsay Campbell; Kenneth Helphand

2010-01-01

In this contribution, we propose and explore the following hypothesis: civic ecology practices, including urban community forestry, community gardening, and other self-organized forms of stewardship of green spaces in cities, are manifestations of how memories of the role of greening in healing can be instrumentalized through social learning to foster social-ecological...

Stewardship: A Biblical Model for the Formation of Christian Scholars

ERIC Educational Resources Information Center

Smith, Julien C. H.; Scales, T. Laine

2013-01-01

This article explores theological dimensions of the academic vocation, taking its cue from the research undertaken by the Carnegie Initiative on the Doctorate, which envisions the scholar as a steward of an academic discipline. We contend, however, that the Christian scholar's sense of stewardship extends beyond one's academic…

A Partnership Model for Training Episodic Environmental Stewardship 4-H Volunteers

ERIC Educational Resources Information Center

Young, Jane Chin; Alexander, Janice; Smith, Martin H.

2013-01-01

The Marin Environmental Stewardship pilot project demonstrates the potential for a partnership model that brings together external and internal collaborators to recruit and train episodic 4-H volunteers to meet environmental education needs within a community. The clientele served by the volunteers trained through the project was at-risk, urban…

Community College Education Foundations and Transformational Philanthropy: Resource Management, Stewardship and Professionalism.

ERIC Educational Resources Information Center

LaBeouf, Joanne P.

This paper argues that, as institutional revenues continue to decline, community college administrators must not only work at developing a robust foundation with an identifiable process similar to that of a private nonprofit foundation, but also provide professional stewardship in its operation. The author used a qualitative, evaluative approach…

Predicting opportunities for greening and patterns of vegetation on private urban lands

Treesearch

Austin R. Troy; J. Morgan Grove; Jarlath P.M. O' Neil-Dunne; Steward T.A. Pickett; Mary L. Cadenasso

2007-01-01

This paper examines predictors of vegetative cover on private lands in Baltimore, Maryland. Using high-resolution spatial data, we generated two measures: "possible stewardship," which is the proportion of private land that does not have built structures on it and hence has the possibility of supporting vegetation, and "realized stewardship," which...

75 FR 12231 - NACEPT Subcommittee on Promoting Environmental Stewardship

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-15

... the Federal Advisory Committee Act, Public Law 92-463, EPA gives notice of a conference call of the... sectors, as appropriate, in order to enhance human health and environmental protection. A copy of the... Environmental Stewardship will hold a public teleconference on Thursday, April 1, 2010 (1 p.m.-3 p.m. Eastern...

The Red Road to Green: Tribal Peoples' Worldviews Preceded "Green" Trend

ERIC Educational Resources Information Center

Pember, Mary Annette

2008-01-01

Green is definitely "in." Green refers not to fashion but the philosophy of environmental protection, stewardship, and social justice. There is nothing new about the green philosophy for tribal colleges and universities (TCUs) and the Native communities they serve. Responsible stewardship of Mother Earth is a natural outgrowth of TCU's missions…

Development and Validation of Two Scales to Measure Elaboration and Behaviors Associated with Stewardship in Children

ERIC Educational Resources Information Center

Vezeau, Susan Lynn; Powell, Robert B.; Stern, Marc J.; Moore, D. DeWayne; Wright, Brett A.

2017-01-01

This investigation examines the development of two scales that measure elaboration and behaviors associated with stewardship in children. The scales were developed using confirmatory factor analysis to investigate their construct validity, reliability, and psychometric properties. Results suggest that a second-order factor model structure provides…

Energy Market and Economic Impacts of S. 280, the Climate Stewardship and Innovation Act of 2007, Supplement to

EIA Publications

2007-01-01

This paper responds to a September 18, 2007, letter from Senators Barrasso, Inhofe, and Voinovich, seeking further energy and economic analysis to supplement information presented in the Energy Information Administration's (EIA) recent analysis of S.280, the Climate Stewardship and Innovation Act of 2007.

Ecosystem stewardship: sustainability strategies for a rapidly changing planet

Treesearch

F. Stuart Chapin; Stephen R. Carpenter; Gary P. Kofinas; Carl Folke; Nick Abel; William C. Clark; Per Olsson; D. Mark Stafford Smith; Brian Walker; Oran R. Young; Fikret Berkes; Reinette Biggs; J. Morgan Grove; Rosamond L. Naylor; Evelyn Pinkerton; Will Steffen; Frederick J. Swanson

2010-01-01

Ecosystem stewardship is an action-oriented framework intended to foster the social-ecological sustainability of a rapidly changing planet. Recent developments identify three strategies that make optimal use of current understanding in an environment of inevitable uncertainty and abrupt change: reducing the magnitude of, and exposure and sensitivity to, known stresses...

Antimicrobial Stewardship and Environmental Decontamination for the Control of Clostridium difficile Transmission in Healthcare Settings

PubMed Central

Bintz, Jason; Lenhart, Suzanne; Lanzas, Cristina

2017-01-01

We implement an agent-based model for Clostridium difficile transmission in hospitals that accounts for several processes and individual factors including environmental and antibiotic heterogeneity in order to evaluate the efficacy of various control measures aimed at reducing environmental contamination and mitigating the effects of antibiotic use on transmission. In particular, we account for local contamination levels that contribute to the probability of colonization and we account for both the number and type of antibiotic treatments given to patients. Simulations illustrate the relative efficacy of several strategies for the reduction of nosocomial colonizations and nosocomial diseases. PMID:27826877

Update in Infectious Diseases 2017.

PubMed

Candel, F J; Peñuelas, M; Lejárraga, C; Emilov, T; Rico, C; Díaz, I; Lázaro, C; Viñuela-Prieto, J M; Matesanz, M

2017-09-01

Antimicrobial resistance in complex models of continuous infection is a current issue. The update 2017 course addresses about microbiological, epidemiological and clinical aspects useful for a current approach to infectious disease. During the last year, nosocomial pneumonia approach guides, recommendations for management of yeast and filamentous fungal infections, review papers on the empirical approach to peritonitis and extensive guidelines on stewardship have been published. HIV infection is being treated before and more intensively. The implementation of molecular biology, spectrometry and inmunology to traditional techniques of staining and culture achieve a better and faster microbiological diagnosis. Finally, the infection is increasingly integrated, assessing non-antibiotic aspects in the treatment.

Optimizing empiric therapy for Gram-negative bloodstream infections in children.

PubMed

Chao, Y; Reuter, C; Kociolek, L K; Patel, R; Zheng, X; Patel, S J

2018-06-01

Antimicrobial stewardship can be challenging in children with bloodstream infections (BSIs) caused by Gram-negative bacilli (GNB). This retrospective cohort study explored how data elements in the electronic health record could potentially optimize empiric antibiotic therapy for BSIs caused by GNB, via the construction of customized antibiograms for categorical GNB infections and identification of opportunities to minimize organism-drug mismatch and decrease time to effective therapy. Our results suggest potential strategies that could be implemented at key decision points in prescribing at initiation, modification, and targeting of therapy. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Prudent Use of Antimicrobials in Exotic Animal Medicine.

PubMed

Broens, Els M; van Geijlswijk, Ingeborg M

2018-05-01

Reduction of antimicrobial use can result in reduction of resistance in commensal bacteria. In exotic animals, information on use of antimicrobials and resistance in commensals and pathogens is scarce. However, use of antimicrobials listed as critically important antimicrobials for human medicine seems high in exotic animals. Ideally, the selection of a therapy should be based on an accurate diagnosis and antimicrobial susceptibility testing. When prescribing antimicrobials based on empiricism, knowledge of the most common pathogens causing specific infections and the antimicrobial spectrum of antimicrobial agents is indispensable. Implementing antimicrobial stewardship promotes the prudent use of antimicrobials in exotic animals. Copyright © 2018 Elsevier Inc. All rights reserved.

A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance.

PubMed

Lanbeck, Peter; Ragnarson Tennvall, Gunnel; Resman, Fredrik

2016-07-27

Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.

Interoperability Across the Stewardship Spectrum in the DataONE Repository Federation

NASA Astrophysics Data System (ADS)

Jones, M. B.; Vieglais, D.; Wilson, B. E.

2016-12-01

Thousands of earth and environmental science repositories serve many researchers and communities, each with their own community and legal mandates, sustainability models, and historical infrastructure. These repositories span the stewardship spectrum from highly curated collections that employ large numbers of staff members to review and improve data, to small, minimal budget repositories that accept data caveat emptor and where all responsibility for quality lies with the submitter. Each repository fills a niche, providing services that meet the stewardship tradeoffs of one or more communities. We have reviewed these stewardship tradeoffs for several DataONE member repositories ranging from minimally (KNB) to highly curated (Arctic Data Center), as well as general purpose (Dryad) to highly discipline or project specific (NEON). The rationale behind different levels of stewardship reflect resolution of these tradeoffs. Some repositories aim to encourage extensive uptake by keeping processes simple and minimizing the amount of information collected, but this limits the long-term utility of the data and the search, discovery, and integration systems that are possible. Other repositories require extensive metadata input, review, and assessment, allowing for excellent preservation, discovery, and integration but at the cost of significant time for submitters and expense for curatorial staff. DataONE recognizes these different levels of curation, and attempts to embrace them to create a federation that is useful across the stewardship spectrum. DataONE provides a tiered model for repositories with growing utility of DataONE services at higher tiers of curation. The lowest tier supports read-only access to data and requires little more than title and contact metadata. Repositories can gradually phase in support for higher levels of metadata and services as needed. These tiered capabilities are possible through flexible support for multiple metadata standards and services, where repositories can incrementally increase their requirements as they want to satisfy more use cases. Within DataONE, metadata search services support minimal metadata models, but significantly expanded precision and recall become possible when repositories provide more extensively curated metadata.